Natural Family Feature August 2003

Excerpts from Baby Matters, What Your Doctor May Not Tell You About Caring for Your Baby, Linda Folden Palmer, DC (Lucky Press)

Feeding and Cavities
(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): 132–5.

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): 200–4.

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): 523–8.

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

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