Dee Kassing writes about a theory from her paediatric dentist:
>        This dentist thinks that *perhaps* the babies who stay attached to
>breast all night long, rather than feed and come off, do lots of
>fluttersucking.
>This fluttersucking *may* cause the breast to drip a drop of milk every so
>often.  But because it's not a mouthful of milk, the baby does not swallow, so
>the drops accumulate slowly before there is a big enough bolus to trigger a
>swallow.  This allows those drops to bathe the teeth in breastmilk and *may*
>contribute to dental caries.

I think this could well be true, Dee. We have a BF-friendly
paediatric dentist here who also still is cautious about night-time
continuous feeding. His beliefs are based upon hard evidence of what
he sees in his practice. Sure he treats *lots* of bottle-fed children
with caries, but there are still some long-term breastfed ones as
well. He showed us slides of some of these and the pattern of decay
is consistent with classic 'bottle caries' - ie along the back of the
upper front teeth (I think it was), not like you get with caries
caused by solids.

He explained that this happens when the milk travels in channels
around the gums, and is characteristic for bottle caries. Yet the
occasional breastfed toddler shows this and has never had a bottle.
This is devastating for the mothers when this happens.

He explained that there needs to be a combination of factors (not
just the night breastfeeding) before decay happens. One of these is
bacteria, and the more the parents have, eg if they have cavities
and/or lots of plaque, the worse the chances for the baby. And they
need to avoid transferring saliva from adult mouth to baby's, eg
'cleaning' pacifier in mum's mouth, sharing spoons. Brushing baby's
teeth is important to remove plaque, and hence bacteria. Of course,
they should take care of their own mouths as well - have cavities
treated, and brush and floss properly.

Other factors implicated in caries include time (how long the
substance is in contact with the teeth); how 'sugary' the substance
is (ie sugary drink is worse than milk that also has some protective
factors); what the saliva flow is like (reduced during sleep - also
reduced swallowing reflex during sleep); weak spots on the enamel
making the tooth more susceptible to the bacterial 'attack'.

These have to *combine* to create caries, and unfortunately in the
occasional breastfed toddler they do. The main message seems to be if
your child likes to breastfeed a lot at night, but has weak enamel
(which you cannot control), you need to be much more diligent with
cleaning their teeth regularly, perhaps wiping out the toddler's
mouth after feeds (or encouraging rinsing with water) when practical,
and avoiding prolonged time with milk in the mouth as much as
possible, especially during sleep. Making feeds *separate* would
help, as Dee's dentist also mentioned.

Hope this helps with understanding of caries in breastfed toddlers.
--
******************************************************************
Joy Anderson B.Sc. Dip.Ed. Grad.Dip.Med.Tech. IBCLC
Australian Breastfeeding Association counsellor
Perth, Western Australia.   mailto:[log in to unmask]
******************************************************************

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