(Excerpted from Chapter 10 -- Baby Feeding
Facts and Fallacies)
Reprinted with the author's permission
Unedited by BPO staff
Breastfed children have far fewer dental
cavities than those who are bottle-fed.9–11
This includes nursing caries as well as other cavities. The
unfortunate term “nursing caries” refers to a typical pattern
of dental decay seen when juice, formula, or breastmilk sits
in the mouth frequently for extended periods. Nighttime snacks
are highly cavity causing because saliva is not very mobile
during sleep, leaving baby without its rinsing and antibacterial
qualities. Juice bottles by far promote the greatest number
of nursing caries.12 Both breastfed and bottle-fed
infants have a need for comfort nursing. The only way bottle-fed
infants can find this comfort is to “nurse” their bottles very
slowly when allowed to lie and hold their own bottle, causing
formula to sit against their teeth for long periods. Nursing
caries are more common in bottle-fed infants, especially in
those who have nighttime bottles at older ages. Among breastfed
infants who develop nursing caries, most are those who comfort
nurse for long periods during the night after teeth have developed.13
And among these, most are those who have frequent snacking and
sugary foods or juices in their diets.14,15
In cavity-prone families, or when any evidence
of decay has been detected in an infant, night nursing and bottle
practices can be gently reduced (not necessarily eliminated)
once several teeth are present. A squirt of water into the mouth
or stirring the child enough to cause some extra swallowing
after nursing will help to clear the mouth of milk. Juice bottles
should never be given at night. Still, there will be genetic
tendencies or other unknown factors that will make some children
more susceptible to bacterial presence and destruction in their
mouths no matter what measures are taken.16 Although
damage to baby teeth does not affect adult teeth, a strong tendency
for decay will likely carry over to adult teeth. Caries in baby
teeth can serve as a warning that good preventive measures must
be taken with permanent teeth.
Mother’s milk has immune factors that reduce
the presence of unfriendly bacteria, and laboratory tests show
human milk does not encourage cavities.17 On the
other hand, formula is definitely cavity promoting.18
Formulas with sugars other than lactose are the worst.19
Although Streptococcus mutans bacteria is generally
thought to be the chief cause of dental decay, the candida yeast
that builds up on pacifiers has been found to promote cavity
formation to a great degree.20 Because of this candida
and the high incidence of nursing caries from bottles or nighttime
breastfeeding, dentists, and thus pediatricians, commonly recommend
throwing out bottles and pacifiers at 12 months of age and weaning
breastfed infants prematurely. But we must remember that permanent
teeth are not harmed by baby teeth cavities.
Babies naturally experience hunger and need
comforting during the night. Withholding response to these needs
can possibly be more harmful to a child than any risk of damage
to temporary teeth, although your dentist may feel that teeth
are the primary concern. While dental treatments on infants
are certainly traumatic, the mere possibility of infant caries
(about a 14% chance) is not enough of a worry that I would withhold
or withdraw important feeding and comforting from any infant,
especially before any such symptoms have occurred. Feeding and
comforting practices can be modified when needed to protect
teeth, without blunt, drastic weaning measures.
Nursing mothers may be prone to cavities related
to nursing (maybe these are the true “nursing caries”). Especially
during the first months of breastfeeding, nursing mothers often
find a need for midnight snacks. This food sitting against the
teeth in a sleeping mom may cause some cavities in her teeth,
which have mildly reduced calcium content (no matter how much
calcium she supplements) until after the end of lactation. Preventive
measures should be taken in a cavity-prone mom.
More on Teeth
“Did you know that according to the American Association of
Orthodontists, two out of three children need braces?” cants
an orthodontic ad in my local paper. As mentioned in the chapter
entitled “Crying and Caring,” prolonged bottle-feeding, pacifier
use, or thumb-sucking (found chiefly in bottle-fed, schedule
fed, or prematurely weaned children) cause dental malocclusion
and crossbite (buckteeth) that lead to the recommendation of
correction with dental braces. Breastfeeding does not.
A Breastfeeding Effect in Mother
Breastfeeding mothers often experience about a 5% reduction
in bone density. This is not rightfully referred to as osteoporosis
because this level of reduction does not lead to bone fractures.
