Keeping caries at bay in breastfeeding babies
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
After the first year. A Canadian study found an increased risk of ECCs associated with breastfeeding for longer periods of time. The study of healthy urban children reported that breastfeeding for >24 months was associated with a 2- to 3-fold increased odds of ECCs compared with shorter breastfeeding duration.11
No relationship? Lastly, a US study using National Health and Nutrition Examination Survey data found there was no evidence to suggest that breastfeeding duration was an independent risk factor for ECCs.12
A possible explanation for a link
An initial protective effect of breastfeeding against ECCs may be related to breast milk’s immunomodulatory factors and rich microbiome. Breast milk contains Lactobacilli and substances, including human casein and secretory IgA, that inhibit growth and attachment of bacteria,9 particularly the caries pathogen S mutans. Early defense against ECCs may be mediated through the establishment of a healthy oral and gut microbiome that results from exposure to breastfeeding and contact with skin, gut, and breast milk microbiomes. Later on, the child’s oral microbiome changes with the emergence of teeth and the introduction of complementary foods andother drinks.
A look at the role vitamin D plays
Vitamin D status may influence childhood dental health.13 Low maternal vitamin D levels have been associated with ECCs,14 and mothers with higher prenatal vitamin D intakes were more likely to report that their children were caries-free compared with women who had lower vitamin D intake.15 Additionally, children with severe ECCs were found to have lower vitamin D levels than cavity-free children.16 Unfortunately, only a minority of infants who are predominantly breastfed for > 6 months receive vitamin D supplementation.17
Other factors at work: Carbohydrate exposure, nocturnal feedings
Exposure to carbohydrates—the essential substrate for cariogenic bacteria—is a key factor in ECC development. Refined sugars contribute considerably to tooth decay. Frequency of feeding and feeding practices, such as prolonged nocturnal feeding (either breast or bottle) may increase ECC risk.3 Further, a major determinant of ECC risk is colonization of the infant’s mouth by cariogenic bacteria. Finally, ECC risk depends on socioeconomic status, oral hygiene, exposure to fluoride, and the mother’s oral health, education, and smoking status.3 Even birth order plays a role, with those born first having lower risk than subsequent children.18
Continue to: Breastfeeding and another area of oral health...
