Early childhood caries is of epidemic proportions, but such was not always the case. Looking at prehistoric and ancestral human skulls, it is noted how infrequent cavities were in ancestral humans. From what we know, modern humans have been around for about 100,00 years…but cavities have only been noted in anthropological specimens for the past 8,000-10,000 years. That means that babies who breastfed had little to no decay for about 92,000 years. So, what gives?
The cavity process is complicated. But from the latest research, we know IT IS NOT breastmilk by itself that causes cavities. Many mamas are told to stop breastfeeding because their children are a higher cavity risk. While I understand the reason that many providers advise this, we are not truly addressing or educating about the ROOT CAUSES. It is not the breastmilk itself, rather a perfect storm of events. Things that may be contributing to the “nursing caries” process:
The introduction of sugars and flours. This includes puffs, cereals, crackers, teething cookies, granola bars, pretzels, and most anything that comes from boxes and bags. It is generally after foods have been introduced that caries are noted.
cavity-causing bacteria is CONTAGIOUS and most babies receive an introduction of these bad bacteria from their caregivers. It is important to get your own dental needs under control prior to having a baby, and if this isn’t an option, use things like baking soda rinses and avoid kissing and sharing cups and spoons if possible. Prebiotic and probiotics are also key.
Candida may be to blame. Again, a sign of dysbiosis or an imbalance between good and bad microbes in our oral cavity, yeast, and fungal microbes may be a big piece of this puzzle.
I am seeing more and more undermineralized or hypocalcified teeth in my practice. The reasons are hard to pin-point, but if seen in primary teeth it is an issue that arose in utero, or around 17-21 weeks post conception. It can be a result of an illness of the mother during this time, her exposure to certain medications or environmental toxins, depletion of critical nutrients like A, D, E, K, and calcium, or that her microbiome (gut, oral, even the placenta) is in dysbiosis. I tend to see more of this in second+ born children, very likely due to depleted mothers.
Once food is introduced, it is critical to start hygiene practices, including brushing and flossing daily. Consider using hydroxyapatite toothpaste or baking soda slurries. Xylitol wipes are great after feedings in the middle of the night or after meals during the day when brushing and flossing are not an option.
Restricted labial frenums may contribute to decay on upper anterior teeth by allowing breastmilk to pool against already susceptible teeth, whether due to poor oral hygiene or under mineralized enamel.
babies and toddlers who mouth breath dry out their oral tissues, greatly contributing to increased cavity risk. Mothers with sleep-disordered breathing or apnea may be affecting their microbiome, too, continuing the issue with dysbiosis in their mouths and guts, or if pregnant, possibly in their placenta. More research on this is needed.
Knowledge is power. Reading this two-part series of posts and applicable research will help you make choices to help prevent this heart-breaking and sadly, common disease.
Ideally, try to get your own oral health, gut health, and sleep/airway addressed prior to conceiving. If this is not possible, try to tackle them as best you can during pregnancy and after birth. Xylitol daily and baking soda can help create a more balanced oral microbiome, along with excellent hygiene, nutrient-dense foods (especially pre and probiotic-rich), and regular dental check-ups.
Eat nutrient-dense foods during pregnancy and breastfeeding. Focus on fat-soluble vitamins, probiotic-rich foods, lots of veggies, hydration, and quality sleep as best as you can. Read ‘The Dental Diet’ by @drstevenlin for more ideas.
Ask for help and create a tribe. Community is key and being a parent is really hard to do alone. Try to reach out to friends, family, and if you can, outside providers to offer support and care during pregnancy and after birth.
Establish a good hygiene routine as soon as a first tooth erupts. You can even start wiping gums prior to that, especially if you know your oral health and hygiene is not optimal.
Address mouth breathing or frenum restrictions early. Your pediatrician, pediatric dentist, IBCLC, or ENT can help guide you.
**PLEASE NOTE: this post and these studies are regarding BREASTMILK and Nursing, NOT FORMULA or COW’s MILK and babies and toddlers falling asleep with a bottle. I never advise letting baby or young child fall asleep with a bottle at bedtime**
Please see comments below for more research citations and references. DM if you’d like more on this topic.
Sending love to all you Mama-Bears (and Papas!) out there! You are doing a great job caring for and nurturing your babies and children.
With Love + Health,
1. The March/April 1999 issue of Pediatric Dentistry stated, “It is concluded that human breast milk is not cariogenic.” This study utilized extracted teeth to obtain most of its results and studied children only for determining the pH changes in dental plaque (Erickson 1999). A Finnish study could not find any correlation between caries and breastfeeding among children who were breastfed longer (up to 34 months) (Alaluusua 1990). Valaitis et al concluded from their studies, “In a systematic review of the research on early childhood caries, methodology, variables, definitions, and risk factors have not been consistently evaluated. There is not a constant or strong relationship between breastfeeding and the development of dental caries. There is no right time to stop breastfeeding, and mothers should be encouraged to breastfeed as long as they wish.” (Valaitis 2000)
2. Dr. Brian Palmer states in his paper that, “Human milk alone does not cause dental caries. Infants exclusively breastfed are not immune to decay due to other factors that influence the infant’s risk for tooth decay. Decay causing bacteria (streptococcus mutans) is transmitted to the infant by way of parents, caregivers, and others” (Palmer 2002).
3. The other foods in baby’s diet and not breast milk that are responsible for supporting the tooth decay process. The P.R. Erickson study Investigation of the role of human breast milk in caries development. Pediatric Dent 1999 (healthy teeth were placed in different solutions) indicated that breast milk alone was virtually identical to water and found not to cause tooth decay. Another experiment demonstrated that the teeth became stronger when immersed in breast milk, but after a small amount of sugar was added to the breast milk, the mixture became greater than a sugar solution in terms of causing tooth decay. This study stresses the importance of tooth brushing and good dental hygiene not only for our babies, but for all of us. All are excerpts from research, presentations, and publications by Brian Palmer, DDS
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