New Study PROVES Breastfeeding Causes Cavities!

News headlines to cover this study include:

"The Breastfeeding Health Risk No One Talks About"

"Breastfeeding May Be Causing Your Baby To Suffer From This Common Issue Later In Life"

"Prolonged breastfeeding linked to higher risk of severe cavities"

"Toddlers who are breastfed have a higher number of fillings and decayed or missing teeth - because mothers are not brushing their teeth afterwards"

<Insert dramatic sound effect of your choosing here>

Mom.me continue with:

"Women who breastfeed may putting their babies at risk for something that's rarely on a newborn mother's radar: cavities. 

According to a recent study published in Pediatrics, despite the fact that breastmilk is nutritional AF (and 100 percent free of charge!), moms should be wary one of the common downsides, particuarly for those who nurse their babies well beyond their first 6 months. 

For the study, researchers analyzed breastfeeding behaviors and sugar consumption of 1,129 children. What they found was that kids who were breastfed for two years or longer were 2.4 times more likely to experience severe cavities than those breastfed for less than a year. 

The study's author, Dr. Karen Peres told CNN, “There are some reasons to explain such an association. First, children who are exposed to breastfeeding beyond 24 months are usually those breastfed on demand and at night. Second, higher frequency of breastfeeding and nocturnal breastfeeding on demand makes it very difficult to clean teeth in this specific period."

Perhaps Dr. Karen Peres isn't aware studies have found that whilst soaking a clean tooth in lactose (the sugar in breastmilk) results in caries, breastmilk as a complete substance doesn't.  And it seems barely anyone is aware of all the studies prior to this that found the opposite, including conclusions such as

• "Human breast milk is not cariogenic [cavity causing]" Ericsson 1999
• "No correlation found between caries and breastfeeding among children who were breastfed up to 34 month" Alaluusua 1990
• "There is not a constant relationship between breastfeeding and the development of dental caries. Mothers should be encouraged to breastfeed as long as they wish."  Valaitis 2000
• "Prolonged demand breastfeeding does not lead to higher caries prevalence" Weerheijm 1998
• "Breastfeeding may act preventively and inhibit the development of nursing caries in children" Oulis 1999

Otherwise they'd have realised Dr Peres' explanation made zero sense.  But hey now, let's not let evidence stand in the way of a hefty dose of sensationalism.

Of course I had to get my hands on the original.

Within a few seconds I'd established an association a whole lot more plausible than that proffered by Peres.

The short answer?

Many Brazilian children don't brush their teeth properly and/or see a dentist regularly.

At age 5 years, 37.0% of the children had visited a dentist, and 45.7% still received assistance when toothbrushing. 17

Brushing should be assisted until children are 7.  Whilst many may be enthusiastic, dexterity to ensure all surfaces are adequately cleaned is required.  The NHS also recommend:

Take your child to the dentist when their first milk teeth appear. This is so they become familiar with the environment and get to know the dentist. The dentist can help prevent decay and identify any oral health problems at an early stage. Just opening up the child's mouth for the dentist to take a look at is useful practise for the future.

Remember the researchers  above concluded dropping a clean tooth into breastmilk didn't cause decay? They conversely found:

"HBM is not cariogenic in an in vitro model, unless another carbohydrate source is available for bacterial fermentation"

Carbs on the teeth + breastmilk causes decay.

This perfectly ties in with the presentations by Dr Brian Palmer who noted:

"There are 4,640 species of mammals, all of whom breastfeed their young. Lactose is present in most of the breastmilk of these species, yet humans are the only species with any significant decay in deciduous teeth. Modern Homo sapiens have been around for 30,000 to 35,000 years, but dental decay, however, did not become a significant problem until about 8,000 to 10,000 years ago. Anthropologists believe the increase in decay was primarily due to the advent of the cultivated crops."

