Wednesday, May 12, 2010

Weaning Wednesdays: Breastfeeding and dental caries

Just recently, I was browsing through a motherhood forum and came across a discussion on dental caries, where quite a few mothers were lamenting about their children having tooth decay.  I remembered how a friend commented about how frequent night feedings may increase the risk of dental caries, and that started bugging me, since I really wanted to take good care of Junior J's little pearly whites.  So I did a quick search online, and browsed a couple of websites, as well as some dentistry journal articles (Its all that scientific training that makes you try to obtain information from reliable sources. But you do end up with alot of medical mumbo jumbo, which resulted in me never getting beyond the abstracts for some!).

So here's what I unearthed:

1. How teeth rot: These nasty buggers (microbes like Streptococcus mutans) gate-crash a party on someone's teeth, decide they like it there, and move in.  They feast on the sugars left on the teeth, and leave a thank-you gift of acids.  These acids then start to eat (or to use the proper term "de-mineralize") into the enamel of the teeth.  Since the enamel acts like the wall of a fortress, breaching the wall would be like the orcs storming Helm's Deep in the Lord of the Rings: Lots of noise (thanks to the dentist), and pain.  (Get the more scientific version here.)

2. Preventive measures that one can take for young children: Eliminate all those factors mentioned above...
:: Brush regularly to prevent sugars from sticking to teeth.  No happy food, no party for those microbes.
:: Reduce exposure to sweet stuff, and limit it to meals.
:: Don't let the bugs gate-crash: Parents are advised to avoid giving babies kisses on the mouth, as well as avoid feeding babies food that has been in placed in their mouths, to prevent the bad bugs from moving in.  (We're guilty of those things on all fronts, since we sometimes do try to remove sauces containing MSG from foods before feeding Junior J... oops!  And how can you not give kisses to your little boy?)

:: Latch direct for feeds if possible, since bottle feeding increases the risk of dental caries (due to the method of delivery of milk, as milk tends to pool around the teeth during bottle feeding).

3. Then there comes this whole controversy that has sparked alot of discussion: Does extended breastfeeding (beyond 12 months), and frequent night feeds increase the risk of dental caries?
:: One study showed that the duration of breastfeeding did not affect the incidence of caries (Abstract of study here).
:: Continuous night feedings (where baby is permanently attached to mum most of the night, which isn't the case for me!) may increase the risk of caries (Discussion here).
:: Some reviews stated that the studies that showed that extended nursing was a risk factor for caries had weak methodology (eg. small sample size, did not account for confounders like diet, dental hygiene etc).

4.  All that left me still doubtful as to whether I should ignore Junior J at night when he wants his "nen-nen", for the sake of a brilliant smile... So I continued reading, and found out about the properties of breastmilk:
:: Breastmilk does not cause a significant drop in pH in the mouth (the nasty bacteria thrive at lower pH).
:: Exposure to breastmilk results in the deposition of calcium and phosphate on enamel (that's rebuilding the walls of Helm's Deep so the orcs can't storm in... Get the details of the study here.)
:: It contains lactoferrin and antibodies that prevent bacterial growth (This is an excellent article on the entire topic of breastfeeding and caries).

The boy doesn't like his food that much, but he loves his milk...  
Which explains the mess, and the hubby pinching his nose!

So all in all, most articles that I read concluded that there was no conclusive evidence that extended breastfeeding, or night feeds increased the risk of developing dental caries (If you've lost me in all my ramblings, here's a good article that probably explains it better!).  However, parents do have to  pay close attention to the child's diet and dental habits as well...  So if someone tells me to stop breastfeeding since the boy is already 15 months old, I'm going to ask them to read this, and take a hike. (Which was what I told a GP when he told me to stop feeding Junior J when I was down with the flu, in case I spread it to the boy.  I'm sorry if I'm such a "lactivist"!)


