I am dismayed at the ignorance of the physiology of breastfeeding and
breastmilk implied in the recent recommendation that all infants be weaned
from the breast at one year of age.  Some factors that this panel obviously
did not consider:
Lactoferrin is a human milk component that interferes with bacterial
carbohydrate metabolism, and is protective against tooth decay.  Excessive
iron intake saturates lactoferin and interferes with it's activity.  American
infants are routinely supplemented with iron fortified cereals and vitamin
drops.  Human milk also contains live lymphocytes and secretory IgA, among
other active immune components.

The mechanics of breastfeeding are such that milk pooling in the mouth has not
been demonstrated.  The infant must suck actively for milk to be expelled from
the breast, the negative intraoral pressure neccessary to keep the nipple
placed deeply in the mouth is not sufficient to express milk.  Therefore, milk
does not passively drip into the breastfeeding child's mouth.  Swallowing is
linked to sucking in a self-replicating cascade that further precludes
pooling.  Furthermore, the position of the maternal nipple at the junction of
the hard and soft palates causes milk to be released onto the posterior
tongue, not against the teeth.

Long term breastfeeding provides health benefits that outweigh a theoretical
risk of primary tooth decay.

Dentists need to work together with other health care professionals before
making pronouncements that would jeopardize the health of children.  Though
the documentation is clear that nursing bottles do pose a hazard to dental
health, this research is not applicable to breastfeeding infants.  I do not
dispute that there are rare cases of tooth decay in breastfeeding infants, but
these are the exception, not the rule, and have been attributed to congenital
enamel weakness.

Catherine Watson Genna, IBCLC  International Board Certified Lactation
Consultant, New York City