> Question I just received is that a 13 month old is losing tooth
> enamel and teeth are decaying. Mother does not eat a lot of sweets.
> Baby eats very little solids. Breastfeeds 3 or 4 x day and most of
> the night.  What do you think ?

There was an *excellent* presentation at the 1995 LLLI Conference in
Chicago (available on audiotape) by an Irish dentist, Harry Torney,
BDS, MDentSC.  "Breastfeeding/Dental Health: An Investigation of
Prolonged, On-Demand Breastfeeding and Dental Caries".  I don't know
whether he has since published.

He described 3 factors as involved in tooth decay. A susceptible
tooth, appropriate bacteria (strep mutans) and the presence of
sugars. An increase in any one factor can set the scene for decay.
However, the common tendency to focus on sugars (and diet) as the
culprit gives the impression that decay is primarily a nutritional
disease when, in fact, it is primarily a bacterial infection. The
primary bacteria is strep mutans and breastmilk has been shown to
contain antibodies to strep mutans (of course!). The sugars in
breastmilk appear to be outweighed by the antibacterial effect of
the milk, *unless* one of the other factors (a susceptible tooth) is
present.

Dr Torney studied long-term breastfeeding children who developed
caries under age 2.  His conclusion was that the caries were related
to enamel defects in the first teeth, probably from when they were
formed in utero.  There was NO correlation with night-time feeding
(frequent or infrequent) or any other dietary factors. He said that
decay in first teeth was unrelated to risk of decay in second teeth,
which form their enamel at a different time (after birth). He also
found some association between tooth decay under two (enamel
defects) and possible decreased calcium intake during pregnancy,
although in his study this was hard to measure retrospectively.
Like Brian Palmer he reviewed the studies of the skulls of our
long-term breastfeeding ancestors and found little early decay,
except in one skull which had extensive enamel defects.

Dr Toney is adamant that there is no evidence that breastfeeding is
the primary cause of tooth decay - all the evidence points the other
way. However, if there are enamel defects, the lactose in breastmilk
could contribute to decay. Active caries in the mother's mouth has
also been associated with earlier increased colonisation of the
baby's mouth with strep mutans.

I would think the child Opal mentioned needs to be reviewed and
monitored by a dentist supportive of continued breastfeeding. If the
problem is extensive, there may be ways to help preserve the enamel
and prevent escalation of the caries. It is apparently also important
to monitor for silent abscesses in the gums above decayed teeth, as
this can damage the new teeth coming through. Otherwise, the new
teeth are unlikely to have problems (I would add, especially if the
child was breastfed while the new teeth were developing!).

Opal, you or the mother may like to purchase the tape from LLLI,
which I recall has other suggestions for management once decay
starts.  It is very easy to listen to and entertaining.  There is a
long question and answer session which is informative.

Ros Escott BAppSc IBCLC
Tasmania, Australia
Readjusting to the winter, having just returned from the LLLI
Conference in Washington DC.  Wonderful to meet Kathleen
Bruce and many other Lactnet "names" in person.