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 the 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 bottle.

As of April 1992, all known references point back to three articles by Kotlow, Brams, and Gardner. The authors present case reports of 9 babies, 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 milk. 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 cariogenic."

FACT: There is no published, valid evidence that establishes long-term, at-will breastfeeding as a risk factor in BBTD. Limitation of the duration 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, 1988.

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