Breastfeeding and tooth decay

What the research says

Blaming prolonged breastfeeding or breastfeeding to sleep for tooth
decay is very common. The belief that breastfeeding to sleep causes
dental caries is based on only 3 articles by Bram and Maloney 1,
Gardner, Norwood and Eisenson2 and Kotlow3 that were done in the
late 1970s and early 1980s. The authors presented case reports of
just nine babies in total, two of whom also received bottles. Case
reports have a very low level of scientific evidence; not one of them
included any experimentation or trials. The conclusions in these
articles were based on this small number of case reports and on the
dentists own inadequate understanding of breastfeeding.

Later (and far more evidence-based) research strongly opposes the

notion that breastfeeding has anything to do with tooth decay. This
evidence includes population studies which have shown no
relationship between breastfeeding and tooth decay in large groups
of young children, for example:

http://www.ada.org/3143.aspx
http://pediatrics.aappublications.org/content/120/4/e944.full.pd
f
http://www.aapd.org/upload/articles/Erickson-21-02.pdf
In fact, research suggests that breastfeeding may actually protect
against tooth decay, whereas artificial milk may play a role in its
development. Antibodies in breastmilk help to impede bacterial
growth (including Steptococcus mutans, which is the bacterium that
causes tooth decay). Lactoferrin, a protein in breastmilk, actually
kills S. mutans.4,5Rugg-Gunn and colleagues reported that S.
mutans may not be able to use lactose, the sugar found in
breastmilk, as readily as sucrose, which is found in some artificial
baby milks.6 Dr Erickson and her co-workers research has
demonstrated that some artificial baby milks dissolve tooth enamel,
significantly reduce pH, support bacterial growth and can lead to
tooth decay.7 Ribeiro and Ribeiros review article concluded that
artificial milk has the potential to cause tooth decay. 8
Breastfeeding is different to bottle-feeding
There is a vast difference between sucking on a bottle and sucking
on the breast. In bottle-feeding the milk is released into the front of
the mouth and pools around the teeth, whereas in breastfeeding,
the nipple is drawn far back into the mouth and the milk is released
into the throat, stimulating the baby to swallow. When a baby falls
asleep with a bottle, the teat will continue to leak any remaining
bottle contents slowly into the babys mouth, while the breast will
not release milk unless actively sucked.

Did our ancestors suffer tooth decay?

Archaeological studies of the teeth of children in prehistoric times
show that very little decay existed, even though it can be assumed
that those who survived babyhood would have been breastfed for
lengthy periods and probably would have slept with their mothers
and breastfed during the night.9,10
Factors which contribute to tooth decay
Factors other than how a baby feeds may also impact the
development of tooth decay. For example:

Sugar intake. Frequent exposure to sugar-laden food and

drink.8
Strep mutans entering a babys mouth. S. mutans can be
transmitted to the baby by way of parents, caregivers, siblings,
friends and others.11 They may inadvertently pass on tooth-
decay-causing bacteria to the child by kissing on the mouth,
sharing a toothbrush, drink or spoon with them or by sucking on
their dummy, thinking that this cleans it before putting it back
into the childs mouth.
Salivary disorders. Saliva provides a defence against S.
mutans because it helps to wash sugars from the teeth and also
provides buffering against acids. Saliva flow naturally reduces
during sleep.12 Apart from sleep, saliva flow is also reduced in
 asthma, prematurity, diabetes and use of certain medications
such as beta 2 agonists (used to treat asthma), antihistamines,
benzodiazepines and anti-emetics etc.8,13
Maternal or foetal illness or stress during pregnancy.8,13
Maternal smoking during pregnancy.14
Poor dietary habits of the family.8,13
Poor oral and overall hygiene of the family.8,13
Family genetics for example the presence of enamel
defects.8
Other conditions for example low birth-weight (including
prematurity), malnutrition, asthma, recurrent infections and
chronic diseases.8

So there is plenty of evidence that rejects the notion that

breastfeeding causes tooth decay. Breastmilk alone does not cause
tooth decay. Infants who are exclusively breastfed, however, are not
immune to decay as a number of other factors may influence a
babys risk of tooth decay.

Further information
http://mumsright.libsyn.com/webpage/lrc-podcast-3-was-the-tooth-
fairy-breastfed-
http://www.llli.org/NB/NBSepOct02p164.html
http://www.kellymom.com/bf/older-baby/tooth-decay.html which also
has links to articles by Dr Brian Palmer, who has done a lot work in
this area.
The Lactation Resource Centre (LRC) has a more detailed and fully
referenced articleEarly Childhood Caries (tooth decay) and
Breastfeeding (2010). This article can be obtained upon subscription
to the LRC or for a fee. The LRC can be contacted on 03 9885 0855
or email at: lrc@breastfeeding.asn.au
References
1. Brams M, Maloney J 1983, Nursing bottle caries in breastfed
children. J Peds103(3): 415-416.
2. GardnerDE, Norwood JR, Eisenson JE 1977, At-will breast
feeding and dental caries: four case reports. ASDC Journal of
Dentistry for Children 44 (3):186191.
3. Kotlow LA 1977, Breast feeding: A cause of dental caries in
children. ASDC Journal of Dentistry for Children 44 (3): 192193.
4. Arnold R, Cole M, McGhee J 1997, A bactericidal effect for
human lactoferrin.Science 197:26365.
5. Mandel ID 1996, Caries prevention: current strategies, new
directions. JADA127:147788.
6. Rugg-Gunn A, Roberts GJ, Wright WG 1985, Effect of human
milk on plaque pH in situ and enamel dissolution in
vitro compared with bovine milk, lactose, and sucrose. Caries
Res 19:32734.
7. Erickson PR, McClintock KL, Green N, et al 1998, Estimation of
the caries-related risk associated with infant formulas. Pediatr
Dent 20:395403.
8. RibeiroNM, Ribeiro MA 2004, Breastfeeding and early childhood
caries: a critical review. Jornal de Pediatria 80(5 Suppl):S199
S210.
9. Erickson PR, Mazhari E 1999, Investigation of the role of human
breast milk in caries development. Pediatr Dent 21:8690.
10. Palmer B 1998, The influence of breastfeeding on the
development of the oral cavity: a commentary. J Hum Lact14:93
98.
11. Berkowitz R 1996, Etiology of nursing caries: a microbiologic
perspective. Public Health Dent 56:514.
12. Bowen WH 1998, Response to Seow: biological mechanisms of
early childhood caries. Community Dent Oral Epidemiol 26(1
Suppl):2831.
13. Palmer B 2000, Breastfeeding and infant caries: no
connection. ABM News andViews, The Newsletter of The
Academy of Breastfeeding Medicine 6(4):27 & 31.
14. Iida H, Auinger P, Billings RJ, Weitzman M 2007, Association
between infant breastfeeding and early childhood caries in the
United States. Pediatrics 1(120): e944 -e952.