Early childhood caries is a common concern among dental professionals as well as parents. Early childhood caries and breastfeeding has been studied for years with contradictory results. A review published in 2019 in the journal Archives de Pédiatrie aimed to “analyze the links between breastfeeding and the appearance of caries, as described in the scientific literature and in the recommendations of specialist societies.”1
The benefits of breastfeeding are well established including prevention of malocclusion. Previous studies have shown breastfeeding beyond 12 months of age seems to be associated with an increased prevalence of tooth decay. Tooth decay is a multifactorial disease including bacterial factors (presence of S. mutans, etc.), oral environment (tooth morphology, quality and quantity of saliva, etc.), social environment (lifestyle, oral hygiene habits, etc.), and sugar intake.
A total of 25 studies were included in the review. Of those 3 were meta-analysis, 5 were cohort studies, 10 were cross-sectional, and 7 were in vitro studies. The authors noted that confounding factors were not always adjusted for, such as mode of feeding (night-time versus daytime feeding), the child’s age, oral hygiene, among others. Additionally, many of the studies were carried out in low-income countries causing varied DMFT scores.
The results indicated that breastfeeding up to the age of 12 months is not associated with increased caries risk and might, in fact, offer a level of protection when compared to formula fed infants. However, babies breastfed beyond 12 months demonstrated an increase in caries risk. A clear direct link between breastfeeding until 24 months and severity of caries in primary teeth was observed. This link was independent of sugar intake.
Nonetheless, confounders including the introduction of solid foods at around 6 months could play a role highlighting the complexity of conducting a study that clearly shows a causal link. Additionally, factors, such as dental visits, sugared medication, fluoride supply, and night-time feeding are all confounders which makes it difficult to conduct an unbiased study that adjusts for so many factors.
The authors conclude by stating, “Extended breastfeeding is a protective factor for childhood caries under 1 year of age. Beyond 1 year, it is difficult to conclude between protection and aggravation of caries because of the multiplicity of confounding factors such as dietary patterns that vary depending on countries and families and problems of oral hygiene. In practical terms, when breastfeeding continues beyond 1 year, consultation with a dentist is necessary for examination and for prevention advice regarding dietary practices (especially sugar intake, day and night), oral hygiene, and supplementary fluoride.”
What guidance do you provide to your breastfeeding patients regarding their child’s oral health? Do you discuss potential concerns regarding breastfeeding past 12 months? Do you encourage patients with young children to see a pediatric dentist by 12 months of age?
- Branger B, Camelot F, Droz D, et al. Breastfeeding and early childhood caries. Review of the literature, recommendations, and prevention [published correction appears in Arch Pediatr. 2020 Apr;27(3):172]. Arch Pediatr. 2019;26(8):497-503. doi:10.1016/j.arcped.2019.10.004