Dental caries is the most widespread infectious disease amongst children. Early childhood caries is a manifestation of this condition and is defined as ‘the presence of one or more decayed lesions (cavitated or non-cavitated), missing teeth (due to caries), or filled tooth surfaces in a child 71months of age or younger.
The cause of dental caries is multifactorial with the 3 primary factors being:
- Cariogenic microorganisms – The main pathogens are Streptococcus Mutans and Streptococcus Sobrinus. These microorganisms colonize the tooth surface and subsequently cause the destruction of teeth by producing acid at a faster rate than the neutralization capacity of the mouth.
- Susceptible Host – Teeth serve as a host for this disease and often become more susceptible by enamel defects, crowding and reduced salivary flow.
- Cariogenic diet – The carbohydrate sucrose is the most cariogenic food source. The small sugar molecules are easily metabolized by cariogenic bacteria. Frequent or prolonged exposure, as well as an increased retentiveness of these sugars, results in exacerbation of the caries process.
Where does breastfeeding fit in?
Breastmilk is often the only source of nutrition for the first few months of an infant’s life. The numerous health benefits associated with breastfeeding have been widely researched and well-established. Despite this, the research on the oral risks and benefits as a result of breastfeeding is inconclusive. Some studies have concluded that human breast milk can cause caries, principally in combination with other sugars whereas others report no demineralization of tooth structure by breastmilk. It is apparent for many reasons that the cariogenic potential of breastmilk needs to be established. The aim of this blog is to give mothers a better understanding of the relationship between breastfeeding and a child’s oral health.
Advantages of breastfeeding:
General Health:
Breastfeeding has numerous advantages including developmental, nutritional, economic, immunological, psychological and social.
Breast milk is tailored to the infant’s precise immunological and nutritional needs, thus making it their ideal source of nutrition.
Below is a brief overview of the health benefits of breastfeeding:
- Protection against short-term infections including gastroenteritis diarrhoea and acute otitis media.
- Assistance in combatting serious conditions such as necrotizing enterocolitis, leukaemia and sudden infant death syndrome.
- The incidence of chronic diseases and conditions are reduced by human breast milk. These include asthma, type 2 diabetes mellitus and obesity.
The health benefits of breastfeeding are also seen in mothers. Longer and exclusive breastfeeding is linked to preferable health outcomes. Breastfeeding reduces postpartum bleeding and suppresses ovulation thus allowing the mother’s body to recover. Breast cancer, as well as ovarian cancer risks, are reduced by breastfeeding.
Oral Health:
Other than the numerous health benefits, breastfeeding also contributes to favourable oral health. Outlined below are some of these benefits:
- The sucking mechanism displayed during breastfeeding involves a ‘peristaltic-like’ motion as the movement of the lips and tongue results in squeezing rather than sucking. Bottle feeding, on the contrary, results in a ‘piston-like’ motion caused by the compression of the teat against the palate. Using electromyography, researchers have suggested that the muscle activity displayed during breastfeeding imparts a reduced likelihood of developing dysfunctional muscular patterns and a resultant malocclusion.
- Studies conducted by Dr. Brian Plamer illustrate that a major component of breast milk, lactoferrin, is highly bactericidal to Streptococcus Mutans.
- IgA found in breast milk hinders the colonization of Streptococcus Mutans.
- Finally, the study by Erickson demonstrated that human breast milk does not cause a significant drop in the pH of the oral cavity and moreover, it promotes mineralization of the enamel with calcium and phosphate.
Oral disadvantages of breastfeeding:
- A study conducted by Gardener proposed that at-will breastfeeding increases the risk of caries in an infant. It is rationalized that the suckle-sleep-suckle cycle leads to stagnation of the breastmilk and the resultant demineralization of teeth.
- Nocturnal breastfeeding further increases the caries risk as the salivary flow at night is reduced.
- There are certain factors that when combined with breastfeeding, can predispose an infant to caries. These include; a high sugar intake, poor oral hygiene, enamel hypoplasia, reduced salivary flow and a short frenum attachment.
The connection between prolonged breastfeeding and caries is a great controversy. As caries is a multifactor infectious disease we are convinced that there is no single factor that causes it on its own. There are very few studies that link breastfeeding to ECC and they often only deal with a small number of cases.
Advice:
- The American Academy of Paediatric Dentistry ‘Encourages breastfeeding of infants to ensure the best possible health and developmental outcomes, with care to wiping and brushing as the 1st primary tooth begins to erupt and dietary carbohydrates are introduced. ‘Ad libitum breastfeeding should be avoided after the first primary tooth begins to erupt.’
- The World Health Organization advises exclusive breastfeeding for the first 6months of an infant’s life, after which other sources of nutrition can be supplemented. Breastfeeding is recommended for up to 2 years.
- Start cleaning you baby’s mouth as soon as possible, even if they don’t have teeth. You can clean their gums with a moistened gauze, cloth or a silicone rubber fingertip toothbrush.
- The intake of sugars should be limited. Frequent feeding and snacking is discouraged and nocturnal feeding should be kept to a minimum.
- Early visits to the dentist will allow for early detection and optimum preventative measures.
This blog was adapted from a postgraduate assignment completed by Dr Desai. You may email us for a list of references.
