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The Sweet Tooth Truth

Does Breastfeeding Cause Cavities?
By Gwen Morrison

Some researchers believe there is a link between infant caries and breastfeeding. Some have even suggested that mothers wean their babies before the first teeth erupt. This research is being challenged by new studies that show no link to an increased risk for caries in breastfed babies. Contrary to the earlier belief, research now indicates that there may actually be a reduced risk for caries in nursing infants.

Early childhood caries (ECC) is tooth decay that affects babies and young children. Infant caries very often appears as a white, chalky area on the enamel of the tooth. If not treated, the area can soften and cause the breakdown of the tooth structure.

Human Breast Milk Is Not Cariogenic
"I see no relationship between breastfeeding and cavities," says Dr. Brian Palmer, a family dentist from Leawood, Kan. "The fact that we are basically the only mammal that has significant dental decay proves it is what we eat that causes decay – not breast milk, [since other mammals exclusively breastfeed their infants]."

Dr. Palmer hasn't been able to find any research that indicates breast milk, when used as the control, causes decay in infants. Most of the studies that suggest a link between breastfeeding and infant caries are population-based studies.

"Figures are juggled, and breastfeeding just happened to get thrown in the numbers as a possible contributing factor," Dr. Palmer says. "Breastfeeding is accused of causing decay based on 'guilt by association' rather than true laboratory studies."

In a 1999 review article on breastfeeding and infant caries, Dr. Pamela Erickson concluded that human breast milk is not cariogenic. It was Dr. Erickson's research which indicated that some infant formulas dissolve tooth enamel, causing tooth decay.

"Statistically, artificial feeding is linked to poorer outcomes in dental health and oral development," says Margaret Wills, IBCLC, a certified lactation consultant from Silver Spring, Md. "Because breastfeeding is just normal – and not some magic bullet – some breastfed children are going to have dental problems despite being breastfed, but not because of it."

Bacteria Transmission
Wills explains that the selected feeding method is just one variable to consider in dental health. "Sometimes parents or siblings share cavity-causing bacteria early on with a baby," she says. "Sometimes the tooth enamel is imperfect to start with due to heredity or a mother's illness or nutritional deficiencies during gestation."

There are many other factors that can contribute to infant tooth decay. Breastfeeding as a cause is not among the top indicators.

"Recent studies have concluded that caries is an infectious and transmissible disease primarily caused by streptococcus mutans," Dr. Palmer says. "Accumulation of this organism to pathogenic levels results from frequent and prolonged exposure to cariogenic subtrates."

When an infant is born, his mouth is basically sterile; he does not have decay-causing bacteria in his mouth. The decay-causing bacteria is acquired at some point in his life. It may be the timing and amount of the inoculation that determines the risk of decay.

The Natural Thing to Do
"Breastfeeding is the normal way to feed an infant," Wills says. "Through most of our evolutionary history, breastfeeding routinely lasted for years, [including nighttime]. How could we have survived as a species if breast milk harmed our teeth?"

Because parents are warned of the damaging effects of putting baby to bed with a bottle, many have mistakenly extended their concern to breastfeeding a baby at night.

This is not the case at all, Dr. Palmer says. "Falling asleep at the breast does not cause cavities or weakness in baby's teeth," he says. "Breastfeeding is the best form of health care there is. I don't understand why some doctors and dentists discourage it. What options are there for an infant if they are not allowed to breastfeed? The next option is formula feeding, and recent research by Erickson showed that formula can be very cariogenic. Why is that the better option?"

Dr. Palmer agrees that breastfeeding is the optimal way for mothers to feed their infants – and it always has been. "An important issue remains that all mammals breastfeed their young," he says. "Prehistoric skulls show minimal decay in teeth. And now humans are the only mammal out of over 4,000 species that show extensive decay in infant teeth."

Why? Decay has only become common as more and more refined starches and sugars have entered our diets, Wills says. "Breast milk alone doesn't foster the bacteria that causes decay," she says. "In fact, as a living substance, it has antibacterial qualities, but it can't overcome the presence of bacteria-feeding starches and sugars. So as soon as a baby's teeth emerge, parents should start on good dental routines of cleaning the teeth – [especially before bed] – combined with nursing as needed."

Kay Bolden from Joliet, Ill. recently brought her almost 4-year-old son for his first dental checkup. They left the office with a report of no cavities. "I nursed him until he was 3...," she says. "He often nursed himself to sleep and stayed attached after falling asleep."

Margaret Byers Smith, a mom from Fayetteville, Ariz., raised two breastfed babies. "Both have excellent teeth and have certainly never had any childhood cavities," she says.

No Connection
Sucking from a bottle is different than suckling at the breast. When a baby is breastfeeding, the baby draws the mother's nipple deep into his mouth, drawing the breast milk to the back of the mouth – away from the teeth.

"During breastfeeding, the majority of milk is expressed into the throat," Dr. Palmer says. "During bottle-feeding, the majority of the content of the bottle is dumped into the mouth and 'pools' around the teeth, leaving teeth more prone to decay."

Dr. Palmer strives to educate people about the fact that breast milk alone does not cause caries, and that breast milk is the best form of health care for infants. "It is now time to educate both parents and health care providers that breast milk does not cause decay," he says. "Breast milk alone does not cause tooth decay, but exclusive breastfeeding does not mean that the infant will be immune to decay. Anything that is put in the mouth can be broken down into a sugar that can cause decay – even healthy foods."

Evidence has clearly identified several factors that may increase an infant's risk for caries. The fact remains that there is currently no published, valid evidence that establishes that long-term, at-will breastfeeding is a contributing factor in tooth decay.

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About the Author: Gwen Morrison is an assistant editor for iParenting Media. She is the mother of four children.

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