Annie raises some good points:
> IMHO it is about the teeth. How can they test this? Take a tooth from a mouth
> drop it in EBM see what happens? take a tooth from the SAME mouth, drop it in
> ABM see what happens?
> My bet is that they will both show signs of decay, both not how signs of decay
> or the EBM tooth will be LESS vulnerable.
Actually, a study like this has been done. When a tooth is put into plain
water, nothing happens (decay potential of 0.00). When it is put in plain
human milk, it is almost the same as in water (decay potential of 0.01).
When a tooth is put into 10% sucrose solution, the decay potential is 1.00.
This was tested in various infant formulas as well, with a range in decay
potential of 0.01 (Nutramigen) to 1.11 (Prosobee). When a tooth is put in
human milk to which sucrose has been added, there is a decay potential of
1.30. (Erickson P et al. Estimation of the caries related risk associated
with infant formulas. Pediatr Dent 20;1998:395-403, and Erickson PR and
Mazhari E. Investigation of the role of human milk in caries development.
Pediatr Dent 1999;21:86-90. Cited by Dr. Kathleen Marinelli, see below)
So decay potential increases with the introduction of nutritional sources
other than breast milk. Breast milk alone is not the problem. The problem
is when other foods are introduced and interact with the teeth, such as
juices, colas, and other carbohydrates.
Recent research has increased our knowledge into early childhood caries. It
is now understood to be an infectious disease. To get caries you need to
have 3 factors present: 1) a susceptible tooth (meaning the teeth have
erupted), 2) the bacteria called mutans streptococci (which grows in an acid
environment), and 3) sugar (sucrose, fermentable carbohydrates). Removing
any one of these three risk factors decreases the chance for caries.
In the mouth, the pH should normally be neutral. If sugar is added in the
presence of strep mutans, the strep works on it to form an acid environment.
The acid etches the tooth and creates decay. If you clean the tooth off, it
helps prevent decay. If you bathe the tooth frequently with sugar, there is
more potential for decay. (So sipping milk or juice from a bottle through
the night, when saliva flow is decreased is a problem). The more frequent
the eating, the more frequent the cycles of decreased pH and the more risk
of cavities.
New research shows there are two "windows of infectivity" for strep mutans
to colonize a child's mouth. The first is usually at age 19-31 months, but
can be as early as 10 months. This period ends when all the primary teeth
have erupted. The second window is at ages 6 - 8 years, when the first
permanent molars erupt. (Caufield PW, Griffin AL. Dental Caries. An
Infectious and transmissible disease. Pediatric Clinics of North America
2000; 47(5):1001-1019.)
Where does the strep mutans come from? Most often from the child's mother,
especially if she has untreated tooth decay herself. Reducing the bacterial
count in the mother's mouth will reduce the risk of transmission to her
child. We need to think about ways that the saliva from the mother gets
into the child's mouth: mom cleaning off the pacifier that falls on the
floor by putting it in her own mouth, then giving it back to the baby (I've
seen this many times); tasting the baby food and feeding the baby from the
same spoon; baby putting fingers in mom's mouth as part of the lovely dance
that takes place between mother and baby while nursing, then sucks own
fingers; kissing the baby. I don't know that it is possible or feasible to
try to prevent all this. I wonder what the risks are in cultures where the
parent commonly pre-chews foods and then feeds them to the baby?
How do we combat this problem of early childhood caries? We can make sure
that mothers themselves have good oral hygiene and good dental care. Studies
are showing that Xylitol chewing gum for women with a high strep count can
reduce the risk for her children. (Xylitol interferes with the ability of
the bacteria to stick to the tooth surface). We can try to reduce sugar in
the diet. (I understand that WHO is initiating an effort to do this). We
can limit children's juice intake to 2-4 ounces a day, and make sure it is
100% pure juice, not sugared juice drink. We can try to reduce the frequency
of food intake. We can make sure the teeth are cleaned off at least twice a
day. (The mechanics of brushing disrupts the bacterial biofilm matrix.
Bacteria must colonize to emit toxins. The decay process is inhibited by
disrupting the colonies and acid production is halted). Fluoride is helpful
in reducing cavities (supplements after 6 months in non-fluoridated areas),
but apparently some budget-strapped municipalities are eliminating
fluoridation of the water to cut costs. Frequent oral exams and recognizing
and dealing with problems early are important, too. There is a campaign
called "lift the lip" to look at the child's 4 upper front teeth on a
monthly basis. We can teach parents to do this. If the parent notices
white chalky areas or white spots, a dentist or health care provider should
be seen. Early Childhood caries can progress very quickly, with bad short
term and long term consequences.
80% of dental caries are found in 25% of the population. Five to 10% of
young children, 20 % of children from low income families and 43% of
children in some American Indian populations have Early Childhood Caries. In
Sweden, it affects 22.2% of immigrant 2 year olds, but only 4.5% of
non-immigrant children. Canada - 3.2%, Hong Kong - 7.6% of 1-3 year olds,
Kuwait - 19%, Australia 5.4% overall but 78-83% of Aboriginal 5-6 year olds.
(Various studies look at different age populations of children). It is a
world wide problem.
Research in this area is being done by Dr. David Drake at University of
Iowa. Kathleen A. Marinelli, MD at University of Connecticut spoke on this
topic at the Academy of Breastfeeding Medicine conference in Chicago,
October 19-20, 2003. There is information and articles from "New
Beginnings" on Breastfeeding and Dental Health on the La Leche League web
site at http://www.lalecheleague.org/NB/NBdental.html This includes an
article on how one mother successfully dealt with nighttime nursing for a
baby with early caries. ("Coping with Dental Caries" by Renee Cox, Vol 14,
no 1, Jan-Feb 1997, pp 10-11)
The Madison (Wisconsin) Health Department has a handout on Breastfeeding and
Early Childhood Caries, but I was not able to find it on their web site. We
had one of their dental health specialists speak to some of our local
breastfeeding groups on Caries Prevention and Breastfeeding, which is where
I learned a lot of this information.
Anne Altshuler, RN, MS, IBCLC and LLL leader in Madison, WI
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