Now let's explore the typical Brazilian diet:

"Rice and beans is a staple of the Brazilian diet. They are usually eaten with a protein (meat or eggs), salads, farofa (a toasted flour of manioc or corn). The afternoon snack (merenda or lanchinho) is a small meal between lunch and dinner, and it could consist of coffee, tea or chimarrão, which is a traditional infusion of the South, accompanied by cookies, typical cakes or bread. Dinner consists of a light meal of soups, salads and vegetables, and pasta and rice-and-beans are the most common dishes."

Carb city.

 So in short, brush your teeth, see your dentist, encourage your toddler to snack on cheese instead of carbs (traditionally aged cheddar would be perfect) and breastfeed as long as you blooming well want.

Related Reading
Ask The Armadillo - Does Breastfeeding Cause Tooth Decay?

Dummies, Thrush & Decay - What Every Parent Needs To Know

Pacifiers, Dummies, Binkies whatever you want to call them (and there are 160 options here!) chat to any parent and you will find they're rather like Marmite - either loved or loathed.

Some (myself included before number one) just think all babies have them!  They like to suck and that does the job right?

As discussed in this post - a pacifier is ultimately an attempt at replicating the breast, and indeed babies use them as a replacement nipple, not the other way around (ie to say baby is using mum like a dummy actually makes no sense).

Like most discussions surrounding something truly normalised in our culture, it often turns anecdotal ie I had one and I'm fine, my children had them and their teeth are perfectly straight after they were breastfed for two years, it's personal preference - and so on and so forth.

But something I'm yet to hear mentioned is the rather more compelling evidence linking pacifiers to Candida (thrush) and ultimately tooth decay.  Yup caries, holes, decay, bad teeth! (I wonder if there are 160 alternatives to describe that?)

You're expecting evidence right?

A study that considered infants under 18 months of age detected Candida in 58%.  Pacifiers were positively associated with both frequency and severity of yeast infections, whilst no relationship was detected between the prevalence of yeast and breast-feeding or bottle-feeding habits.

"The results suggest that use of a pacifier is an important local factor in the colonization and proliferation of yeast in the oral cavity." (1)

Another assessed the surface of 25 pacifiers in a daycare setting and found 80% had a biofilm.  The two main genera isolated were Staphylococcus and Candida.

"Our results confirm that pacifiers can be seen as potential reservoirs of infections" (2)

A third swabbed the mouth and dummies of 100 children under 18 months and found Forty four per cent of dummies were colonised by Candida.

"Children who sucked dummies had clinical thrush and positive mouth swabs for candida more frequently than those who did not." (3)

A 2006 study found:

Infants who routinely sucked a pacifier had a significantly higher rate of oral candidal carriage, suggesting a reservoir of infection. (4)

Candida & Its Relationship To Pacifiers & Caries

The Brazilian Journal of Oral Sciences in 2007 reviewed the literature surrounding Candida in the mouth of infants and its association with early childhood caries (ECC).  They concluded that colonisation of Candida could be related to pacifier usage, feeding habits and caries lesions. (5)

A study that analysed 166 children aged 1-4 years found candida in 24% of samples:

"The results of the study suggest that the use of a pacifier increases the occurrence of both salivary lactobacilli and candida. It could therefore be a factor influencing caries susceptibility and activity in children." (6)

Another study examining children over 2 years old for a period of 2 years, found that although both pacifier sucking and using a bottle at night increased the occurrence of both candida and oral lactobacilli - bottle use was less significant than dummy use

"The results of the logistic regression analysis showed prolonged pacifier-sucking (≥24 months) to be a significant risk factor for caries development in children, with a rather high relative risk (RR) of 3.5 (95% confidence interval (CI), 1.5–8.2; P = 0.003). (7)

A 2012 study took 30 children with caries (group 1) and 30 children without and found Candida levels were "remarkably higher" in group 1.  They concluded:

"This study supports the active role of Candida species in dental caries." (8)

In 2009 a study noted candida are frequently detected in the mouths of children with extensive caries compared to those without:

"Samples of saliva from 14 children with caries lesions and from 13 caries-free subjects were evaluated for the presence of mutans streptococci, lactobacilli and Candida spp. by culture. Eleven of 14 carious subjects hosted Candida spp. in their saliva as against only 2 out of 13 subjects without caries lesions." (9)

Another in 2006 considered plaque and dentine from from 56 children aged 1–5 years - which were divided them into three groups early childhood caries (ECC); caries and caries-free.  They concluded:

"There is a significant association between the presence of C. albicans and early childhood caries." (10) 

Whilst pacifier manufacturers have created orthodontic dummies to try and combat the effect of abnormal pressures caused by pacifiers on teeth and gums, it seems to me problems such as thrush and caries are just as significant, yet don't appear to have been well publicised.  

