Will Breastfeeding Give Your Child Cavities?

Breastfed children have far fewer dental cavities than those who are bottle-fed.(1-3) This includes nursing caries as well as other cavities. The unfortunate term “nursing caries” refers to a typical pattern of dental decay seen when

juice, formula, or breastmilk sits in the mouth frequently for extended periods. Nighttime snacks are highly cavity causing because saliva is not very mobile during sleep,

As First Published on The Natural Child
by Dr. Linda Folden Palmer

leaving baby without this rinsing and antibacterial protection. Juice bottles by far promote the greatest number of nursing caries.(4)Both breastfed and bottle-fed infants have a need for comfort nursing. The only way bottle-fed infants can find this comfort is to “nurse” their bottles very slowly when allowed to lie and hold their own bottle, causing formula to sit against their teeth for long periods. Nursing caries are more common in bottle-fed infants, especially in those who have nighttime bottles at older ages.(5) There are mixed findings, but common concerns, about comfort nursing at the breast for long periods during the night after teeth have developed.

Among breastfed infants who develop nursing caries, most are those who have frequent snacking and sugary foods or juices in their diets.(6,7) It’s the grains and sugary foods in a child’s diet, or corn syrup in formulas, that contribute to cavities; not antibacterial breastmilk. You will be hard-pressed to find cavities in an exclusively breastfed child (one who consumes no other foods). It appears that such foods can diminish the protection of teeth, making them possibly also susceptible to breastmilk at night. It’s not clear whether this is true, but going to sleep with very clean teeth is a good start.

The making of a cavity
A cavity is a small infection in the tooth that destroys the tooth material. Fresh mother’s milk has many antimicrobial activities but both human and cow’s milk have lactose sugar, which may feed cavity-causing bacteria when allowed to sit in the mouth. Mother’s milk has immune factors that reduce the presence of unfriendly bacteria, and laboratory tests show human milk does not encourage cavities,(8) but this doesn’t confirm that caries can’t develop on breastmilk alone. On the other hand, formula is definitely cavity promoting.(9) Formulas with sugars other than lactose are the worst.(10)

Although Streptococcus mutans bacteria are generally thought to be the chief cause of dental decay, living on sugars, the candida yeast that builds up on pacifiers has been found to promote cavity formation to a great degree.(11) Because of this candida and the occasional incidence of nursing caries linked to bottles or nighttime breastfeeding, dentists and pediatricians commonly recommend throwing out bottles and pacifiers at 12 months of age and weaning breastfed infants prematurely. Of course, the common suggestion that one must switch from human milk to bovine milk, i.e. “wean,” makes no sense at all. Targeting the least cariogenic (cavity-causing) and most healthy food in a breastfed child’s diet doesn’t make sense either.

Consider the whole child
Babies naturally experience hunger and need comforting during the night. Withholding response to these needs can possibly be more harmful to a child than any risk of damage to temporary teeth, although your dentist may feel that teeth are the primary concern. Certainly, the known health benefits of extended breastfeeding outweigh any potential challenges to temporary teeth. While dental treatments on infants are traumatic, warranting preventive measures, the mere possibility of infant caries (about a 14% chance) is not enough of a worry that I would withhold or withdraw important feeding and comforting from any infant, especially before any such symptoms have occurred. Feeding and comforting practices can be modified when needed to protect teeth, without blunt, drastic weaning measures.

Mother too
Nursing mothers may be prone to cavities related to nursing (maybe these are the true “nursing caries”). Especially during the first months of breastfeeding, nursing mothers often find a need for midnight snacks. This food sitting against the teeth in a sleeping mom may cause some cavities in her teeth, which have mildly reduced calcium content (no matter how much calcium is supplemented) until after the end of lactation. Preventive measures should be taken in a cavity-prone mom.

If cavities are found
There are times when a parent chooses “watchful waiting” over immediate repair of small dental insults in a very young child who appears quite traumatized by dental procedures; hoping the repair will be simpler and less harrowing when the child is some months older or that the parent can get the problem under control with diligent efforts.

Like all other bones of the body, teeth have a potential to heal, when attacks are very small, but this will only occur with conscientious efforts and even then, only occasionally. A small brown spot may be left even after the bacterial assault in a tooth has stopped, because the enamel coating does not heal. One must remember that the decay can “spread” however, creating a larger problem. Below are some efforts that can be tried during “watchful waiting,” and even better, before cavities are ever present.

Cavity prevention and care
In cavity-prone families, or when any evidence of decay has been detected in an infant, night nursing and bottle practices can be gently reduced (not necessarily eliminated) once several teeth are present. A squirt of water into the mouth or stirring the child enough to cause some extra swallowing after nursing will help to clear the mouth of milk. Juice bottles should never be given at night. Good dental hygiene in the parents’ mouths will reduce baby’s risk of developing cavities. Still, genetic tendencies, imbalanced flora, and other unknown factors make some children susceptible to bacterial presence and destruction in their mouths no matter what measures are taken.(12) Although damage to baby teeth does not affect adult teeth, a strong tendency for decay will likely carry over to adult teeth. Caries in baby teeth can serve as a warning that good preventive measures must be taken with permanent teeth.