This effect is seemingly harmless for mom (except possibly to
teeth), and this bone loss is not prevented or reduced by calcium
supplements21 or by exercise.22 Bone density
returns to normal after weaning, with some return beginning
during lactation at around 9 months.23 The return
of density after weaning is only slightly augmented by calcium
supplementation. Reduced estrogen is most likely responsible
for the reduced retention of calcium in mother’s bone, just
as it is after menopause. This period of low estrogen is also
responsible for the reduction in breast and ovarian cancers
in women who breastfeed. This period of lower bone calcium should
cause no concern about osteoporosis since it has been shown
that women who have breastfed suffer fewer hip fractures in
old age (indicating less osteoporosis).24
The amount of calcium available to baby through
mother’s milk is just right and is also unaffected by calcium
supplementation to mother (including cow’s milk). Incidentally,
research suggests that vitamin A, not calcium, may be the most
important supplement for increasing baby’s bone growth when
there is an undernourished mother.25
9. A.A. al-Dashti et al., “Breast
feeding, bottle feeding and dental caries in Kuwait, a country
with low-fluoride levels in the water supply,” Community
Dent Health (England) 12, no. 1 (Mar 1995): 42–7.
10. R.O. Mattos-Graner et al.,
“Association between caries prevalence and clinical, microbiological
and dietary variables in 1.0 to 2.5-year-old Brazilian children,”
Caries Res 32, no. 5 (1998): 319–23.
11. N. Kanou et al., “[Investigation
into the actual condition of outpatients. II. Correlation between
the daily habits of eating and toothbrushing and the prevalence
of dental caries incidence],” Shoni Shikagaku Zasshi (Japan)
27, no. 2 (1989): 467–74.
12. A. Mohan et al., “The relationship
between bottle usage/content, age, and number of teeth with
mutans streptococci colonization in 6–24-month-old children,”
Comm Dent Oral Epidemiol 26, no. 1 (Feb 1998): 12–20.
13. K.L. Weerheijm et al., “Prolonged
demand breast-feeding and nursing caries,” Caries Res (Holland)
21, no. 1 (1998): 46–50.
14. L. Lopez Del Valle et al.,
“Early childhood caries and risk factors in rural Puerto Rican
children,” ASDC J Dent Child 65, no. 2 (Mar–Apr 1998):
15. A.L. Hallonsten et al.,
“Dental caries and prolonged breast-feeding in 18-month-old
Swedish children,” Int J Paediatr Dent (Sweden) 5,
no. 3 (Sep 1995): 149–55.
16. M.I. Matee et al., “Mutans
streptococci and lactobacilli in breast-fed children with rampant
caries,” Caries Res (Tanzania) 26, no. 3 (1992): 183–7.
17. P.R. Erickson and E. Mazhari,
“Investigation of the role of human breast milk in caries development,”
Pediatr Dent 21, no. 2 (Mar–Apr 1999): 86–90.
18. C. Sheikh and P.R. Erickson,
“Evaluation of plaque pH changes following oral rinse with eight
infant formulas,” Pediatr Dent 18, no. 3 (May–Jun 1996):
19. D. Birkhed et al., “pH changes
in human dental plaque from lactose and milk before and after
adaptation,” Caries Res 27, no. 1 (1993): 43–50.
20. P. Ollila et al., “Prolonged
pacifier-sucking and use of a nursing bottle at night: possible
risk factors for dental caries in children,” Acta Odontol
Scand 56, no. 4 (Aug 1998): 233–7.
21. H.J. Kalkwarf et al., “The
effect of calcium supplementation on bone density during lactation
and after weaning,” N Engl J Med 337, no. 8 (Aug 1997):
22. K.D. Little and J.F. Clapp
III, “Self-selected recreational exercise has no impact on early
postpartum lactation-induced bone loss,” Med Sci Sports
Exerc 30, no. 6 (Jun 1998): 831–6.
23. M. Sowers et al., “Changes
in bone density with lactation,” JAMA 269, no. 24 (Jun
23–30, 1993): 3130–5.
24. R.G. Cumming and R.J. Klineberg,
“Breastfeeding and other reproductive factors and the risk of
hip fractures in elderly women,” Int J Epidemiol (Australia)
22, no. 4 (Aug 1993): 684–91.
25. J.H. Himes et al., “Maternal
supplementation and bone growth in infancy,” Paediatr Perinat
Epidemiol 4, no. 4 (Oct 1990): 436–47.
© Copyright 2002 Dr. Linda Folden
Palmer, All rights reserved.
Linda Folden Palmer, DC, is the author of
the healthy parenting book: Baby Matters, What Your Doctor
May Not Tell You About Caring for Your Baby. She provides
telephone consultations for colic, lactation difficulties,
child nutrition, food allergy issues, and infant sleep challenges.
Promoting attachment and natural parenting principles, she
is dedicated to raising awareness about how powerfully early
parenting and healthcare choices can influence a child's mental
and physical outcomes. Find her at www.babyreference.com