Abstract
To synthesise the current evidence for the associations between breastfeeding and dental caries, with respect to specific windows of early childhood caries risk. Systematic review, meta-analyses and narrative synthesis following searches of PubMed, CINAHL and EMBASE databases. Sixty-three papers included. Children exposed to longer versus shorter duration of breastfeeding up to age 12 months (more versus less breastfeeding), had a reduced risk of caries (OR 0.50; 95%CI 0.25, 0.99, I(2) 86.8%). Children breastfed >12 months had an increased risk of caries when compared with children breastfed <12 months (seven studies (OR 1.99; 1.35, 2.95, I(2) 69.3%). Amongst children breastfed >12 months, those fed nocturnally or more frequently had a further increased caries risk (five studies, OR 7.14; 3.14, 16.23, I(2) 77.1%). There was a lack of studies on children aged >12 months simultaneously assessing caries risk in breastfed, bottle-fed and children not bottle or breastfed, alongside specific breastfeeding practices, consuming sweet drinks and foods, and oral hygiene practices limiting our ability to tease out the risks attributable to each. Breastfeeding in infancy may protect against dental caries. Further research needed to understand the increased risk of caries in children breastfed after 12 months.
Highlights
Dental caries is a major public health problem affecting 60–90% of school-aged children [1], with increased prevalence in children from lower socio-economic groups [2]
It is possible that children breastfed beyond 12 months are engaging in nocturnal breastfeeding but the modification of dental caries risk by infant feeding practices has not been examined in depth in any of the studies included in this review
We provide quantitative evidence that is suggestive of the potentially protective effects of breastfeeding from dental caries up to 12 months, but higher risk of dental caries in children breastfed beyond 12 months, frequently, and/or nocturnally
Summary
Dental caries (tooth decay) is a major public health problem affecting 60–90% of school-aged children [1], with increased prevalence in children from lower socio-economic groups [2]. The pain and infection caused by dental caries can be extremely distressing and can impact on quality of life and ability to function [3], lead to lost productivity and involve high health care costs [4] including general anaesthesia for treatment of severe cases. This accounts for one of the most common causes of child hospitalisation in industrialised countries [5] and is among the most common causes of avoidable child hospitalisations [6].
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