The current WHO guidelines for breastfeeding recommend exclusive breastfeeding for the first 6 months with complimentary breastfeeding up to 2 years of age. A 2015 review found that breastfeeding up to the age of 12 months was not associated with an increased risk of caries although children breastfed beyond 12 months had an increased risk of caries.

The aim of this review was to investigate the association between breastfeeding and early childhood caries (ECC) focusing on the infancy feeding patterns and duration of breastfeeding in children age 0-71 months.

Methods

Searches were conducted in the PubMed, Web of Science and Embase databases. Birth cohort, case-control and cross-sectional studies that provided sufficient data to calculate odds ratios (OR) and 95% confidence intervals (CIs) that were published in English were considered.

Two reviewers independently abstracted data and assessed study quality using the Newcastle-Ottawa Scale.  Categories of feeding patterns; ever breastfed vs never breastfed; exclusive breastfeeding vs bottle feeding; or duration breastfeeding ≥12 months vs. breastfeeding <12 months, breastfeeding ≥6 months vs. breastfeeding <6 months were investigated.

Results

• 35 studies involving a total of 73-401 children were included (11 birth cohorts, 3 case-controlled studies and 21 cross-sectional studies).
• 13 studies were considered to be high quality (9 birth cohorts, 3 case-controlled studies and 1 cross-sectional study).
• Overall, children ever breastfed had a reduced risk of ECC compared with those never breastfed, OR=0.77, (95%CI: 0.61-0.97) I2=85.6%, p<0.001, [22 studies 52,389 children].
• Exclusive breastfeeding did not significantly decrease the risk of ECC relative to bottle feeding, OR=0.68, (95%CI: 0.35-1.31) [10 studies 13.075 children].
• Breastfeeding ≥12 months could increase the risk of ECC compared with breastfeeding <12 months, OR=1.86, (95% CI: 1.37-2.52, p<0.001) I2=90.5%, p<0.001,  [14 studies 15,029 children].
• The overall meta-analysis showed that breastfeeding ≥6 months did not significantly increase the risk of ECC compared with breastfeeding <6 months, OR=1.13, (95%CI: 0.83-1.53) [8 studies – 8552 children]

Conclusions

The authors concluded: –

Our analysis suggests ever breast-feeding may protect children from ECC, and breastfeeding duration ≥12 months is associated with higher ECC risk. Additional large cohort studies are required to illustrate the relationship in further study.

Comments

We previously looked at this question when the review of Tham et al was published in 2015 (Dental Elf – 12^th Nov 2015). The Tham review included a larger number of studies, 63 in total and the main findings of the two reviews are similar.  A detailed assessment of the Tham review and its contributing studies is included in the oral health section of the recent PHE consultation on ‘feeding in the first year of life’

As we noted previously (Dental Elf – 12^th Nov 2015) given the well documented benefits of breastfeeding dental professionals should continue to support the WHO recommendations for breastfeeding, and stress the importance of good oral hygiene from the eruption of the first along with appropriate dietary advice.

Links

Primary paper

Cui L, Li X, Tian Y, Bao J, Wang L, Xu D, Zhao B, Li W. Breastfeeding and early childhood caries: a meta-analysis of observational studies. Asia Pac J Clin Nutr. 2017;26(5):867-880. doi:10.6133/apjcn.082016.09. PubMed PMID: 28802297.

Other references

Dental Elf – 17^th May 2017

Breast feeding duration and caries risk

Dental Elf – 12^th Nov 2015

Breastfeeding and caries risk