On 14 May Alison asked:

"Why in the world would we want to rinse the protective benefits of
breastmilk against dental caries out of the mouth with a water chaser and in
turn possibly disturb the intestinal flora to increase the risk of dental
caries by giving water chasers post feeds?"

Can provide me with well done research references on the protective benefits
of breastmilk against dental caries?

I do not believe that intestinal flora is very significant in protecting
against caries.  Certainly oral flora is.  High levels of strep mutans have
been associated with caries.  Strep mutans does not colonize shedding
surfaces so is not a concern until erruption of the first teeth which often
coincides with introduction of other foods than breastmilk, so that usually
breastmilk is no longer the only source of fermentable carbohydrates.

For several years I have been collecting references on breastfeeding and
caries. Much of the dental community still tends to attribute "nursing
mouth" or "nursing bottle" type decay to extended breastfeeding or ad lib
night feeding.  Some Canadian pedodontists are distributing pamphlets by the
American Association of Pedodontists recommending weaning by 1 year and
water bottles as the only dentally safe night feed.  The literature I have
collected is conflicting.  A recent Japanese study also supported the
weaning at one year recommendation.

As a LLLl and IBCLC I am aware of, and in agreement with the arguments for
the mechanics of breastfeeding not being condusive to milk bathing of
anterior teeth.  I am the only dental professional on the British Columbia
Baby Friendly Network, representing the B.C. Dental Hygienists Association.
I would love to have recent convincing clinical studies to take to my dental
colleagues.  Have looked at publishing a lit. review in the CDHA journal but
so far results would seem inconclusive.

Clinically I have screened about 120 children 5 years and younger for dental
caries in the past several years.  And discussed this with colleagues who
have screened many more.  There have been a very small number of those
children who were exclusively breastfed for the first 6 months, never had a
bottle and had significant decay.  One was the child of a LLL leader who had
breastfed all 4 of her children to toddlerhood and beyond, had a whole foods
low sucrose diet and good oral hygiene.  There was no history of fluoride
consumption until 18 months when decay was first noted and care was sought.
Mother began daily brushing when 6 incisors were present and began flossing
at 24 mo.  Three of her children are caries free, dentist has said they have
lovely strong teeth.  One had visible caries (first appearing on mandibular
molars) at 18 months.  She had these lesions restored including pulpectomy,
but recently reported that at 2 1/2 years the teeth are continuing to break
down now involving maxillary anterior and posterior and mandibular posterior
teeth.  A possible risk factor mom identified at 18 mo. were cewable
(acidic) Vit.C tablets, a lot of which had been consumed at 16 mo. when the
toddler had chicken pox.  These are now given only with meals now followed
by brushing.

I am hoping for replies, especially from dentists.  How can I protect and
promote breastfeeding with my dental colleagues?

TIA

Suzanne