Avoiding Dental Caries
From: New Beginnings, Vol. 29 No. 5-6, 2009, pp. 44-47
"Toddler Tips" is a regular feature of the magazine New Beginnings, published bimonthly by La Leche League International. In this column, suggestions are offered by readers of New Beginnings to help parents of toddlers. Various points of view are presented. Not all of the information may be pertinent to your family's lifestyle. This information is general in nature, and not intended to be advice, medical or otherwise.
My first child had trouble with cavities in his front teeth even though we brushed them regularly. The dentist reassured me that they were not caused by breastfeeding, but I still felt guilty. Now that my second child is a toddler, I'm starting to worry. I want to avoid the teeth problems my firstborn had. What have other mothers done to help prevent cavities from developing in their young toddlers?
I still remember how horrified I was the day I noticed that one of my twin sons had small hollows (pitting) and brown patches on his front teeth. He was 17 months old and I felt terrible. I immediately started to do a bit of research and discovered that this is often blamed on night nursing (or bottle feeding at night) by dentists. The theory is that after a feed milk pools in the mouth of the sleeping child and teeth are more susceptible to decay.
Coincidentally, at about the same time that I noticed the damage to my son's teeth, several pieces appeared in New Beginnings about dental caries in young children. You can find the articles online at www.llli.org See, for example, http://www.llli.org/NB/NBSepOct05p211a.html and do a search on the Web site on "caries" for more about the subject.
After doing lots of reading I decided that even if breastmilk were a factor in the decay (and I was not convinced -- in fact, some of the research suggests that breastmilk has a protective effect), it was still more important for my son to continue breastfeeding for its health and emotional benefits.
In order to limit any further decay we brush regularly in the recommended manner. We avoid candy and sugary food as much as possible. Fruit juices are only allowed at mealtimes. I also read up on the benefits of xylitol* in preventing decay and hunted around to find toothpaste containing it. My son has recently self-weaned and has had no problems with any further decay.
*Xylitol is a natural carbohydrate sugar substitute that interferes with bacteria's ability to stick to the tooth surface and has been shown to be effective in reducing the caries risk for children of mothers with high levels of S. mutans (a dental pathogen and the leading cause of tooth decay).
When my first daughter, Haley, was two and a half years old, she was diagnosed with four dental caries on her top back teeth. I was devastated because I felt we were taking good care of her teeth and monitoring her diet. I started questioning whether or not I should nurse her to sleep or during the night.
When I started charting how often we brushed her teeth, I noticed that we were not brushing as often as we thought. I chose not to night wean my daughter, just to be more diligent about brushing. We brushed morning and night with fluoride toothpaste. She is now five and a half and has never had a cavity since. When my second daughter's teeth erupted I knew what to do. From that day on, we have brushed morning and night with fluoride toothpaste. I continue to nurse her to sleep and during the night.
Plymouth, Minnesota, USA
It's normal to feel guilty. As parents, we are responsible for what happens to our children. We internalize that in many different ways, both for the good and for the bad. Do you feel proud of the teeth in your firstborn that are cavity free? Maybe breastfeeding actually prevented dental caries in these teeth.
I believe the tendency in very young children to develop dental caries is mainly genetic. Breastfeeding is the norm for proper oral development, but there are a few oral hygiene rules that you should follow to help enhance dental health. Brush your child's teeth after meals and before bedtime and minimize sugary food sources that stick to the teeth (raisins and other dried fruit are good examples). If you do give these types of food to your child, pay special attention to removing residue after she has eaten.
Lastly, listen to your dentist. Be grateful for a dentist that is so knowledgeable and supportive of breastfeeding.
Caroline Cameron, Tallahassee, FL, USA
What a shame your first child had problems with tooth decay: it is understandable that you will worry, but it is true that each child is different and what happens to one may not happen to the next. When my own daughter's teeth showed signs of decay, I was safe in the knowledge that I had three older children whose teeth were still perfect. They had all been breastfed into childhood, had all fed at night and survived what I thought was a fairly healthy diet, with candy mostly eaten just once a week on Fridays, followed by teeth cleaning, usually straight afterwards. In fact, I felt that my youngest daughter with tooth problems probably had the healthiest diet of all my children -- she vomited if anyone gave her chocolate as she gagged on the texture of it and she chose to eat mostly healthy foods. This did not prevent her problems with tooth decay.
