|Sleep Apnea from an Anatomical and Developmental Perspective|
Infant Dental Decay - Is it related to Breastfeeding?
Brian Palmer, D.D.S., Kansas City, Missouri, USA
The following notes
will explain The Infant Caries
Presentation and add to your understanding of the numbered slides.
It is suggested that you print this page of notes to read along with the
presentation slides. The Caries Presentation is in Portable Document
Format, which requires the free Adobe Acrobat Reader. You may download it
It is suggested that you print this page of notes to read along with the presentation slides. The Caries Presentation is in Portable Document Format, which requires the free Adobe Acrobat Reader. You may download it here.
Click here to view The Infant Caries Presentation (2091 KB)
(bottom left corner)
- Terminology can be confusing because various authors use it inter-changeably.
Example: Nursing caries (cavities) is used when discussing either
bottle-feeding or breastfeeding activities that relate to infant caries.
Many assume that both bottle-feeding and breastfeeding can cause the same
amount of decay. Another term is Early Childhood Caries (ECC).
- The official position of the American Academy of Pediatric Dentistry (AAPD) in
1996. The AAPD is a great
organization, and since it is the national organization for pedodontists, they
look to the association for leadership. Because
of new research that has come out since 1996, research that has even been
published in their journal, it is hoped the association will consider changing
it’s position statement.
- In 1996, it was the position of the AAPD that nocturnal breastfeeding should
be avoided after the first primary tooth began to erupt. But what options does that give the mother for
nurturing the infant? When the
infant starts erupting his/her first primary tooth that infant may not be on an
adult 3 meal-a-day schedule. It is
usually best to feed the infant on the infant’s cue, not on a fixed eating
schedule contrived by our adult society. The
options would be: 1) Not feed the child or, 2) feed the infant formula. Both are poor options. Not
feeding the child on cue is not good for the proper development of the child,
and feeding the child formula puts that child at greater risk for decay - as
discussed later in the presentation (Dr. Pamela Erickson’s research).
- Examples of infant caries -
Children Mercy Hospital in Kansas City does approximately 10 cases per week.
In a personal conversation with Dr. Cross in Winnipeg, Manitoba, Canada,
he stated they do about 1200 cases per year, mainly on the Aboriginals in
Manitoba. He is finding a decay
rate of about 89% in that culture.
- Note abscess above front tooth. Lower
front teeth are usually least affected by decay.
- Was this infant born with a high palate or was it acquired due to
thumb sucking? Documenting
how many infants are born with high palates would be a great research project -
because a high palate is a risk factor for sleep apnea and possibly SIDS.
- In our society today (Year - 2000), infant caries is extremely high in some
cultures or areas, especially in areas of poverty. Prehistoric skulls, on the other hand, have/had minimal
decay in their teeth. They did not
have the benefit of fluoride either. Since
breastfeeding was the only way of nurturing infants in the past, breastfeeding
cannot be accused of causing dental decay today.
- Prehistoric infant skulls. These skulls were evaluated at the Smithsonian
Natural History Institute in Washington, DC.
Minimal decay was found in teeth of prehistoric skulls.
Malocclusions (bad bites) were also rare.
Anyone in the world can do similar research by going to any museum that
- Also note good width of palate and nice “U” shape of dental arches in
these skulls. Good arch width and
shape are important for good occlusions. High
palates as shown in slide #8 were not observed during my evaluation of
- Skull accidentally cracked in middle of palate. During rapid palatal expansion in some orthodontic cases
today, this is the area that separates during the expansion.
- Many prehistoric skulls do have flattened teeth due to course diets.
- Data put together by the staff at the Smithsonian.
Dentist on staff stated she is quite aggressive when she classifies
decay. These numbers, especially 19
lesions, may be over stated.
- This is a significant slide. This
research of 1989 concluded that the Native Americans in the study had a decay
rate of 57%. That sampling had a
similar background genetically as the prehistoric skulls evaluated at the
Smithsonian that had a decay rate of 1.4%.
Some of the previous slides in this presentation showing gross decay also
had similar backgrounds and had a decay rate of 89%.
- I encourage others to evaluate skulls in museums around the world for decay
and quality of occlusion.
- In discussions with anthropologists, veterinarians, mammalogists and
biochemists, they cannot believe that anyone is actually accusing breastfeeding
of causing decay. It is not
scientifically reasonable for a natural process like breastfeeding to cause
teeth to decay. If infants lost
their teeth in the past they would die because of their inability to chew food.
They could have died as well from the possible infections that could have
occurred when the teeth abscessed. That did not happen in the past.
- 35 - Defective teeth. Defects can
be due to genetics, malnutrition, disease, accidents, etc. during the time a
tooth is developing.
- This infant was around 11 years of age (2nd molars were about ready to erupt).
Most likely all 4 of the decayed areas (2 cavities shown by one of the
arrows) developed after the infant was weaned.
- #40 - “Pooling”. During
breastfeeding, the majority of milk is expressed into the throat.
