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Title Limited Evidence as to caries-Protecting Effect of Breastfeeding Compared to Bottle-Feeding in the first 3 to 6 months of age.
Clinical Question Does bottle-feeding, compared to breastfeeding, result in more caries in the primary dentition?
Clinical Bottom Line The scientific evidence gathered from the studies is limited as to the caries-protecting effect of breastfeeding vs. bottle-feeding, but nighttime bottle-feeding or breastfeeding past 12 months are both associated with greater early childhood caries.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26579710Avila/20157 studies on children with only primary dentition (meta-analysis: 2 studies/453 children)Systematic Review and Meta-Analysis
Key resultsThe systematic review included case control, cross-sectional, and cohort observational studies. Meta-analysis was performed on two of the cross-sectional studies, showing that breastfed children were at less risk of dental caries than bottle-fed children (OR: 0.43, 95% CI: 0.23-0.08). The authors concluded that breastfeeding was more protective compared to bottle-feeding when it came to early childhood caries. However, the authors noted that some of the included studies failed to adjust for confounding variables such as early preventive dental visits, water fluoridation and nighttime feeding, which should limit the confidence in their conclusions.
#2) 26587516Olatosi/2014302 childrenCross-sectional study
Key resultsThis cross-sectional study collected information about infant feeding practices from mothers; then, the children were examined clinically for early childhood caries (ECC). Of the 302 children in this study, 44% were breastfed only, 2% were bottle-fed only, and 54% were both breastfed and bottle-fed. "Children who were solely bottle-fed had a caries prevalence of 33% followed by those who were both breastfed and bottle-fed (25.3%) and those who were solely breastfed had the least caries prevalence least (15.7%). There was no statistically significant difference in the three methods of infant feeding with regards to the prevalence of dental caries among the children, (P=0.099).” However, “ECC significantly increased with night time bottle feeding (OR=4.5, p=0.001, CI=1.8-11.1), whereas it was significantly lower in children who were breastfed for 3 to 6 months (OR= 0.1, p<0.001, CI=0.03-0.18) as compared to those who were breastfed greater than 12 months duration.” The conclusion was that breastfeeding children within the first 3 to 6 months of life can lead to a lower frequency of dental caries versus infants who are night time bottle fed (P<0.001) or breastfed past age 1.
#3) 26206663Tham/201563 papers that included children and adolescents of both general and high-risk populations. Systematic Review and Meta-Analysis
Key resultsWhen extracting data that included the prevalence of early caries between bottle-feeding and breast-feeding, the authors determined various findings. Six cross-sectional studies concluded there was no significant difference between breast-feeding and bottle-feeding in causing early dental caries. One cohort study and one cross-sectional study showed a significant decrease in dental caries risk for breast-fed children (OR= 0.61, 95%CI 0.39-0.97, p=0.038). One cross-sectional study determined an increased risk of dental caries in children who were only breast-fed, having a significance of p=0.08. However, since the p-values are low, the results are inconclusive. One cross-sectional study found a lower caries risk in children who were breast-fed bottle-fed children. Overall, it was concluded that breastfeeding in infancy may protect against early childhood dental caries; however, breastfeeding past 12 months shows an increased risk in dental caries.
Evidence Search Early childhood caries breastfeeding bottle feeding
Comments on
The Evidence
Validity: The systematic review by Avila used a thorough and extensive search of the literature, including grey literature, clearly listed inclusion/exclusion criteria, and assessed individual included studies for risk of bias. Reasons for exclusion were listed and included investigation of only one type of feeding practice, the absence of comparison, etc. When the investigators could not extract the data they needed from a study, they personally contacted the authors to get a clear answer. The study by Olatosi is limited to the population of Southwestern Nigeria. The children were randomly selected from amongst group enrolled at a well-baby clinic. Calibrated examiners carried out the caries examination. The children ranged from 1 month – 71 months, like the Avila article. The authors stated that they adjusted for confounding variables in their statistical analysis. The study done by Tham also used a thorough and extensive search of literature, using PubMed, Central, CINAHL, and EMBASE databases. To determine the risk of bias, they utilized the GRADE system in order to decide the quality of evidence of observational studies. One conflict of interest in the article was that it was partially funded by the World Health Organization; however, the organization did not take part in determining the outcomes of the article. Perspective: In my opinion, there is no significant difference between breastfeeding vs bottle-feeding in the prevention of early childhood caries. However, the frequency of feeding as well as time of day/night can be a factor of the incidence of caries present.
Applicability In clinical practice, especially in the San Antonio community, early childhood caries is high. These studies/articles really highlight how influential-feeding habits can be in the development of early childhood caries. Dentists can counsel their pregnant patients and parents of young children by explaining the importance of breastfeeding infants and also limiting bottle-feeding to infants only. They can also counsel their patients on minimizing the frequency and duration of feeding, which will ultimately decrease the prevalence of early childhood caries.
Specialty/Discipline (Pediatric Dentistry)
Keywords Early childhood caries, breastfeeding, bottle-feeding
ID# 3201
Date of submission: 04/10/2017spacer
E-mail acostak@livemail.uthscsa.edu
Author Kirsten Acosta
Co-author(s) e-mail
Faculty mentor/Co-author Kelly Lemke, DDS
Faculty mentor/Co-author e-mail lemkek@uthscsa.edu
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