“If breastmilk caused decay – evolution would have selected against it. It would be evolutionary suicide for breastmilk to cause decay.”
An anthropologist’s view, quoted by the late Dr. Brian Palmer, DDS in “Infant Dental Decay: Is it related to Breastfeeding?” *
A new statement on infant feeding issued in January 2018 by the British Society of Paediatric Dentistry (BSPD) has suggested that “Consideration should be given to reducing on demand and night time feeds in light of the emerging evidence-base suggesting a potential link between these practices and complementary feeding after 12 months of age and dental decay.” [1]
The statement goes on to say that “From 12 months of age, where possible, the last feed should take place before tooth-brushing at bedtime so that the last thing on the child’s teeth before they go to sleep is always fluoride toothpaste.” [2]
LLLGB is concerned that this statement will worry mothers who are breastfeeding their babies, as they may feel pressured into weaning before they are ready. We would agree that looking after children’s dental health is extremely important but, as human milk by itself actually helps to protect against cavities, night weaning is not the answer to the problem of tooth decay.[3]
The importance of breastfeeding covers a wide spectrum
When considering the advice given by the BSPD, it is helpful to consider the wider significance of breastfeeding, its importance to the short- and long-term health of both mother and child, and its contribution to emotional security, mental and intellectual development and well-being.
There are many studies which show how important breastfeeding is, including its increased significance the longer babies are breastfed. These studies were summarised in 2016 in The Lancet Breastfeeding Series.[4]
Breastfeeding is an important part of a mother and child’s relationship
As a baby grows, the nutritional aspect of breastmilk remains important, but breastfeeding also plays a significant role in the relationship between mother and child. The comfort breastfeeding can offer to a child is incredibly important and night nursing is a large part of this.
Night weaning before a baby is ready might cause milk production to slow down and could lead to premature weaning. The baby won’t understand why he can’t feed at night and may be frustrated by a drop in milk supply during the day. Putting mothers at risk of weaning earlier than they wanted would be contrary to the WHO recommendations of breastfeeding for a minimum of two years.[5] It may also lead to mothers and babies experiencing unnecessary nights of crying and distress without the comfort offered by breastfeeding.
Studies show that breastmilk may protect against decay
The BSPD recommendations published in the statement on infant feeding claim to be supported by the best available evidence. However, not all studies concur with these recommendations.
The late Dr. Brian Palmer, DDS studied children’s skulls that were thousands of years old and he found almost no cavities.[6] He found evidence to show that bacteria which cause cavity formations are inhibited by several components of human milk including high pH levels. Human milk also actively strengthens teeth by depositing calcium and phosphorus on them.
Dr. Harry Torney found in a survey – Prolonged, on-demand Breastfeeding and Dental Caries – An Investigation[7] – that four factors were significantly associated with the high caries group and these did not include breastfeeding.
Diet and Dental hygiene are significantly associated with tooth decay
Our modern diet has many more cavity-inducing foods and it’s often impossible to get all those sugars off a child’s teeth; this is more likely to be the cause of problems than breastmilk.
Streptococcus mutans is an oral bacterium that’s especially hard on tooth enamel in the presence of sugar. Babies can pick up S. mutans from adults who carry the strain and who share food, utensils or mouth kisses with them; therefore, it‘s important that the primary caregiver of a baby also maintains good oral health.
The Womanly Art of Breastfeeding [8] suggests that the best way to aid dental health is to wipe or brush your child’s teeth thoroughly at least twice a day. It might help to encourage him to swish with, or at least sip, water after eating. Brushing before going to sleep and not offering any carbohydrates after the bedtime teeth cleaning make sense, but there is no need to keep your child from nursing at night since human milk by itself actually helps protect against cavities, making night weaning an irrelevant solution to the problem.
New research says too much sugar is to blame for increase in tooth decay
Research issued in March 2017 by the Faculty of Dental Surgery (FDS), part of the Royal College of Surgeons (RCS), states that dental problems are being caused by a diet of too much sugar and lack of knowledge of oral health. According to this research, nine out of 10 cases of tooth decay could have been prevented with better knowledge of oral health among health professionals.[9]
The research found that parents were often unaware of the risks of a diet of high-sugar food and drink, which begins at an early age, and may not realise which foods contain a lot of sugar.