During bottle-feeding, the majority of the content of the bottle is
dumped into the mouth and “pools” around the teeth, leaving teeth more prone
- Lactose is a sugar - but it is naturally designed to be digested and broken
down into its two sugars while in the lower intestine, not while it is in the
mouth. While in the breastmilk, it
is surrounded and protected by antibodies, lactoferrin, etc. which protects it
from Strep mutans.
Yes, it can be broken down on paper and on the lab bench to create
sugars, but artificial situations do not take info account that the lactose is
surrounded by the protective qualities of the breastmilk.
- Since breastmilk is the best source for calcium, and since calcium is needed
for proper development of bones, teeth, etc., why would any health care provider
discourage breastfeeding? Milk is
species specific. Milk from
other animals is designed for the young of that species - not the human species.
- There are 4640 species of mammals (Olaf Oftedal - National Zoological Park in
DC). Humans are but one of those
species. Isn’t it strange that only
the human specie has infants with decay in their teeth?
Does that mean that the female of the human specie has inferior
breastmilk compared to all other
species? Mammals in the wild rarely
have deciduous decay. Domesticated
animals sometimes get decay - but that is mainly due to the fact that they are
given food processed by humans.
- Check with your veterinarian to see if this is true. Do they see wild infant animals with decay?
- Currently (2000-2001), Dr. Casamassimo is the president of the AAPD.
- Research shows that caries can be infectious.
When an infant is born, its mouth is basically sterile.
It does not have decay causing bacteria in its mouth.
The decay causing bacteria is “acquired” or “inoculated” at some
point in its life. It may be the
timing and amount of the inoculation that determines the risk of decay. The
infant could be inoculated by Strep mutans in many different ways -i.e.-
kissing, using same spoon, etc. Once
exposed to Strep mutans, the critical
issue then becomes how often the infant is exposed to sugar. Frequency of
exposure to sugar is more important than the amount
of sugar. A low bacteria count
with many sugar exposures can be just as cariogenic as a high bacteria count and
less sugar exposure.
- Saliva has a protective effect by bathing or washing the teeth.
Less saliva production at night, or mouth breathing due to nasal
congestion, airway obstructions, enlarged tonsils, polyps, etc., can dry the
teeth and makes them more prone to decay.
- This Gardner et al. article may be first article written discussing the
relationship between breastfeeding and the risk of infant caries. The article appears to have logic, and the relationship seems
apparent, but the authors did not report doing in-depth evaluation of what went
into the infant’s mouth other than breastmilk.
It may have been only the mother’s opinion that the infant did not
receive cariogenic food or drink. The
article has been referenced in many other articles on infant caries. This is an
example of an article that demonstrates guilt by association.
- If breastmilk can kill cancer cells, it should be able to kill bacteria that
cause decay. Stomach acid may be
the key to the activation of this fantastic benefit of breastmilk.
- Dr. Slavkin states that population-based studies do not support a link between
breastfeeding and caries. It is a
very strong and influential statement coming out of the National Institute of
Health. I strongly agree with his
statement. Many of the articles
accusing breastfeeding as a cause of infant decay have been population-based
- After extensive evaluation of multiple articles, Dr. Joyce Sinton et al also
made a similar statement as made by Dr. Slavkin.
They found many of the studies had contradictory findings and weak
methodology. I strongly agree with
their research as well. I have been
unable to find any scientific research in which teeth and breastmilk have been
placed together which resulted in decay. If
anyone has knowledge of such research, I would appreciate a copy of the article.
- Dr. Pamela Erickson’s article on infant formula.
This is an important article for those who recommend not breastfeeding
and giving formula instead.
article concludes that:
some formulas are quite cariogenic
- some formulas dissolve enamel
- most reduce pH significantly (this makes the mouth more acidic and teeth more prone to decay)
- some caused dentinal caries within weeks
- some supported significant bacterial growth
this kind of scientific research, why would any health care provider recommend
formula over breastmilk? For
this research, Dr. Erickson received the AAPD - Educational Foundation Research
Award (first place).
This is one of the best scientific research articles proving that breastmilk
alone does not cause infant caries. For
this research, Dr. Erickson was runner up for the 1998 AAPD award.
- Conclusions of Dr. Erickson’s
- Human breastmilk (HBM) actually deposits calcium and phosphorus onto enamel.
- HBM does not cause a significant pH drop in plaque
- HBM is not cariogenic UNLESS another carbohydrate source is available for
- The buffer capacity of HBM is very poor
- HBM supports moderate bacterial growth.
on these conclusions:
- This point demonstrates that HBM actually PREVENTS decay.
- This point also helps in the prevention of decay.
A pH drop would increase the risk of decay.
- I do not quite understand the reason for linking these two points with an
UNLESS. It states HBM is not
cariogenic. Since nocturnal
breastfeeding appears to be the biggest issue as to when decay occurs, is this
point suggesting the mother is going to let the infant “sip” on the breast,
then “sip” some soda pop, and then alternate back and forth?
When is this OTHER carbohydrate supposed to be introduced during
breastfeeding at night?
- Buffer capacity - (Definition: amount of a liquid required to bring about a pH
change). As stated above, our
creator designed HBM to be a perfect food.