Two other things seemed to have been different in our case. One was my stressful pregnancy until about 16 weeks, which covered the crucial time at 11 weeks when tooth enamel is formed. The other was my daughter's preference for orange juice, which, although exceedingly well diluted with water, seemed to cause the primary stains on her weakened tooth enamel. My thoughts on prevention are to avoid those two issues if possible, breastfeed to boost immunity, ensure a healthy diet, and insist on tooth cleaning after consumption of any sugary foods. Some mums start tooth cleaning with a soft cloth even before solids are offered.
With hindsight, we cannot always make things perfect for our children. Things happen that are not always within our control but we can continue to offer comfort, health protection, and security through breastfeeding, while taking what steps we can to minimize the risks. My youngest daughter's second teeth came through perfectly, despite warnings about the extractions causing second teeth to come through in strange positions. She is 19 years old now and they are still perfect. My feelings of guilt diminished with time.
I hope this doesn't happen for your second child.
LLL Berkshire, GB
I too felt guilty when my son had "staining" on his molars as soon as they came in. I puzzled as to why this happened because he hardly ate any candy, and he only drank breastmilk, and water. Luckily, my dentist was a relaxed mother of five and grandmother to many! She wasn't concerned and assured me that it wouldn't affect his adult teeth, and that she wouldn't do anything unless he was in pain. My son is now 12 and has just had a clean bill of health from the dentist, with all his adult teeth in good condition.
In 2000 I heard a talk by Harry Torney, an Irish dentist, member of the La Leche League Health Advisory Council, and husband to an LLL Leader. He said that there were four factors associated with cavities. The most significant relationship was with defective enamel, which I understand is genetic in origin. The other three factors related to events in pregnancy: maternal stress and/or bereavement as reported by the mother, reduced intake of dairy products by the mother, and medically diagnosed illness in the mother.
I had a very stressful pregnancy and that may be related to my son's problems. There was nothing I could do about it. I stopped feeling guilty as I realized that I had done the best I could under the circumstances. I remember his closing words so clearly: "Cavities happen in spite of breastfeeding, not because of it!"
Here is a link to the abstract of Harry Torney's paper presented at the 2000 European conference I attended:
We had a similar situation with my 18-month-old son. Unfortunately, the dentist blamed our night nursing for my son's cavities and insisted that we stop. After much research and soul searching, we chose not to stop his night nursing given our son's age and emotional needs.
I know it's hard not to feel guilty when something like this happens to your child. It reassured me to learn that human milk by itself will not cause cavities. It is wonderful that your dentist has reassured you on this point, especially when one considers how vital nursing is for optimal teeth and jaw formation.
"Adult" bacteria (strep mutans) in the mouth are passed to the baby by sharing items such as utensils, drinking glasses, and straws. The earlier baby teeth erupt, the more time they have to be exposed and the greater the likelihood of decay. My son got his first teeth at about four and a half months of age.
Both of our children go to the dentist for a check-up twice a year. Regardless of what happens, we are happy that we have established a good dental hygiene routine with both of our children that we hope will last a lifetime.
San Ramon, CA, USA
Response I was devastated when I brought my two-and-a-half-year-old daughter, Kaela, to the dentist because I saw a dark spot between her teeth (I thought it was a chip) and the dentist told me that she has six cavities! She is having them filled in three weeks.
In our family, I have an aunt who had dentures by the age of 19, and my mother and my sister both have had numerous cavities, root canals, and extractions. My children's dad has also had a few cavities and many of his siblings have bridges, dentures, and fillings. I might not be able to avoid all of the cavities due to genetics, but I am going to fight them as much as I can.
To try to prevent further cavities we have made changes in my daughter's diet by restricting sugars. We make brushing and flossing part of our daily routine. We have a monthly chart (from the dentist) that we check off each day when she flosses. After 30 days, we return it to the dentist and my daughter gets one dollar. My daughter always wants to brush her own teeth. "Me do it," she says. I let her, but then I get to do it after her, too. She seems okay with this.
Simi Valley, CA, USA