Ione wrote about an article that was printed in Advance for Nurse
Practitioners about Baby Bottle Tooth Decay.
>Several times in the course of the article, it is stated that BBTD is
>associated with "long periods of bottle or breastfeeding". Bottle and
>breastfeeding are treated as equally contributive.

This is a current topic here at the moment, as we have a paediatric dentist
who is anxious to break down the barriers between dentists and
breastfeeding advocates (especially Nursing Mothers' Association of
Australia Members and Counsellors) in the best interests of all children
and their parents (including their pockets, as the treatment he carries out
is so expensive). He knows that breastfeeding is far superior to
bottle-feeding, but still sees some children in his surgery with rampant
caries who have been exclusively breastfed. Admittedly, they are far
outnumbered by bottle-fed ones, but they do exist. When I first talked with
him, I was quite defensive, and of similar opinion about breastfeeding
being protective, etc as I guess many of you are.

It has been interesting to learn more from his point of view. He can tell
that the caries are from milk feeding (bottle or breast - sorry to equate
it here, but it is true) from the pattern of decay. So it's not from
juices, solids, etc. He has found there are several risk factors that
contribute to decay. *One* of these is the time sugar and teeth are in
contact, such as continuous or semi-continuous night feeding, where baby
(who has teeth) sucks during sleep, doesn't always swallow the milk
straight away, and has breastmilk pooling around the mouth. (It actually
travels up along under top lip to affect upper incisors, as well as
affecting rear molars of side baby is lying on.) This contact time factor
is exacerbated during sleep, day or night, because of the lessening of
saliva flow, which would normally help wash the sugar off the teeth. There
also have to be other risk factors present, so night-feeding per se is not
the cause. The others are
1) decay-causing species of bacteria, usually transmitted from mother via
saliva, like sharing spoons. It's important that mum's mouth is free of
cavities to minimise this, and she should avoid sharing spoons, licking
dummies, etc.
2) substrate - any sugar-containing food in contact with teeth. It is
interesting that breastmilk is considered more cariogenic than cow's milk
because of the high lactose content. This is relevant especially when baby
is bottle-fed EBM. I wonder whether the antinfective properties may help
balance this out?
3) susceptible tooth - some teeth more likely to decay from genetic
factors, fault in enamel, etc.

The message, as I see it now, that we should be giving to mothers is that
caries when breastfeeding is still a possibility, but there are steps for
minimising risk, especially if there is a family history of dental
problems:
- try to make feeds discreet, rather than continuous, especially during
sleeping times. ie roll over and detatch baby from breast when he is
asleep.
- clean baby's teeth every day from when they first emerge. Decay bacteria
cannot work unless covered with plaque, so remove it every day by brushing
and flossing. Make it a game so baby gets used to it, and is happy to
cooperate. An adult should brush the teeth of children until about 8 or 9
years of age. I liked our dentist's idea that they should have the
dexterity to be able to tie their shoe-laces with their eyes shut before
they brush their own teeth!

Other suggestions were:
- if practical, use a soft cloth to wipe baby's mouth after a feed, eg if
in a deep sleep and milk still pooled in the mouth.
- for older babies/toddlers, if they are not asleep after a feed, offer a
drink of water to rinse the mouth.
- start visiting dentist between 6 and 12 months for monitoring and
catching any problem before it gets too big.

The information in the article Ione quoted is fairly good for dental
information - it just doesn't discuss relevant information specifically for
breastfeeding situations. (Here in Australia the recommendation is weaning
from the bottle at 12 months.) I agree that there is an unfortunate
tendency to equate breast and bottle feeding in dental articles. This is
why I am so keen to liaise with a sympathetic paediatic dentist to enable
us to get some sensible advice in print for breastfeeding mothers. Neither
of us can afford to keep burying our heads in the sand and disagreeing all
the time. The ones suffering are the babies and their parents.

I know I have learnt a lot recently about this, and hope this post helps
others become a little less defensive about dentists. It also helped
explain much of the stuff that was discussed on Lactnet many months ago,
when there was much criticism of newspaper articles, etc. (Do you 'oldies'
of Lactnet remember this about dental caries, kissing babies, etc?) It
helped explain where the statements had come from and the grain of truth
that was in them.

Joy Anderson IBCLC, NMAA Breastfeeding Counsellor
Perth, Western Australia
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