Surely parents have a right to all the facts when deciding whether to introduce one?  

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References
1.  ASDC J Dent Child. 2001 Jan-Feb;68(1):33-6, 10
2.  Nursing & Health Sciences Volume 8, Issue 4, pages 216–223, December 2006

3.  Arch Dis Child 1985;60:381-382 doi:10.1136/adc.60.4.381
4.  Oral candidal flora in healthy infants, Journal of Oral Pathology & Medicine, Volume 24, Issue 8, pages 361–364
5.  Brazilian Journal of Oral Sciences, Vol. 6, No. 20, January - March 2007, pp. 1249 - 1253

6.  Acta Odontologica Scandinavica, 1997, Vol. 55, No. 1 , Pages 9-13

7.  Acta Odontologica Scandinavica, Department of Preventive Dentistry and Cariology, Institute of Dentistry, and Department of Pediatrics, University of Oulu, Oulu, Finland 1998, Vol. 56, No. 4 , Pages 233-237
8. Comparative Evaluation of Oral Candida Albicans in Children with and without dental caries.  Int J Clin Pediatr Dent 2012;5(2):108-112

9. Support for the role of Candida spp. in extensive caries lesions of children.  NEW MICROBIOLOGICA, 32, 101-107, 2009
10. Archives of Oral Biology Volume 51, Issue 11, November 2006, Pages 1024–1028

Oil Pulling For Children?? You Raging Hippy You!

So when I first mentioned oil pulling on Facebook, the replies were interesting.  My previously cavity free just turned 8 year old has developed three in the last six months, and as someone always plagued by needing loads of dental work (despite all the oral hygiene measures as advised by the dentist) I was interested in exploring natural approaches that may prevent further decay in my daughter.  Some were horrified, including one mum who replied; "I would never ask a child to do that!"  Some were interested and wanted to know more, and of course given how cool Armadillo readers generally are, some were already doing it.

What is oil pulling?
To be honest you can dress it up in various ways, but the bottom line is it's a traditional Indian folk remedy that requires sesame, olive or coconut oil (all virgin cold pressed) to be swilled around your mouth for 5-20 minutes (depending upon which website you read) pulling it through your teeth before spitting and brushing; swallowing is not recommended  Optimum appears to be first thing in a morning, but some do twice a day - generally the guidance seems to be 4hrs after eating (not sure I ever go that long!) and 1hr after drinking...

Er why?
Well proponents of oil pulling claim it pulls toxins from the body, which can help a whole host of health conditions.  From eczema to acne and joint issues, diabetes, migraine, hypertension, ischemic heart
disease, liver & respiratory conditions; Google and you will find someone claiming oil pulling cured them.  I don't honestly see how toxins could be pulled through the mucous membrane as some websites suggest, which I will discuss more in a moment; but as it is also reputed as excellent for oral health, getting rid of toothache and reducing gum disease, I decided to read more.  What's interesting about oil pulling is that there's no big pharma heading up this campaign, posting fake reviews etc; clearly people who advocate pulling believe it helped them.

There are those however who take the claims of oil pulling to another level, particularly  Dr Karach MD - feel free to do your own digging!

How?
Ok as I said above, I'm not convinced toxins can be pulled through the mucosal surfaces of the mouth; however things can certainly pass into the bloodstream sublingually - think of the tiny pills or spray that people put under their tongue during an angina attack.  In fact this route is faster and the substance is only exposed to saliva before entering the bloodstream; anything swallowed has to pass through the digestive tract where enzymes get to work.

