Breastfeeding and tooth decay

What the research says

Blaming breastfeeding or breastfeeding to sleep for tooth decay is very
common. The belief that breastfeeding to sleep causes dental caries is based on
only 3 articles by Bram and Maloney 1, Gardner, Norwood and Eisenson 2 and
Kotlow3 that were done in the late 1970s and early 1980s. The authors
presented case reports of just nine babies in total, two of whom also received
bottles. Case reports have a very low level of scientific evidence; not one of
them included any experimentation or trials. The conclusions in these articles
were based on this small number of case reports and on the dentists own
inadequate understanding of breastfeeding.
Later (and far more evidence-based) research strongly opposes the notion that
breastfeeding has anything to do with tooth decay. This evidence includes
population studies which have shown no relationship between breastfeeding and
tooth decay in large groups of young children, for example:

http://jada.ada.org/content/144/2/143.full.pdf?sid=2fe3586f-1975-4542871a-c338a289b475
http://pediatrics.aappublications.org/content/120/4/e944.full.pdf

http://www.aapd.org/upload/articles/Erickson-21-02.pdf

In fact, research suggests that breastfeeding may actually protect against tooth
decay, whereas formula may play a role in its development. Antibodies in
breastmilk help to impede bacterial growth (including Steptococcus
mutans, which is the bacterium that causes tooth decay). Lactoferrin, a protein
in breastmilk, actually kills S. mutans.4,5Rugg-Gunn and colleagues reported
that S. mutans may not be able to use lactose, the sugar found in breastmilk, as
readily as sucrose, which is found in some formulas. 6 Dr Erickson and her coworkers research has demonstrated that some formulas dissolve tooth enamel,
significantly reduce pH, support bacterial growth and can lead to tooth
decay.7 Ribeiro and Ribeiros review article concluded that formula has the
potential to cause tooth decay.8

Breastfeeding is different to bottle-feeding

There is a vast difference between sucking on a bottle and sucking on the

breast. In bottle-feeding the milk is released into the front of the mouth and
pools around the teeth, whereas in breastfeeding, the nipple is drawn far back
into the mouth and the milk is released into the throat, stimulating the baby to
swallow. When a baby falls asleep with a bottle, the teat will continue to leak
any remaining bottle contents slowly into the babys mouth, while the breast will
not release milk unless actively sucked.

Did our ancestors suffer tooth decay?

Archaeological studies of the teeth of children in prehistoric times show that
very little decay existed, even though it can be assumed that those who
survived babyhood would have been breastfed for lengthy periods and probably
would have slept with their mothers and breastfed during the night. 9,10

Factors which contribute to tooth decay

Factors other than how a baby feeds may also impact the development of tooth
decay. For example:

Sugar intake. Frequent exposure to sugar-laden food and drink.8

Strep mutans entering a babys mouth. S. mutans can be transmitted
to the baby by way of parents, caregivers, siblings, friends and
others.11 They may inadvertently pass on tooth-decay-causing bacteria to
the child by kissing on the mouth, sharing a toothbrush, drink or spoon
with them or by sucking on their dummy, thinking that this cleans it
before putting it back into the childs mouth.

Salivary
disorders. Saliva
provides
a
defence
against S.
mutans because it helps to wash sugars from the teeth and also provides
buffering against acids. Saliva flow naturally reduces during sleep. 12 Apart
from sleep, saliva flow is also reduced in asthma, prematurity, diabetes
and use of certain medications such as beta 2 agonists (used to treat
asthma), antihistamines, benzodiazepines and anti-emetics etc. 8,13

Maternal or foetal illness or stress during pregnancy. 8,13

Maternal smoking during pregnancy.14

Poor dietary habits of the family.8,13

Poor oral and overall hygiene of the family.8,13

Family genetics for example the presence of enamel defects. 8

Other conditions for example low birth-weight (including

prematurity), malnutrition, asthma, recurrent infections and chronic
diseases.8

So there is plenty of evidence that rejects the notion that breastfeeding causes
tooth decay. Breastmilk alone does not cause tooth decay. Infants who are
exclusively breastfed, however, are not immune to decay as a number of other
factors may influence a babys risk of tooth decay.

Further information
http://mumsright.libsyn.com/webpage/lrc-podcast-3-was-the-tooth-fairybreastfedhttp://www.llli.org/NB/NBSepOct02p164.html
http://www.kellymom.com/bf/older-baby/tooth-decay.html which also has links to
articles by Dr Brian Palmer, who has done a lot work in this area.
The Breastfeeding, Information and Research (BIR) division of ABA has a more
detailed and fully referenced article Early Childhood Caries (tooth decay) and
Breastfeeding(2010). This article can be obtained upon subscription to BIR or for
a
fee.
BIR
can
be
contacted
on
03
9885
0855
or
email
at: birteam@breastfeeding.asn.au

References
1. Brams M, Maloney J 1983, Nursing bottle caries in breastfed children. J
Peds103(3): 415-416.
2. GardnerDE, Norwood JR, Eisenson JE 1977, At-will breast feeding and
dental caries: four case reports. ASDC Journal of Dentistry for Children 44
(3):186191.
3. Kotlow LA 1977, Breast feeding: A cause of dental caries in children. ASDC
Journal of Dentistry for Children 44 (3): 192193.
4. Arnold R, Cole M, McGhee J 1997, A bactericidal effect for human
lactoferrin.Science 197:26365.

5. Mandel ID 1996, Caries

directions. JADA127:147788.

prevention:

current

strategies,

new

6. Rugg-Gunn A, Roberts GJ, Wright WG 1985, Effect of human milk on

plaque pHin situ and enamel dissolution in vitro compared with bovine
milk, lactose, and sucrose. Caries Res 19:32734.
7. Erickson PR, McClintock KL, Green N, et al 1998, Estimation of the cariesrelated risk associated with infant formulas. Pediatr Dent 20:395403.
8. RibeiroNM, Ribeiro MA 2004, Breastfeeding and early childhood caries: a
critical review. Jornal de Pediatria 80(5 Suppl):S199S210.
9. Erickson PR, Mazhari E 1999, Investigation of the role of human breast
milk in caries development. Pediatr Dent 21:8690.
10.
Palmer B 1998, The influence of breastfeeding on the development
of the oral cavity: a commentary. J Hum Lact14:9398.
11.
Berkowitz R 1996, Etiology of nursing caries: a microbiologic
perspective. Public Health Dent 56:514.
12.
Bowen WH 1998, Response to Seow: biological mechanisms of early
childhood caries. Community Dent Oral Epidemiol 26(1 Suppl):2831.
13.
Palmer B 2000, Breastfeeding and infant caries: no connection. ABM
News andViews, The Newsletter of The Academy of Breastfeeding
Medicine 6(4):27 & 31.
14.
Iida H, Auinger P, Billings RJ, Weitzman M
2007,
Association
between infant breastfeeding and early childhood caries in the United
States. Pediatrics 1(120): e944 -e952.