Life, Mum, toddler

Breastfeeding and Tooth Decay. Are they linked?

As a dentist and a breastfeeding mum this is an area that I did a lot of personal research into following the birth of my son and when I decided to continue breastfeeding beyond 6 months. During my training at dental school we were told that ‘extended’ breastfeeding beyond 18 months, especially at night, increased the risk of developing tooth decay. My 2 and a half year old son still breastfeeds and only stopped feeding at night after turning 2 so this is a topic that is very important to me.
Whilst researching this subject I was shocked by how little relevant, up to date, high quality research is actually available on the subject and this disappoints me greatly.  Surely, this is an important subject that deserves to be well researched especially due to the shocking number of children who are admitted to hospital in the UK to have teeth removed.

Breastfeeding carries many benefits to both mother and child (here are a few) and it concerns me that breastfeeding mothers are being deterred by health professionals who should be helping to support this most natural method of providing nutrition to babies and young children.  I am not ‘anti-formula’ and I believe that how a mum feeds her child is a personal choice.  I also know that it is not always possible for every mother  to breastfeed (which is why wet-nurses were employed in the past!).
I do believe that all new mothers should be well informed on both  breastfeeding and formula before making an informed choice about how to feed their baby.  Unfortunately, I don’t think there is enough information getting out to mums for them to be able to do this and I think that this is because there is so much conflicting research into the matter .
It is often cited that the World Health Organisation encourages breastfeeding up to the age of 2 years and beyond.  It’s exact statement on this position is:
It is important to remember that the WHO is concerned about the welfare of mothers and children worldwide; both in developed countries where clean water, formula and healthy food are available but also  countries where access to clean water may be limited and therefore breastfeeding up to and beyond the age of 2 may help to reduce infant mortality.
Breastfeeding carries benefits to the development of the skull which forms the jaws and supports the face and the teeth.  The sucking motion generated during breastfeeding is very different to that used for a bottle and has been associated with lower incidences of problems with bone positioning and malocclusion (i.e. teeth in poor position that usually require braces to fix) (Peres KG, Cascaes AM, Nascimento GG, Victor CG, Acta Paediatric 2015 Dec; 104 (467): 54-61)
During my training we were advised to tell breastfeeding mothers that they should stop breastfeeding by the age of 18 months and to definitely cease night-feeding as it increases the risk of tooth decay. Now, please note that we were never told that it causes tooth decay but that it can increase the risk of decay developing.
Whilst I was researching the matter, I came across a lot of conflicting evidence, some of which was based on case reports of only a small number of children and others that provided more in depth comparison and analysis.  There seemed to be as many studies claiming that breastfeeding increased the risk of dental decay as there were stating that it reduced the risk or that there was no difference.
The most interesting study I came across was a  fairly recent high quality meta-analysis of existing research (Tham R, Bowatte G et al, Breastfeeding and the risk of dental caries: a systematic review and meta-analysis, ACTA PAEDIATRICA 2015, 104, 62-84) There were quite strict inclusion criteria for this study and of the 480 identified papers relating to the subject, 63 were selected to be included in the analysis.
This paper had 3 major conclusions:
1. Children aged up to 12 months who were exposed to a longer duration of breastfeeding had a reduced risk of tooth decay.
2. Children breastfed for more than 12 months had an increased risk of tooth decay
3. Children breastfed for more than 12 months who fed at night or more frequently had further increased risk of tooth decay
However, in the conclusion this study also stated that it is not possible to exclude other risk factors such as a carbohydrate/sugar rich diet or inadequate care of the teeth and mouth.  It expresses that further research with careful control of these confounding factors is required in order to provide feeding guidelines for babies and young children.  In other words, even the authors of this paper felt that there was insufficient evidence to provide consistent advice regarding the matter.
Based on the research I read and the results I found I concluded that I would continue to breastfeed my son whilst trying to control as many of the other risk factors as possible.   None of the research I read concluded that breastfeeding causes tooth decay but that breastfeeding beyond 12 months can increase the risk of tooth decay when combined with other risk factors and in comparison to children who a) were not breastfed at all or b) were breastfed for less than 12 months. No figure can be placed on how much the risk of dental decay is increased.  If risk was increased by 80% then it would be a very different story to if it was increased by 5%.
The other conclusion I made was that breastfeeding beyond 12 months can prevent the need for braces and corrective surgery at a later due due to poor tooth position.
It is a personal choice for every mother whether they breastfeed and for how long.  For other mothers in my position my advice would be:
2. Offer a drink of water after meals and after breastfeeding, especially at night.  This will help to wash away any remaining sugars that bacteria can feed on to cause decay.
3. Follow the 5:2 rule – brushing twice a day protects against 5 ‘meal moments’ over the course of the day. This would include breastfeeding due to the milk sugars it contains
4. Stick to water and milk for fluids. Even ‘no added sugar’ squash contains natural fruit sugars and NEVER EVER put juice in a bottle for a baby or child.
5. Visit a dentist regularly to look for any early signs of tooth decay
Other sources of information:

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