A little digging turned up a paper entitled "Oil pulling – Unraveling the path to mystic cure", Alaka Hebbar* Vaishali Keluskar** Arvind Shetti*** *Post Graduate Student, **M.D.S, Professor and Head, ***M.D.S, Professor, Department of oral Medicine & Radiology, KLES V.K Institute Of Dental Sciences, Nehru
Nagar, Belgaum, Karnataka, India. Published in the Journal of International Oral Health 2010 states:

"Sesame seed oil has a high concentration of polyunsaturated fatty acids and is a good source of vitamins. The antioxidants present in it are namely sesamin, sesamolin and sesaminol. These lignans have certain actions on the living tissues like- Detoxification of toxins, antioxidant effect, potentiates the action of vitamin E, prevents lipid peroxidation and antibiotic effect in that it helps in the destruction of microorganisms. Sesamin has found to inhibit the absorption of cholesterol as well as its production in the liver, reduces lipogenesis and exhibits an antihypertensive action."

You can find it here and is well worth a read if this subject interests you.  This suggests amongst other things that the oil hit alone is responsible for some results.

In terms of dental health the claims are it breaks down plaque and neutralises harmful bacteria - resulting it whiter, cleaner, healthier teeth and gums and fresh breath.  The paper above also explores this:

"The mechanism by which the oil pulling therapy causes plaque reduction is not known. The viscosity of the oil probably inhibits bacterial adhesion and plaque co-aggregation. Other possible mechanism might be saponification or the „soap-formation‟ process that occurs as a result of alkali hydrolysis of fat.  Sesame oil is a vegetable fat and when it is acted upon by the salivary alkali like bicarbonates, the soap forming process is initiated. Soaps are good cleansing agents because they are effective emulsifying agents. Emulsification is the process by which insoluble fat like sesame oil is broken down into minute droplets and dispersed in water. Emulsification greatly enhances the surface area of the oil there by increasing its cleansing action."

Evidence?

Interestingly there is, particularly pertaining to dental health:

"AIMS: The aim of this study was to evaluate the effect of oil pulling with sesame oil on the count of Streptococcus mutans in plaque and saliva of children, using the Dentocult SM Strip mutans test, and to compare its efficacy with that of chlorhexidine mouthwash. 

RESULTS: There was a reduction in the S. mutans count in the plaque and saliva samples of both the study and the control groups. The reduction in the S. mutans count in the plaque of the study group was statistically significant after 1 and 2 weeks (P=0.01 and P=0.008, respectively); the control group showed significant reduction at all the four time points (P=0.01, P=0.04, P=0.005, and P=0.005, respectively, at 24 h, 48 h, 1 week, and 2 weeks). In the saliva samples, significant reduction in S. mutans count was seen in the control group at 48 h, 1 week, and 2 weeks (P=0.02, P=0.02, P=0.008, respectively) 

CONCLUSION: Oil pulling can be used as an effective preventive adjunct in maintaining and improving oral health." (1)

and in another study:

"The effect of oil-pulling on the reduction of total count of bacteria was determined. There was a remarkable reduction in the total count of bacteria. The process of oil-pulling reduced the susceptibility of a host to dental caries." (2)

and another:

"The oil pulling therapy showed a reduction in the plaque index, modified gingival scores, and total colony count of aerobic microorganisms in the plaque of adolescents with plaque-induced gingivitis." (3)

and

"Oil pulling is having dental benefits. Hence this holds a chance to be added to other oral hygiene measures" (4)

I think the paper discussed above; "Unravelling the path to mystic cure", sums things up well in its conclusion:

"Inspite of all the advances in the field of health science, traditional healing methods still have a major role to play. These methods are born out of native wisdom of very high intellectualism. They are untouched and unspoiled. If they are analysed on scientific backgrounds they stand the test of time. Hence oil pulling is one such method which improves the oral health and benefits various systems as well."

So do you oil pull?  Has it helped?  Are you planning on trying?  If so please keep us updated!

