How many mothers have been told that they must stop breastfeeding because continued nursing will damage their children’s teeth? Well, here’s some good news: A new study shows that this is not the case.

Researchers from the University of Rochester and New York University recently examined national data on oral health, infant feeding, and other child and family characteristics for 1,576 children ages 2 to 5 years. They looked at breastfeeding and its duration, as well as other factors that have been associated with early childhood caries.

About the Study
This study sought to use nationally representative data to assess the potential association between breastfeeding and its duration with early childhood caries (ECC); it also looked at other factors that may be associated with the risk for ECC among children in the United States. Data were from the 1999-2002 National Health and Nutrition Examination Survey (NHANES). The NHANES includes a household interview with parents about children’s diet, nutrition and oral health behavior, and socioeconomic factors, as well as dental examinations.

Breastfeeding and Caries
Previous studies have reported that “prolonged and unrestricted” breastfeeding is a risk factor for early childhood caries. However, this study did not support that finding.

Approximately 60% of children in this study were ever breastfed. Overall, these children had lower rates of early childhood caries than their non-breastfed peers.

A major strength of the study is its large, nationally representative sample of U.S. children. However there are several study limitations. For example, the quantity and quality of supplemental feedings, the quantity of breastfeeding, and information about other factors, such as bedtime breastfeeding or bottle feeding are not available from the NHANES data. In addition, reliance upon parental recall for data on breastfeeding duration and age at introduction of other foods, introduces the potential for recall bias.

Other Risks and Caries
The researchers looked at several other possible risk factors, including birth weight, age, gender, race/ethnicity, poverty status, maternal age at child’s birth, maternal smoking during pregnancy, history of admission to a NICU, and time since last dental visit.

Those factors that increased the risk for early childhood caries included:

• Older child age
• Poverty
• Being Mexican American
• Dental visit within the last year
• Maternal prenatal smoking

It seems contrary to logic that children who had a dental visit in the past year would be at greater risk for caries. The researchers explain that this is likely due to parental perceptions of pediatric dental care, notably the belief that preschool-age children do not yet need to see the dentist. Therefore, only those children between the ages of 2 and 5 years who were perceived to have a need (e.g., those who have complained of tooth pain, those whose primary health care providers have identified a problem) had a dental visit within the past year.

What does it mean?

• Parents do not need to choose between breastfeeding and their children’s dental health. Parents should not feel pressure to stop breastfeeding before they and their children are ready. (Although they may want to arm themselves with additional research since, despite the World Health Organization’s recommendation that breastfeeding continue until at least 2 years of age, the American Academy of Pediatric Dentistry recommends weaning by the age of 12 to 14 months and discourages nighttime feeding after the eruption of the first tooth. Brian Palmer may be a good place to begin.)

• Parents should stop smoking during and after pregnancy. It is not possible for the researchers to determine whether exposure to smoke before or after birth was the culprit, since women who smoke during pregnancy are likely to continue to smoke afterwards. We do know however, that exposure to smoke puts children at risk for a host of health woes.

• Parents should schedule early preventive dental visits for their children. This is crucial for those who are at-risk, but it is important for all children so that their parents may begin to understand strategies for maintaining good dental health.

• Last, but certainly not least, parents should concern themselves with their children’s dental health from a very young age. They should discuss specific recommendations with their child’s health care provider, but generally, once the first tooth has emerged parents can begin cleaning the child’s teeth after feeding with a soft brush and water. Fluoridated toothpaste is not recommended until a child is 2 to 3 years of age. Caries can develop early, but they don’t have to.