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Nancy E. Wight MD, FAAP, IBCLC
The American Academy of Pediatric Dentistry recognizes the distinct nutritional advantages of human milk for infants and endorsed the position of the American Academy of Pediatrics on the promotion of breastfeeding. 1,2 However, they note that the risk of devastating nursing pattern dental decay exists for the breastfed child as it does for the bottle-fed child, and recommend avoiding at libitum nocturnal breastfeeding after the first primary tooth begins to erupt. Many pediatric dentists also recommend complete weaning by 1 year of age. The American Academy of Pediatrics recommends exclusive breastfeeding for approximately the first six months of the infant's life and continued breastfeeding for at least one year with addition of appropriate complementary foods and continued breastfeeding for as long as mother and infant mutually desire. 3
Early childhood caries result from a complicated combination of factors.
Factors Determining a Child's Susceptibility to Dental Caries:
The child's own genetics
The genetics of the child's parents
The genetics of infectious micro-organisms
Transmission of infectious microbes at age of infant or child
Mucosal immunity
Diet and nutrition
Biofilms and microbial ecology
Relative susceptible of incisor and molar teeth
Prevention measures
Early detection of dental caries
From: Slavkin, JADA, 199 (ref 6)
Breastfeeding has been implicated in the disease, but population-based studies do not support a definitive link between prolonged breastfeeding and caries.4-7 Human milk does not cause a significant drop in plaque pH, nor does it cause enamel decalcification. In fact, in a study using enamel powder, calcium and phosphate were deposited onto the enamel when breastmilk was present. When 10% sucrose
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was added, caries developed in 3.2 weeks.8 A recent meta-analysis of the available literature suggested a common set of public health recommendations for both pediatricians and dentists.5 New practice recommendations included encouraging breastfeeding for as long as women and infants wish, encouraging water fluoridation, encouraging a consistent mouth care regime and tooth brushing as soon as the first tooth erupts and early dental visits (at the latest by one year of age). In addition, if a breastfed infant is ever given a bottle, it should never be propped and an infant should never go to bed with a bottle containing anything other than water.
References:
- American Academy of Pediatric Dentistry: Baby Bottle Tooth Decay/Early Childhood Caries. Revised May 1996, J Am Acad Ped Dent, Special Issue: Reference Manual 18:25, 1996-1997
- American Academy of Pediatric Dentistry: Breast-Feeding. Revised May 1994, J Am Acad Ped Dent, Special Issue: Reference Manual 18:27, 1996-1997
- American Academy of Pediatrics Work Group on Breastfeeding: Breastfeeding and the Use of Human Milk. Pediatrics 100:1035, 1997
- Ramos-Gomez FJ, Tomar SL, Ellison J et al: Assessment of early childhood caries and dietary habits in a population of migrant Hispanic children in Stockton, California. ASDC J Dent Child 66(6):395, 1999
- Sinton J, Valaitis R, Passarelli C, et al: A Systematic Overview of the Relationship Between Infant Feeding Caries and Breast-feeding. Ont Dent 75:23, 1998
- Slavkin HC: Streptococcus Mutans, Early Childhood Caries and New Opportunities. JADA 130:1787, 1999
- Weerheijm KL, Uyttendaele-Speybrouck BF, Euwe HC, Groen HJ: Prolonged demand breast-feeding and nursing caries. Caries Research 32(1):46, 1998
- Erickson PR, Mazhari E: Investigation of the Role of Human Breastmilk in Caries Development. Pediatr Dent 21:86, 1999
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