1.  Effect of oil pulling on Streptococcus mutans count in plaque and saliva using Dentocult SM Strip mutans test: a randomized, controlled, triple-blind study. Journal of the Indian Society of Pedodontics and Preventive Dentistry (2008)
Volume: 26, Issue: 1, Pages: 12-17

2. Effect of oil-pulling on dental caries causing bacteria, African Journal of Microbiology Research Vol.(2) pp.063-066, March, 2008

3. Asokan S, Emmadi P, Chamundeswari R. Effect of oil pulling on plaque induced gingivitis: A randomized, controlled, triple-blind study. Indian J Dent Res 2009;20:47-51

4.  Effect of Oil Pulling on Plaque and Gingivitis, J Oral Health Comm Dent 2007 ;1(1):12-1

Ask The Armadillo - Does Breastfeeding Cause Tooth Decay?

Q.  Dear Armadillo
My dentist has warned me to cut nightfeeds now my daughter has some teeth, as it will cause decay.  This is proving easier said than done, is it true breastfeeding at night rots teeth?
Sarah

A.  Hi Sarah

I contacted Dr Brian Palmer DDS about your question, as a world respected dentist who has extensively studied anthropological evidence surrounding normal oral development, infant feeding and decay - who better?

The upshot?

No, breastfeeding is not thought to cause tooth decay - it's another one of those old breastfeeding myths. It is widely recognized as being the main cause of dental caries (cavities) is caused by bacteria such as streptococcus mutans, which feeds on food sugars producing an acid that causes decay.  It's estimated that around 20% of the population have increased levels of this bacteria (predisposing them to decay) and it can be passed from parent/caregiver to baby via saliva eg a parent sucking baby's pacifier, sharing spoons etc.  A researcher called Berkowitz concluded that "caries is an infectious and transmissible disease".

I think the confusion about breastfeeding and teeth comes from two sources; firstly many don't understand the difference between breastmilk and substitutes and their effect on teeth.  A 1999 study by Erikson demonstrated that some infant formulas dissolve tooth enamel, significantly reduce pH, and cause dental caries.    In addition bottle feeding causes milk to pool around the teeth, because it is delivered much further forward in an infant's mouth.

Secondly whilst an extracted tooth soaked in lactose (the sugar in breastmilk) decayed,  infant teeth exposed to breastmilk as a whole producted react quite differently.  Breastmilk has antibacterial properties, with lactoferrin as a major consituent - and lactoferrin actively helps to neutralise strep mutans.  Furthermore unlike other sugars, lactase enzyme splits lactose into glucose and galactose in the intestines, rather than in the mouth.  When teeth were exposed to breastmilk, it did not cause enamel decalcification even after 12 weeks exposure; furthermore breastmilk did not cause a significant drop in plaque pH when compared to rinsing with water.

In 1999 a study published in Pediatric Dentistry stated:

"It is concluded that human breast milk is not cariogenic."

What the study did find was that when a small amount of sugar was added to the breastmilk, it caused more decay than a sugar solution alone - emphasising the importance of tooth brushing and good dental hygiene to ensure all food particles are removed. (Investigation of the role of human breast milk in caries development, Pediatr Dent. 1999 Mar-Apr;21(2):86-90)

There are 4,640 species of mammals, all of whom breastfeed their young.  Lactose is present in most of the breastmilk of these species, yet humans are the only species with any significant decay in deciduous teeth.    Modern Homo sapiens have been around for 30,000 to 35,000 years, but dental decay, however, did not become a significant problem until about 8,000 to 10,000 years ago.  Anthropologists believe the increase in decay was primarily due to the advent of the cultivated crops. (Brian Palmer DDS)

To support this, there are numerous studies demonstrating no link with decay:

No correlation found between caries and breastfeeding among children who were breastfed up to 34 month

Alaluusua 1990

There is not a constant relationship between breastfeeding and the development of dental caries. Mothers should be encouraged to breastfeed as long as they wish."

Valaitis 2000.

