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Toddler Tips

Avoiding Dental Caries

From: NEW BEGINNINGS, Vol. 22, No. 5 September-October 2005 p. 216-219

"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 life-style. This information is general in nature, and not intended to be advice, medical or otherwise.

Mother's Situation

My first child had trouble with cavities in her front teeth even though we brushed 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?

Mother's Response

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.

Lisa Eidenschink
Plymouth Minnesota USA

Mother's Response

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

Mother's Response

We had a similar situation with my 18-month-old son. Unfortunately, the dentist blamed our night nursing for my son's cavities and was insistent that we stop. After much research and soul searching, we chose not to 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 checkup 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.

Jennifer Rhee
San Ramon CA USA

Mother's 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.

Deborah Dennert-Frederick
Simi Valley USA

Mother's Response

As a mother who has experienced tooth decay with three of her four breastfed children, I can sympathize with your feelings of guilt and concern. My dentist also reassured me that breastfeeding was not the culprit -- genetics and weak enamel were. After the necessity of dental surgery for my two older girls, I was determined to be more proactive with my youngest child. Here's what has helped for my family.

  1. Limiting sweets, including natural sugars.
  2. Since I have had problems with cavities myself, I made sure that I did not share spoons with my baby to avoid colonizing her mouth with unfriendly bacteria (see the Conference Report on pages 211-12).
  3. I brushed my baby's teeth each night before we went to bed. After she nursed to sleep, I removed my nipple from her mouth so that milk would not drip and pool around her front teeth. I didn't limit night nursing so long as she was actively nursing.
  4. When I noticed some signs of decay in her front teeth, I made an appointment with a breastfeeding friendly pediatric dentist. She was very supportive of our continued breastfeeding, and when she learned that we did not have fluoridated water, she prescribed a gentle fluoride treatment that was brushed on daily. This seemed to stop the progress of tooth decay.

My "baby" is now three years old and while she has moderate decay in her front teeth, it is much less than her sisters had at a younger age. It has not progressed since her initial dental visit and we hope that she's on her way to good dental health.

My two older girls now have their permanent teeth and I'm happy to say that they are strong and straight -- a testament to the good nutritional start they got through breastfeeding!

Laura Warren
Dawn MO USA

Mother's Response

My first child had many cavities as a preschooler despite my brushing his teeth often. My second, third, and fourth children have no cavities and they all nursed to sleep and into toddlerhood just like my first. I even brushed their teeth less often because of the busyness that comes with multiple children! Of course, I am not saying to brush your daughter's teeth less often, but I wonder if other factors beyond our control can play a part in whether or not a child will develop cavities. It is helpful to remember that just because something happens to one child doesn't necessarily mean another child will have the same experience.

Kim Ann Lorber
Quad Cities IL USA

Mother's Response

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 sweets, and he only drank human milk 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 eight now and his teeth are not causing him any problems. His adult teeth are fine.

In 2000 I heard a talk by Harry Torney, an Irish dentist, member of the LLL Health Advisory Council, and husband to a La Leche League 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: www.babyfriendly.org.uk/pdfs/torney_abstract.pdf. Good luck!

Jennifer Skillen
Tetbury Glos Great Britain

Mother's Response

My first child had no cavities but my second needed three root canals before age two due to hereditary defects in his molars. Like his father, he had deep thin pits that were a magnet for food particles and decay. Luckily, my dentist assured me that breastfeeding was not the cause.

We had to be vigilant about our son's oral hygiene. We brushed every afternoon after lunch and every night before bed -- no excuses. We used a heavy-duty stannous fluoride treatment for about six months until the environment in his mouth was a bit more "friendly." (I believe you need to do this under a dentist's supervision due to the strength of the fluoride in the product.)

We stopped giving him dried fruit and other sticky treats that would easily get caught in the pits in his molars. Finally, each night before he fell asleep after nursing I tilted his head back a little to make sure that he swallowed any milk that might be pooled in the back of his mouth. I did not do this after his middle-of-the night nursings though -- we both needed the sleep more! All of these things combined have worked for us. Our son is 11 now and has only had two more small cavities since that time. Unfortunately, his adult molars have the same genetic defect, but since we were alert, we had sealants placed on them.

Carla Dobrovits
Illinois USA

Mother's Response

My second daughter had four cavities at her first dentist's appointment at age two. I was so disappointed. My first daughter did not have this problem. Some individuals just have "softer" teeth. We definitely had to make some changes in our routine. Here is what we tried:

  1. We reduced juice intake, limiting it to one cup a day mixed with water. We made sure she had a drink of just water before bed to help rinse her teeth a final time.
  2. Sweet snacks such as raisins and dried fruit were reduced or followed by a brushing with water.
  3. Finally, we decided to brush after her last nursing at night. It was possible to rationalize with her about it as she understood, having just had her cavities filled. However, with a young toddler I'm not sure it would be worth the stress. Nursing a baby or toddler to sleep is one of life's peaceful pleasures for both of you.

For us, these changes worked. My daughter is five years old and just had another cavity-free checkup.

Ardie Keck
La Grange KY USA

Mother's Response

My first child had no problems with his teeth and he nursed until three years of age. My second child had major problems. Her teeth erupted black and disintegrating. She eventually had to have the four front teeth removed, two molars capped, and fillings in the others. My research revealed that this was the result of a bacterial infection, most likely contracted in utero or from an adult's saliva after birth. The dentist insisted it was a result of nursing past one year of age (the research contradicting this was very new then). Please do not feel guilty. Continue to brush your toddler's teeth and simply watch for those telltale gray spots. Starting juice early and not diluting it with water can lead to increased cavities, too, so give your children fresh water and continue to breastfeed. Also remember that breastfed babies get cavities despite the protection that mother's milk provides.

Helmi Walker
South Carolina USA

Mother's Response

My first child nursed for six years, including throughout the night for two and a half years, and has no sign of tooth decay. The baby teeth of my second child, however, began visibly decaying within a few months of erupting. My dentist insisted that it was because I had been very ill when I was about three months pregnant, at which time the baby's tooth buds were forming. I was not fully convinced, though, because they continued to decay. As her molars erupted, they also developed cavities. After a lot of research and worry, I discovered a book called Nutrition and Physical Degeneration by Weston A. Price, a dentist who went around the world in the 1940s documenting the diet and physical and dental health of native cultures that had not yet been touched by the modern world. Some of these peoples didn't clean their teeth at all, yet they were remarkably free from cavities. These same peoples developed cavities once they began eating modern processed food.

We were already eating a whole-foods diet, but I modified it to reflect universal dietary practices of native cultures untouched by modern civilization as described in the book. (They all had certain elements in common: for example, all grains, nuts, and legumes were either soaked or fermented before consumption.)

I also give my children one teaspoonful of cod liver oil every day (one of the Norwegian brands that is guaranteed free of mercury and other contaminants). My daughter's teeth remineralized within just a few months of beginning this regime. She is now four years old and still nurses through the night. We always brush her teeth with plain water before bed so that only human milk is in contact with her teeth during those hours.

We also discovered some food sensitivities and we cut out those particular foods, which I believe has helped. It is, of course, impossible to eat a diet that is wholly like those of native human cultures. It takes a lot of effort and money to even try, at least where I live, and our soils are depleted, too. So we just do the best we can.

Last updated Thursday, October 19, 2006 by njb.
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