Professor Nigel Hung, Dean of the FDS, said “When you see numbers tallied up like this it becomes abundantly clear that the sweet habits of our children are having a devastating effect on the state of their teeth.” [10]
Dr. Jenny Godson, who is in charge of oral health improvement at Public Health England, agreed. She said “Tooth decay is preventable and we can all take action – this includes limiting sugary food and drink, making sure children brush their teeth twice a day with a fluoride toothpaste, especially before bed, and visiting the dentist regularly.”[11]
In Conclusion
• LLLGB agrees that “Respecting the choices of parents and caring for their mental wellbeing is of paramount importance” [12] It’s important for parents to make decisions which feel right for them and their children based on accurate information. However, mothers who follow the BSPD guidance and wean at night may experience guilt and distress.
• Historically children who nursed all night had little or no decay until the advent of decay-inducing foods. Human milk rarely contributes to decay and actually has tooth-strengthening properties.
• The BSPD advises that “from 12 months of age, mothers who wish to continue breastfeeding should work closely with their health practitioners to minimise the potential risk of dental decay. This may include the recording of a detailed diet diary identifying sugar in complementary foods and drinks, and discussing the optimal use of fluoride.”[13]
• LLLGB agrees that looking at a child’s diet is an important part of preventing tooth decay. Parents need to be aware of the dangers of sweet foods and drinks and of the benefits of strict oral hygiene and visits to the dentist. However, it’s important not to overlook the many health and emotional benefits of breastfeeding for the baby, family and society as a whole.
• The BPSD says that “consideration should be given to reducing on demand and night time feeds in light of the emerging evidence-base suggesting a potential link between these practices and complementary feeding after 12 months of age and dental decay.”[14]
• LLLGB believes that weaning from the breast because of unsubstantiated fears of tooth decay would be denying a baby – and mother – the many benefits of continued breastfeeding and may actually lead to the unnecessary introduction of bottles.
Written on behalf of LLLGB by Anna Burbidge, February 2018
Further reading:
http://www.lllgbbooks.co.uk/store/p19/Breastfeeding_%26_Dental_Health.html
https://www.laleche.org.uk/breastfeeding-dental-health/
http://breastfeedingtoday-llli.org/dental-caries/
Notes:
* Brian Palmer, DDS: “Infant Dental Decay: Is it related to Breastfeeding?” (http://www.brianpalmerdds.com/pdf/caries.pdf)
1 British Society of Paediatric Dentistry. British Society of Paediatric Dentistry Position Statement on Infant Feeding. January 2018, http://bspd.co.uk/Portals/0/BSPD%20Position%20Statement%20on%20Infant%20Feeding%20Jan%202018.pdf (accessed 15 February 2018).
2 Ibidem.
3 La Leche League International. The Womanly Art of Breastfeeding. 8th Edition, 2010. (http://www.lllgbbooks.co.uk/store/p91/The_Womanly_Art_of_Breastfeeding.html)
4 The Lancet Breastfeeding Series. Available from: http://www.thelancet.com/series/breastfeeding
5 World Health Organization. Exclusive breastfeeding for six months best for babies everywhere. 15 January 2011, http://www.who.int/mediacentre/news/statements/2011/breastfeeding_20110115/en/ (accessed 15 February 2018).
6 Brian Palmer, DDS. Infant Dental Decay: Is it related to Breastfeeding? 2000, http://www.brianpalmerdds.com/pdf/caries.pdf (accessed 15 February 2018).
7 Torney, H. Prolonged, On-Demand Breastfeeding and Dental Caries-An Investigation [unpublished MDS thesis]. Dublin, Ireland, 1992.
8 La Leche League International. The Womanly Art of Breastfeeding. 8th Edition, 2010. (http://www.lllgbbooks.co.uk/store/p91/The_Womanly_Art_of_Breastfeeding.html)
9 Bodkin, H. Rise in removals of rotting milk teeth fuelled by children’s sugary diet. The Telegraph, 21 March 2017, http://www.telegraph.co.uk/news/2017/03/21/rise-removals-rotting-milk-teeth-fuelled-childrens-sugary-diet/ (accessed 15 February 2018).
10 Ibidem
11 Ibidem
12 British Society of Paediatric Dentistry. British Society of Paediatric Dentistry Position Statement on Infant Feeding. January 2018, http://bspd.co.uk/Portals/0/BSPD%20Position%20Statement%20on%20Infant%20Feeding%20Jan%202018.pdf (accessed 15 February 2018).
13 Ibidem
14 Ibidem
* Brian Palmer, DDS: “Infant Dental Decay: Is it related to Breastfeeding?” (http://www.brianpalmerdds.com/pdf/caries.pdf)