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Keeping caries at bay in breastfeeding babies

The Journal of Family Practice. 2019 April;68(3):E1-E4
April 4, 2019|Family Medicine
Jonathan P. Wong, BMBS;Isvarya Venu, MSc;Rosemary G. Moodie, MD, MBA;Vidya Cuddalore Arivudainambi, BDS;Hazel Stewart, DDS;Robert J. Schroth, DMD, PhD;Alexandra Nicolae, DDS, MSc;Khai-Nhu Zweig, DDS;Meta van den Heuvel, MD, PhD;Elizabeth L. Ford-Jones, MD;Peter D. Wong, MBBS, PhD
Author and Disclosure Information

Department of Paediatrics, University of Toronto, Canada (Drs. JP Wong, Moodie, van den Heuvel, Ford-Jones, and PD Wong); Trinity College Dublin, University of Dublin, Ireland (Ms. Venu); School of Dental Medicine, University at Buffalo (Dr. Arivudainambi); Toronto Public Health, Canada (Drs. Stewart, Nicolae, and Zweig); Department of Preventive Dental Science, College of Dentistry, University of Manitoba, Winnipeg, Canada (Dr. Schroth); Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada (Dr. Schroth); Social Paediatrics, Department of Paediatrics, Hospital for Sick Children, Toronto, Canada (Dr. Ford-Jones); SickKids Research Institute, Toronto, Canada (Dr. PD Wong)
peter.wong@sickkids.ca

The authors reported no potential conflict of interest relevant to this article.

As an infant grows, human milk may become the substrate for cariogenic bacteria. Here’s what to watch for and how to counsel parents.

PRACTICE RECOMMENDATIONS

› Promote breastfeeding as the preferred method of feeding infants. A

› Optimize pediatric oral health by reducing risk factors for dental disease and by providing parents with anticipatory guidance to prevent early childhood caries. B

Strength of recommendation (SOR)

A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series

However, as a child’s oral microbiome changes with the emergence of primary teeth and exposure to more and varied bacteria and dietary sugars, the natural sugars in human milk may become the substrate for cariogenic bacteria.3 ECCs can develop and progress rapidly. Importantly, both the practice of breastfeeding and ECC risk are modified by socioeconomic status, maternal oral health and education, and exposure to household smoking.3,7 Understanding these relationships may help you better target risk assessment and counseling efforts.

What the research tells us about breastfeeding and ECCs

Breastfeeding is hypothesized to be one of many factors that influence ECC development. However, studies on this association have had conflicting results and have not adequately controlled for major confounders, such as dietary composition, maternal and infant oral hygiene, and maternal oral health status.

So here is what we know.

Breastfeeding during the first year. In one meta-analysis involving children who breastfed for up to 12 months, those who breastfed longer within the 12-month period had a reduced risk of ECCs compared with those who breastfed for a shorter period of time,3 which implies that breast milk may be protective in the first year of life.3

Further, a 2014 study with about 500 participants found that children were more likely to have caries by 5 years of age if they breastfed for <6 months than if they breastfed for at least 6 months.10

Continue to: After the first year

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