  1. hello there, i have a 4months old daughter,I have been trying to introduce formular to her but she seems not interested in the feeding bootle. She wont event taste or lash on the nipple instead she scream as if i cut her with a sharp object. Could you please advise me on what to do as i will be going back to work soon and she is spending too much time on my breast.

  2. Mhh, I guess I have a lot to read. Lara has 5 teeth and I want her to keep them clean and healthy, of course. Thank you for the info!

  3. Hi Glenna,
    Has your daughter been introduced to the bottle before this? If not, she may not want to drink from the bottle for 2 reasons: 1. She's not used to drinking from the bottle and 2. She's not used to the taste of formula (which can taste quite different from breastmilk!).

    Perhaps you might want to try the following:
    1. Pump/hand-express breastmilk for her to drink in the bottle, instead of formula (recommendation is for babies to be exclusively breastfed til at least 6 months of age).
    2. Get someone else (your hubby/mother/caregiver) to feed her the bottle (I think they sometimes protest if its the mother feeding them since they much rather latch on direct to feed!).
    3. If both steps don't work, you might want to try cup/spoon feeding the breastmilk to your little girl... I had a friend whose baby refused to drink from the bottle but took the milk from a spoon.

    Hope this helps! If you have further questions, you can email me at All the best!

    Kira: No worries! :)

  4. no worries about kissing baby J man! there's not much evidence for horizontal transmission of caries. read Marsh's 'microbial ecology of dental plaque and its significane in health and disease'. there's strep mutans in our normal oral flora. demineralisation and mineralisation takes place concurrently, finding the balance between them or a shift towards mineralisation prevents the onset of the disease.

    caries is a very complex ecological disease. depends a lot on host response too, quality of saliva etc.

    another way to prevent caries in kids is through the diet. soft drinks and sports drinks are highly cariogenic, they have very low pH and plenty of fermentable sugars. fruit juices are very high in fermentable sugars, get him to drink or rinse with plain water after a juice drink.

    encourage him to take yoghurt and feed him lots of cheese. there's ongoing studies on how probiotics in cultured dairy products can disrupt the pathogenic ecology and increase plaque pH. my seniors did a study using Yakult and found that the plaque pH in kids increased after consumption of Yakult. a study in Denmark showed that children who consistently chewed hard cheeses had lower incidence of caries. the probiotics in cheese disrupted the ecology of plaque. casein in cheese helps in remineralisation of enamel. and hard cheeses tend to be sticky, so they stick to the teeth acting as a medium to retain the good bacteria and allow for remineralisation of enamel with all the casein, phosphate and calcium ions.

    cultivating good dietry habits early will go a long long way!

  5. Jon! This is it. The next time I ever think of writing a dental-related post, I'm going to get you to write it as a guest blogger! You always have so many good tips (and scientifically backed too... I like!)... thanks for all the input!

    However, I have one question. Doesn't Yakult have quite a high sugar content, which would contribute to caries? I guess just have to brush after drinking la?

  6. haha... caries is a very complex ecological disease. you can't really pinpoint it to one factor. drinking yakult and then brushing won't help. the idea is to allow the probiotics in yakult to colonise the plaque and present a microbial challenge to the pathogens by disrupting the ecology that favours production of acid. but it also depends on state of the host. lactobacilli, the bacteris contained in yakult is not known for initiation of caries, but is involved in further advancement of carious lesion.

    i was assisting my friend the other day. he had a patient who didn't brush his teeth at all. not a single cavity or filling done and no signs of periodontal breakdown. only simple inflammation of gums. my supervisors were all shocked and they came to 'examine' him, and told him he was just plain lucky to get away without brusing.

  7. If a parent is planning to take their child to a dentist, they should send them to a Pediatric dentist instead of a regular dentist. Pediatric dentists are more familiar to children's teeth than the regular dentists.I'm not saying the latter is not as good, only that the aforementioned underwent special training regarding these little tots. They can comprehend with them if they feel intimidated and can help build a child's trust with dental doctors which can benefit them as they grow old.



Related Posts Plugin for WordPress, Blogger...