Xylitol is a natural fruit ingredient that promotes dental healing and can be found in special chewing gums for those who are old enough. Avocado, carrots, raspberry, strawberry, and yellow plum have all been found to contain anti-cavity ingredients. Likely many other dark-colored fruits and vegetables will be discovered to have the same qualities. There are many herbs that fight caries, such as cloves, mint, thyme and savory. In cheese, the lactose sugar is pre-digested. The milk protein left in cheese has been shown to be anti-cavity. Once the baby is eating solids regularly, it would be a great practice to end a meal with any of these foods or to choose them as snacks.

Some have found good results in preventing and “curing” cavities with the use of calcium and phosphorous-providing ‘MI Paste’ (or a milk-free version), and xylitol-providing Spry gel. Tea tree oil is strongly antimicrobial against cavity-causing bacteria.(13) It can be found in toothpastes in healthfood stores and some parents concoct a mouthwash with it. Like fluoride, ingestion of any significant quantities can be harmful, so these should be used in limited amounts if a child will not refrain from swallowing. Ozone treatments to kill decay-causing bacteria are performed in some dental offices and have gained support from studies. Twice/daily acidophilus drops or other probiotic help to maintain a less aggressive flora in the mouth. Mother can also take probiotics and pass more good flora along in her milk.

Good brushing (not just wiping with a cloth), twice-daily flossing if the decay is between teeth, and some occasional scraping with a dental tool at home are valuable efforts. Do not allow food or drink (besides water) to sit in the mouth at night. Again, when needed, during night breastfeeding one can encourage some swallowing after nursing by disturbing the child a bit before they fall back to sleep or by providing a sip of water.

1. A.A. al-Dashti et al., “Breast feeding, bottle feeding and dental caries in Kuwait, a country with low-fluoride levels in the water supply,” Community Dent Health (England) 12, no. 1 (Mar 1995): 42–7.
2. R.O. Mattos-Graner et al., “Association between caries prevalence and clinical, microbiological and dietary variables in 1.0 to 2.5-year-old Brazilian children,” Caries Res 32, no. 5 (1998): 319–23.
3. N. Kanou et al., “[Investigation into the actual condition of outpatients. II. Correlation between the daily habits of eating and toothbrushing and the prevalence of dental caries incidence],” Shoni Shikagaku Zasshi(Japan) 27, no. 2 (1989): 467–74.
4. A. Mohan et al., “The relationship between bottle usage/content, age, and number of teeth with mutans streptococci colonization in 6–24-month-old children,” Comm Dent Oral Epidemiol 26, no. 1 (Feb 1998): 12–20.
5. S.Z. Virtanen et al., “Feeding habits as determinants of early childhood caries in a population where prolonged breastfeeding is the norm,” Community Dent Oral Epidemiol (Finland) 36, no. 4 (Aug 2008): 363-9.
6. L. Lopez Del Valle et al., “Early childhood caries and risk factors in rural Puerto Rican children,” ASDC J Dent Child 65, no. 2 (Mar–Apr 1998): 132–5.
7. A.L. Hallonsten et al., “Dental caries and prolonged breast-feeding in 18-month-old Swedish children,” Int JPaediatr Dent (Sweden) 5, no. 3 (Sep 1995): 149–55.
8. P.R. Erickson and E. Mazhari, “Investigation of the role of human breast milk in caries development,”Pediatr Dent 21, no. 2 (Mar–Apr 1999): 86–90.
9. C. Sheikh and P.R. Erickson, “Evaluation of plaque pH changes following oral rinse with eight infant formulas,”vPediatr Dent 18, no. 3 (May–Jun 1996): 200–4.
10. D. Birkhed et al., “pH changes in human dental plaque from lactose and milk before and after adaptation,”vCaries Res 27, no. 1 (1993): 43–50.
11. P. Ollila et al., “Prolonged pacifier-sucking and use of a nursing bottle at night: possible risk factors for dentalvcaries in children,” Acta Odontol Scand 56, no. 4 (Aug 1998): 233–7.
12. M.I. Matee et al., “Mutans streptococci and lactobacilli in breast-fed children with rampant caries,”Caries Res (Tanzania) 26, no. 3 (1992): 183–7.
13. K.A. Hammer et al., “Summary of full report: Antimicrobial activity of tea tree oil against oral microorganisms,” http://www.rirdc.gov.au/reports/TTO/03-019sum.html, Rural Industries R&D Corp., (May 2003).