Brian, I went round and round with the folks at Ohio Dept of Health about
this issue - they were adamantly opposed to at-night BF because of BBTD. So I
wrote this:

        Extended Breastfeeding Non-Risk #2: Dental Caries

The most important causes of Baby-Bottle Tooth Decay (BBTD) are documented to
be: (1)  Enamel defects; (2) High carbohydrate intake in the infant's diet;
(3) Oral hygiene of the mother and infant, especially strep mutans; (4) Milk
pooling in the baby's mouth from a dripping bottle. As of April 1992, all
known references point back to three articles by Kotlow, Brams, and Gardner.
 The authors present case reports of 9 babies, only 7 of whom received no
bottles.  Recently, the lactose in milk has been shown to cause decay when
teeth are soaked in it.  This evidence does not establish that direct
breastfeeding as a risk factor in BBTD because:
1.      In these 7 case reports, there was no mention of enamel defects,
carbohydrate intake, or bacterial milieu.
2.      Human milk is protective against strep mutans.
3.      Milk pooling does not occur during breastfeeding because the breast does
not release milk unless the infant is actually sucking and swallowing.  If
human milk is provided by bottle, pooling could occur.  Bottle feeding is a
risk factor; even bottle feeding of human milk.
4.      Case studies report on unusual situations; the reports are from 1977 and
1983.  There have been no large-scale or epidemiological studies on this
phenomenon.  If long-term, at-will nighttime breastfeeding were a risk factor
for BBTD, epidemiologic evidence would have  demonstrated this link.
5.      Dr. David Johnson, DDS, pediatric dentist at Case Western Reserve
University, specialist on BBTD, said in January 1992  "It is a small risk,
rare and unusual.  It's not enough to base a policy of 'no breastfeeding past
12 months.' The advantages of breastfeeding past 12 months are absolutely
overwhelming."
6.      The position of the American Academy of Pediatric Dentistry (wean by 12
months) was challenged by Ruth Lawrence, MD in Feb. 1993.  Dr. Lawrence sent
many solid references on the documented risks of early weaning. The AAPD
position conflicts with AAP, DHHS, WHO and other health policy documents.

FACT:   There is no published, valid evidence that establishes long-term,
at-will breastfeeding as a risk factor in BBTD.  Limitation of the duration
of breastfeeding has documented negative consequences to the baby and mother.
 "Baby Bottle Tooth Decay" is a disease of artificial feeding.

•Brams M and Maloney J. "Nursing bottle caries" in breastfed children.  J
Peds 103(3): 415-416, 1983.
•Gardner DE, Norwood JR, Eisenson JE. At-will breastfeeding and dental
caries: four case ports. ASDC J Dent Child May-Jun 1977, 1-6.
•Kotlow LA. Breastfeeding: a cause of dental caries in children. J Dent Child
May-June 1977, 192-93.
•Woolridge, M., and Baum, J.D. The regulation of human milk flow. Perinatal
Nutrition, Vol 6, ed. BS Lindblad. London: Academic Press, 1988.
•Woolridge, M. Anatomy of infant sucking.  Midwifery 2: 164-171, 1986.

© Copyright Linda J. Smith, December 1994
For information on duplicating this paper, contact LJS at 6540 Cedarview Ct,
Dayton OH 45459.