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
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
"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
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."
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
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.
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
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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