Breastfeeding and Dental Caries

These are some notes I have about this topic and thought I would share:

Early Childhood Caries (ECC)

  • -Formerly known as Baby Bottle Tooth Decay or Nursing Caries
  • -Defined as the presence of one or more cavities in the deciduous teeth in a child aged 71 months or less (LEAVEN, April/May/June 2006)
  • -Recognized as an infectious disease process caused by an overgrowth of microorganisms that are part of normal oral flora.
  • -Streptococcus mutans (S mutans) is thought to be the primary cause.

Three Factors Necessary for Dental Caries:

1. A susceptible tooth – A tooth becomes susceptible through genetics ( leading to pitting/grooving, poor tooth enamel, pH level of mouth low); pregnancy factors ( maternal fever, maternal malnutrition, iron deficiency, lead exposure, stress, antibiotic use). Other risk factors include infants born via cesarean section, prematurity, small for gestational age, infant of smokers.

2. Presence of cavity causing bacteria – Typically transmitted mother to infant or from other adult caregivers, siblings, playmates to infant.

“Reducing the level of bacteria in a mother’s mouth may reduce transmission to the baby.” (La Leche League’s LEAVEN, April/May/June 2006). Ways to do this may include xylitol ( a natural carbohydrate sugar substitute that interferes with bacteria’s ability to stick to teeth), chlorhexidine rinses (this is prescription only, may have side effects, discuss with HCP).

Be aware of the “Windows” of infectivity – 19 – 36 months (although with some children this window can start as early as six months), and 6-8 years of age.

3. Presence of Acid – Decreased saliva flow decreases the protection saliva provides of washing debris away. Children who are mouth- breathers, take antihistamines and/or asthma medications may be at higher risk for caries.

Problems Caused By Caries-

They can be painful and cause abscesses, the ability to eat and chew is compromised, children with dental caries may show “slowed growth rates or failure to thrive”, speech may be affected, if primary molars are lost to decay malocclusion may result, caries may affect self esteem of child. Having ECC is a strong predictor of decay in permanent teeth.

Signs of Decay – White spots on the surface of the teeth, usually on the front teeth, or white lines at base of teeth. This will later turn to brown spots and decay. Dentists recommend a child first visit the dentist by 12 months of age or within first six months of teeth erupting.


  • -Non-breastfeeding infants are at higher risk of decay when compared to breastfeeding infants . One recent study of Jahalin Bedouin infants in Israel found that the children drinking bottles had levels of ECC almost two times the infants that were breastfeeding. (from Early Childhood Caries among A Bedouin Community residing in the eastern outskirts of Jerusalem by Livny, Assali, Sgan-Cohen, BMC Public Health 2007).
  • -Human milk is not cariogenic unless another source of carbohydrate is introduced for bacteria to feed on.
  • -Human milk does not decrease the pH of the mouth while almost all brands of artificial milk do – S mutans thrives in low pH
  • -Most artificial milks support high level of bacterial growth, while human milk supports moderate bacterial growth
  • -Components in breast milk, including secretory IgA and IgG play a protective role and slow the growth of S mutans and lactoferrin kills bacteria. Also, the calcium and phosphorus from breast milk are deposited on the tooth enamel.
  • -However, once first teeth erupt and additional foods and fluids are added to the diet, the breastfed infant can be at risk for caries just like any other infant
  • -Also, if the infant is receiving human milk by bottle the protective mechanisms of breastfeeding are compromised.
  • – Fluoride is controversial in treating caries. Some studies suggest flouride decreases the rates of caries from 50 to 70 percent, but other experts cite fluoride as a neurotoxin and that fluoride inhibits calcium absorption. Some holistic dentists are working with Vitamin D or combinations of Vitamin D, Vitamin C and calcium to try to reverse early decay. Vitamin D can be toxic at higher levels, so please discuss this with your HCP.


Early childhood caries:new knowledge has implications for breastfeeding families. Altshuler, A. LEAVEN, vol 42, No 2. April/May/June 2006, 27-30.

Avoiding dental caries. Fowler J. NEW BEGINNINGS, vol 19, no 5. Sept/Oct 2002, 164-7.

Big bad cavities: breastfeeding is not the cause. Reagan L. Mothering Magazine. July/August 2002.

5 thoughts on “Breastfeeding and Dental Caries

  1. Hi Carrie,
    I’ve been enjoying your blog so much since I discovered it – so first, thank you so much. Our daughter (2 1/2) we just found out has eight cavities (!) even though we eat a very healthy diet, brush, etc. She’s going to need fillings, and I’m a bit freaked out about the whole process. I know this is not your area of expertise, but have you heard anything about laser removal vs drilling, or other options for caries in very young children? Thank you in advance.

    • Adrie, You may consider getting opinions on this over at the Mothering Magazine forum or on the greentaramamas yahoo!group……Two and a half most likely will not sit still to be injected with novacaine! so are they thinking of filling them all at one time under a general anesthesia? How long can you let them go? Are they hurting her? Are some of them minor enough that they could be repaired without drilling and such?
      I think you may find more useful information over at those two sites….I feel you though, both my older girls have had the worst time with accidents to the front two teeth and one had to have surgical repair under a general and the other eventually had to have crowns put on under general…We have not had much luck with teeth, sadly 🙂 Here’s hoping number three will break that streak!

  2. Hi Carrie,
    Thanks for your thoughts -even knowing you’ve been through that dental work makes me feel a little better! They were recommending drilling and filling under nitrous, but seemed really aggressive about the treatment. Thankfully, we’ve found another dentist who doesn’t think it’s so bad, and is working with us on prevention. Thank you again!

    • Hi Czarina, I am not certain I understand your question, but I hope my post has helped you.
      Many blessings on your thesis,

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