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Subject:
From:
Jeanette Panchula <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 4 Jan 2015 11:12:41 -0800
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It seems that the dentist in this case was not aware of the latest recommendation from the American Academy of Pediatric Dentistry: 
http://jada.ada.org/content/144/2/143.full.pdf+html?sid=92e0aa0c-70c5-485a-8485-9a6538f6eccb 

It reflects and supports the AAP's Breastfeeding Section on Breastfeeding Policy Statement:   http://pediatrics.aappublications.org/content/129/3/e827.full#content-block 

I was glad to see that they made a point to include:
 - Breastfeeding should continue as long as mother and baby choose - following the AAP recommendations
- Dentists have a responsibility to treat or refer children no matter what the state of breastfeeding (it had come to their attention that some dentists have refused to treat caries unless the mother weaned).

Caries is a multi-faceted problem that no one factor will address - certainly not removing breastfeeding from the equation!
- Enamel - often genetics play a role, but also mineralization due to medications during the pregnancy and/or given to the baby
- Teeth cleansing - making this a bedtime habit from eruption (or before if you have a child as I did, who did not have a tooth erupt until 15 months, so 'tooth' brushing was part of her normal bedtime ritual)
- Foods of all sorts that are given to babies and toddlers - from liquids in bottles to sticky snacks (not always identified as "unhealthy" such as raisins) without the follow-up tooth cleansing.
- Awareness of the presence of pathogens; in researching for this comment I just came across one called: Streptococcus mutans, Candida albicans, and the Human Mouth: A Sticky Situation by Khalid H. Metwalli, Shariq A. Khan, Bastiaan P. Krom, Mary Ann Jabra-Rizk  (it seems to be a collaboration between U. of Maryland and U. of Amsterdam).
http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1003616  

Clearly, just as with breastfeeding and breast milk, there is a lot more to know about ECC than what we know already!  

I worked with a wonderful asset in the California Department of Public Health's Maternal and Child Health Bureau, Cheryl Terpek, who still keeps me informed and updated.  She also shares the latest information about breastfeeding when she comes across misinformation provided in publications or professional discussions related to pediatric dentistry.  I've asked for her input, but wanted to provide the above links now.

Jeanette Panchula, BSW, RN, PHN, IBCLC
Vacaville, CA

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