At the excellent ABM conference in Chicago in Oct. 2003, Kathleen A.
Marinelli MD, IBCLC, FABM made us all crave our toothbrushes with her
extremely thorough description of early childhood caries (ECC), and its
relationship to BF and overall oral health.  Oral health is more than teeth.
  “ECC” is the preferred term over baby-bottle tooth decay, nursing caries
or bottle caries, as the latter imply causation.  ECC is a complex disease
that can have a significant impact on children and their families.  It is
found world-wide.

ECC requires three elements: a host (the tooth), a bacteria (and dental
plaque is composed of over 500 types) and a diet with refined sugars in it.
Studies show that human milk is *not* in itself a decay-producing
cariogenic.  (Indeed, in the lab, human milk not only didn’t form caries
when teeth were submerged in it – it actually put calcium and phosphorus
back into the tooth enamel!)  But once a child begins to get teeth, and the
diet contains other items, caries can begin.  A review of the literature
shows contradictory findings ... but the take-home message is that *no*
study can tell us when (or if) a mom should reduce BF or wean in order to
avoid caries.  This is, sadly, in conflict with the American Academy of
Pediatric Dentistry’s 2001 statement that “ad libitum nocturnal
breastfeeding should be avoided after the first primary tooth begins to
erupt."

So here is the enlightened message we can give to all of our nocturnal BF
dyads:  make sure your baby has good dental hygiene once teeth erupt AND
foods other than breastmilk enter the diet.  Since breastmilk alone does not
cause ECC, it is perfectly okay for the "just-brushed" child to be nursing
at night, as breastmilk is no more cariogenic than water.

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