I believe it has a poor buffer capacity so that it will not alter the
stomach pH, and thus helps with the digestibility of the breastmilk itself.
The acidity of the stomach may also be the key factor that helps
breastmilk kill cancer cells as stated in Svanborg’s research.
I do not believe it was designed to contribute to tooth decay as
suggested by some.
- Reason why stored breastmilk needs to be refrigerated.
ultimate creator designed breastmilk to be the perfect food for the young of all
4640 mammal species. The young of
ALL mammals, except the young of humans, grow, develop and flourish on
breastmilk without developing decay in deciduous teeth.
Human breastmilk is not inferior to that of all other species.
- Exciting conclusion - HBM is not cariogenic. It is significant that this research was recognized for its
importance by the AAPD.
- Main reason for decay - sugar - frequency is more important than amount -
timing and amount of inoculation of Strep mutans - saliva flow - enamel defects - oral hygiene - eating habits - sugary
- “Store bought food has given us store bought teeth”.
Hooton recognized that in 1938.
- Breastmilk alone does not cause tooth decay - but exclusive breastfeeding does
not mean that the infant will be immune from decay. Anything that is
put in the mouth that can be broken down into a sugar can cause decay - even
healthy foods. Many infants start
getting supplemental foods around 6 months, often times before many of the
deciduous teeth have even started to erupt.
- It is now time to educate both parents and health care providers that breastmilk
does not cause decay. I
understand the position of the AAPD. Like
many other dentists, I have seen or heard of infants who have decay and their
mothers have insisted that the infant has only been breastfed.
But are these mothers really aware of what is going into the infant’s
mouth? At what age are these
infants started on supplemental foods? Even
formula can cause decay! So can
juices, and so can cereals!
are a few cases I have addressed where the mother
insisted her infant had decay even though the child had only been breastfed,
or had never been given any foods or snacks that would cause decay:
- After an extensive discussion, I asked the mother if the child had ever been
ill. She replied the infant had a
problem with constipation. For this
problem, she had been giving the infant a cup of prune juice every day, with the
infant sipping on it all day long. Source
of decay - probably the prune juice. Mother’s focus had been on the constipation and she never
realized the cariogenic potential of the prune juice.
- After an extensive discussion, the mother finally admitted to the child
snacking during the day on her homemade bread.
She believed that since she baked the bread herself from scratch, and
that it was a healthy food, it would not cause decay. Bread can cause decay if it is home made or store bought.
- Another mother insisted she only gave her infant diluted juices.
She reasoned that since she diluted the juice, it would not cause decay.
Juice at any concentration has the potential to cause decay if decay
causing bacteria is in the mouth.
- A mother was shocked that her infant had decay.
This case was easy. While I
was talking with the mother, the infant was continually snacking on a cereal.
The cereal was a very healthy breakfast cereal - but it can also cause
decay if snacked on. Frequency of exposure was critical here.
- I talked with another mother for quite a while but was unable to find a cause
for the infant’s decay based on foods or sickness.
I then inquired about the health of her mouth and that of her husband.
She admitted they both had periodontal and decay problems.
From that statement I felt the parents did not have good home care or
good diet - and that being the case - the cleanliness of the infant’s mouth
reflected that of the parents. ANY
food put into that infant’s mouth was potentially highly cariogenic.
believe the main reason the AAPD has the position it has, is due to the fact
that some mothers whose infants have decay insist
that the infants have only been breastfed, but in actuality, have given other
foods or snacks to the infants. I
believe this happens not from neglect, but because the mothers believe foods or
juices, etc. that have been given to the infants are healthy and would not cause
decay. They have not been educated
enough to understand that nearly any food, snack, juice, sweetened medications,
etc. does have the potential to cause infant decay.
It is also important to understand that parents who are prone to get
cavities or have gum disease can also put their infants at risk for caries.
This is NOT a genetic problem, but rather an environmental problem of
poor oral hygiene and poor eating habits.
solution. For a better understanding of the true cause of infant caries, the
following recommendations are suggested:
- In-depth examinations and evaluations of all care-givers who might possibly
contaminate the infant. It may be
necessary to take strep mutans
cultures on all. It is important to
note the caries rate and periodontal condition of the parents.
If their hygiene is poor, it is very likely the infant’s hygiene is
poor also. Note hypocalcified
areas, possible genetic features, etc.
- In-depth histories as to illnesses, stresses, and other challenges of both the
infant and mother all the way back to the time of conception.
- In-depth dietary analyses of the infant and family members.
EVERYTHING that goes into the infant’s mouth needs to be documented,
even medicines. This information
needs to be written done as it occurs. A
mother’s recall at the end of the day or week is not good enough.
with these type in-depth evaluations will the issue of infant caries be
resolved. Population based research
and guilt by association research are not appropriate for such an important
purpose of this presentation:
- Help educate anyone in the world who is interested in the oral health of his
or her child.
- Educate all that breastmilk alone does not cause caries.
Breastfeeding IS the best form of health care (I will prove this with
other presentations on this website)
FOR BETTER HEALTH!