Extended Breastfeeding & Dental Caries

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Registered: 01-29-2005
Extended Breastfeeding & Dental Caries
Thu, 03-03-2005 - 3:21pm
Extended Breastfeeding Non-Risk #2: Dental Caries

Linda J. Smith, BSE, FACCE, IBCLC

The most important causes of Baby-Bottle Tooth Decay (BBTD) are
documented to be: (1) Enamel defects; (2) High carbohydrate intake in
infant's diet; (3) Oral hygiene of the mother and infant, especially
strap mutans; (4) Milk pooling in the baby's mouth from a dripping

As of April 1992, all known references point back to three articles by
Kotlow, Brams, and Gardner. The authors present case reports of 9
only 7 of whom received no bottles. Recently, the lactose in milk has
been shown to cause decay when teeth are soaked in it.

This evidence does not establish that direct breastfeeding as a risk
factor in BBTD because:

In these 7 case reports, there was no mention of enamel defects,
carbohydrate intake, or bacterial milieu.

Human milk is protective against strep mutans.

Milk pooling does not occur during breastfeeding because the
breast does not release milk unless the infant is actually sucking and
swallowing. If human milk is provided by bottle, pooling could
occur. Bottle feeding is a risk factor; even bottle feeding of human

Case studies report on unusual situations; the reports are from
1977 and 1983. There have been no large-scale or epidemiological studies

on this phenomenon. If long-term, at-will nighttime breastfeeding
were a risk factor for BBTD, epidemiologic evidence would have
demonstrated this link.

Dr. David Johnson, DDS, pediatric dentist at Case Western Reserve
University, specialist on BBTD, said in January 1992 "It is a small
risk, rare and unusual. It's not enough to base a policy of 'no
breastfeeding past 12 months.' The advantages of breastfeeding past 12
months are absolutely overwhelming."

The position of the American Academy of Pediatric Dentistry (wean
by 12 months) was challenged by Ruth Lawrence, MD in Feb. 1993.
Dr. Lawrence sent many solid references on the documented risks of
early weaning. The AAPD position conflicts with AAP, DHHS,
WHO and other health policy documents.

NEW: P. R. Erickson at the University of Minnesota recently
published research that "concluded that human breast milk is not

FACT: There is no published, valid evidence that establishes long-term,
at-will breastfeeding as a risk factor in BBTD. Limitation of the
of breastfeeding has documented negative consequences to the baby and
mother. "Baby Bottle Tooth Decay" is a disease of artificial feeding.

Erickson PR, Mazhari E. Investigation of the role of human breast milk
in caries development. Pediatr Dent 1999 ZMar-Apr;21(2):86-90.

Brams M and Maloney J. "Nursing bottle caries" in breastfed children. J
Peds 103(3): 415-416, 1983.

Gardner DE, Norwood JR, Eisenson JE. At-will breastfeeding and dental
caries: four case ports. ASDC J Dent Child May-Jun 1977, 1-6.

Kotlow LA. Breastfeeding: a cause of dental caries in children. J Dent
Child May-June 1977, 192-93.

Woolridge, M., and Baum, J.D. The regulation of human milk flow.
Perinatal Nutrition, Vol 6, ed. BS Lindblad. London: Academic Press,

Woolridge, M. Anatomy of infant sucking. Midwifery 2: 164-171, 1986.

1994 Linda J. Smith