I have a pamhlet called "The Pediatric Dentist", by the American
Academy of Pediatric Dentistry which describes nursing decay as "a
pattern of decay associated with prolonged nursing....in a
child...who nurses frequently" implicating breastfeeding as well as
night-time bottle use.  This pamplet (Given to a LLL leader by a
Vancouver Canada pedodontist  in 1995 ) states "To prevent nursing
caries, pediatric dentists recommend that a child be weaned  by
approximately 12 months of age", and again under "dental checklist"
for 6 to 12 months "Wean from breast of bottle by first birthday".
Those who are writing to the ADA please also send copies to the
American Academy of Pediatric Dentistry, 211 East Chicago Avenue,
Suite 1036, Chicago, Illinois 60611.  Fax 312-337-6329.
 I wrote to LLLI about this pamphlet and received a reply in August
95 stating that Betty Crase had personally contacted the American
Academy of Pediatric Dentistry on several occasions.  They had not
responded to the information provided to them, or have made any
attempt to respond to Betty's contacts.
The dental literature on the subject is conflicting.  A good review
of literature from around the world between 1967 and 1993 is
contained in a symposium presented at the 23rd Annual Meeting of the
International Association of Dental Research General Session in
Seattle, WA, 1994.  Reprint request to Dr. Billings, Eastman Dental
Center, 625 Elmwood Avenue, Rochester, NY 14620.  Internet:
edieAedl.edc.edu.  Some studies are flawed in their defenition of
breastfeeding not excluding supplementary bottles, or bottles during
or subsequent to weaning.  A universally accepted definition for
Nursing Bootle Tooth Decay (BBTD) does not exist, further confusing
the comparison between studies.
 A 1992 study by Matee et al. published in Community Dent Oral
Epidemiol 1994,22:289-93 looked at 442 1-2.5 year olds in Tanzania
who had not experienced bottles/pacifiers.  Most of these children
who exhibited a  (BBTD) pattern of caries had practiced unrestricted
night-time breastfeeding including sleeping with the breast nipple in
their mouths.  There was also highly prevalent linear hypoplasia (a
band of poorly mineralized dental enamel) in populations with more
decay, and this was considered a predisposing factor.   Caries rates
and linear hypoplasia varied by geographic location.
I agree with Jack Newman that dentists generally know little about
breastfeeding.  Even when studies are quite sound the discussion,
conclusion and recommendations in dental literature can be coloured
by the author's personal or cultural beliefs which view
breastfeeding, especially beyond early infancy, as unhealthy,
unnatural or simply unimportant.  An example of this is
"Nursing-bottle syndrome: Risk factors", Michele Muller, Journal of
Dentistry for Children, Jan-Feb 1996.  Reported risk factors for
decay other than the bottle listed in the introduction include
"breast-feeding beyond the normal age for weaning".  The normal age
for weaning is not defined.  This study looked at breastfeeding
durations of less than or greater than 8 months.  Is the implication
that 8 months is the "normal age of weaning"?  Of the 139 children
who presented with BBTD 10 were breastfed beyond the eighth month (74
less than 8 mo. and 59 not breastfed).  All ten breastfed children
consumed a bottle of milk (usually sweetened) at bedtime and/or
during the day to facilitate weaning.  In the population studied
breastfeeding was more liley practiced by mothers of North-African
origin.  The conclusion made by the author is that "breast-feeding by
African women after the normal age for weaning is no longer
acceptable" (despite nutritional, economic or social or  health
advantages).  Although breastfeeding beyond 8 months may be normal to
African women, the researdher in this French study has a different
view on this and had decided that they must be in error, and that
this is not only abnormal but also risky!  Breastfeeding beyond 8
months is condemened as being unacceptable but inappropriate weaning
practices such as the use of bottles containing sweeted milk is
ignored when blaming breastfeeding for dental decay.  I wonder if
those ten children could have avoided extensive decay by
breastfeeding even longer and avoiding the sweetened feeding bottles
altogether!
Let's educate the ADA and the AAPD.  Originally I felt that because I
was not a U.S. citizen I shouldn't bother with their business.  I
have changed my view on this as they influence mothers, babies,
dentists and other health care providers beyond their national
borders.
I love the idea of enlightening  individual dentists  as to the fact that
our decay  free children breastfed even through the night and beyond
12 months.

Suzanne McBride, RDH,  LLL, IBCLC

mother to Ryan 19, Colin 16, Erika 14, Kristina 11 (breastfed 10 mo,
18 mo, 3.5 y, and 4 y, all caries free except Kristina's 2 small molar
pits ), and wife to Tom, a family physician who learnt most of what
he knows about breastfeeding from us.

PS. Maybe some of our bright breastfed children should become
dentists and shake up the profession.