Prolonged demand breastfeeding does not lead to higher caries prevalence

Weerheijm 1998

Breastfeeding may act preventively and inhibit the development of nursing caries in children

Oulis 1999

If lactoferrin helps destroy strep mutans, how can brestfed infants still suffer decay?

Small enamel defects can occur when teeth are forming in utero, sometimes due to exposure to medicines eg specific antibiotics. or insufficient calcium intake (Torney 1992). These defects make the teeth more vulnerable and breastmilk is not sufficient to counteract high levels of bacteria.

"Human milk alone does not cause dental caries. Infants exclusively breastfed are not immune to decay due to other factors that impact the infant's risk for tooth decay. Decay causing bacteria (streptococcus mutans) is transmitted to the infant by way of parents, caregivers, and others"

 Palmer 2002

According to Dr Brian Palmer, the following are the most common causes of dental decay:

1. Sugar intake is the primary cause of decay. This includes sugar in otherwise nutritious foods such as juices, cereals, breads, raisins, etc. It also applies to sweetened medications. It is very important to understand that it is not the amount of sugar or carbohydrates to which the teeth are exposed, but rather the frequency of exposure that is the key to the development of decay.

2. The timing of introduction and the number of decay causing bacteria that are introduced into the infant’s mouth.

3. Xerostomia or dryness of the mouth (lack of saliva flow).

4. Illnesses of, or stress to, the mother or fetus during development.

5. Poor dietary habits of the family.

6. Poor oral and overall hygiene of the family.

7. Family genetics (minor contributor).

I've also seen increased rates in infants who have a tight or thick labial frenulum (the little tag of tissue in the center of the upper and the lower lip that attaches the lip to the gums) - perhaps because the area is sensitive it's harder to brush and thus more prone to stray food particles remaining.

You can read Brian's own presentation on breastfeeding and tooth decay here - WARNING, the link contains graphic images within a medical context.

Things you CAN do to help prevent or deal with decay:

• Good teeth brushing is essential - any food particles mixed with breastmilk can cause decay.  Some parents find an electric or musical/novelty toothbrush can distract reluctant brushers enough to quickly get the job done.
• Investigate Xylitol - it has been shown to stop strep mutans being able to "do their thing" and comes in various forms.  You can get crystals to dissolve in water to use in a spray bottle, as a mouthwash or in a water bottle to sip (check suitable dosage!) a study also found reduced decay for infants if mum chewed xylitol gum.
• Decay initially may look like small chalky white patches, usually seen on front surfaces of incisors, often close to gumline - many recommend "flipping your baby's top lip once a month for a good look! These patches then turn golden brown and eventully black as decay advances.
• If you spot something get it checked out, ignoring it because they will fall out anyway in a few years isn't a good plan - statistics show infants with decay are 3 x more likely to suffer as an adult.   This condition can progress very rapidly due to the enamel of primary teeth being thinner than that of permanent teeth - resulting in pain, infection and premature loss of baby teeth.
• Teeth can be remineralised and decay arrested given the right care (and at the white patch state is often completely reversible)
• Products such as Tooth Mousse or MI paste may be suitable to remineralise teeth within 2-3 months - always check with your dentist.
• If the decay is more advanced, other products are available to use short-term alongside such as curasept toothpaste and gel - always check with your dentist.
• The NHS seems to only offer tooth removal in cases of severe decay - yet experts urge parents to seek alternative opinion and treatment where possible, because baby teeth need to remain in the mouth for lots of other reasons; chewing on well-formed teeth helps the jaw bones to grow and develop properly, provide spacing for permanent teeth, allow normal chewing of food important for digestion and are also necessary for the development of sounds and proper speech development.  As certain molars are expected to be in the child's mouth until 12-13 years of age - early removal may have significant impact.
• Other options may include infant crowning. 

There is a great yahoo group about teeth problems in young children, it has lots of information and dental professionals to give advice - if anyone needs help or options try: http://health.groups.yahoo.com/group/veryyoungkidsteeth

Further Reading:
Breastfeeding & Infant Caries - No Connection.