Night nursing and cavities

[Siana]

My research in to this was spured on by a local dentist who is concerned about night nursing being a contributing factor to dental carries. I pointed her to several recent articles, two of which were published in Mothering magazine. The most recent one though not delving in to night nursing, did a fabulous job of explaining the muscle movements during nursing (http://findarticles.com/p/articles/m...0/ai_n13734198)

She pointed me to this article (from 1998 if that has a bearing) that states:
"When the baby falls asleep at the breast, the nipple retracts.2 If the mother is also asleep and the baby does not completely remove the breast from his mouth, milk can pool in the babies mouth, coming into contact with the lingual surface of the upper incisors.29 In addition, during sleep there is a decrease in the amount of saliva produced, which decreases the clearance of the milk.11,15 In a baby with a family history of caries and a high streptococcus mutans count, this can lead to rampant nursing caries."
http://www.breastfeeding.org/articles/dental.html

But how can milk pool in the mouth if the baby is not actively milking the breast? I've not known my breasts to spontaneously eject milk unless there was an appropriate stimuli (with my first child however, my let down was forceful since I had oversupply, but I felt it coming minutes ahead, and as my baby grew older, it only happened when she whimpered for food).

I've also gathered from several articles I've read that human milk is protective against strep mutans.

Is this research just out of date, or is there still a grain of thruth to it?

Bottom line is I'd like to know if there's a need for dentists to routinely warn breastfeeding mothers about this? Or is this one of those cut-and-dried situtation where the chances of ECC being as a result of night time nursing are practically nilll -- or better yet nill -- that breastfeeding mothers don't feel like they have to night wean (BTW, I'm a lactivist, and I'm really looking for any reason I can get to make nursing just easier for mothers )

[MistyMM]

basically breastmilk will not contribute to dental caries because the positive bacterium and antibodies found in breastmilk actually help fight AGAINST caries. As long as the babies teeth are brushed before his or her last NONbreastmilk food before bed, I see no reason for nursing to stop. This is also what our dentist told us (my kids have perfect teeth, and dd 2.75yo still nurses at night

hth!
Misty

[Siana]

Thanks Misty. Funny how that was part of my thinking process, but i never thought of actually just saying so! :

Got to say, if a baby can keep breastmilk in their mouth for longer than 8 - 10 hours, then may be there could be an issue :

[Siana]

"In a study done by Dr. Torney, no correlation was found between early onset (< 2 yrs) dental caries and breastfeeding patterns such as frequent night feeds, feeding to sleep, etc. He is convinced that under normal circumstances, the antibodies in breastmilk counteract the bacteria in the mouth that cause decay. However, if there are small defects in the enamel, the teeth become more vulnerable and the protective effect of breastmilk is not enough to counteract the combined effect of the bacteria and the sugars in the milk.[stress mine] Enamel defects occur when the first teeth are forming in utero. His explanation is based on quite a large study of long-term breastfed children with and without caries.

According to this research, a baby who is exclusively breastfed (no supplemental bottles, juice, or solids) will not have decay unless he is genetically predisposed, i.e.. soft or no enamel. In a baby who does have a genetic problem, weaning will not slow down the rate of decay and may speed it up due to lack of lactoferrin."
Source: http://www.kellymom.com/bf/older-baby/tooth-decay.html

Since a mother may not know the condition of her baby's enamel, is this reason enough to put out a word of caution to every breastfeeding mother?

[MistyMM]

imo? LOL I would say no. However, the defects they are talking about, have been linked to several things, such as c/s and antibiotics in labor. also antibiotics during the pg. Messing with night nursing can cause a baby to wean prematurely, and PERSONALLY I don't consider the risk of caries from nursing (very small) worth the risk of night weaning resulting in total premature weaning (very great)

[Siana]

I'm very interested in finding out what the risk factors are of a child being born with enamel deffects (since that's the root issue). I hadn't heard before that "c/s and antibiotics in labor" were two risk factors. Amazing. Thanks for letting me know Misty.

Now I'm on a quest to figure out the known risk factors (aside from genetics) Clearly (IMO) parents should be told about those rather than being told postpartum about the "risks" of night nursing *sigh*

Prematurity
http://www.medscape.com/viewarticle/461574_3
http://www.angle.org/anglonline/?req...e=02&page=0269

Antibiotics
(a) During Pregnancy: Some of the drugs used to treat infection can cause a range of birth defects, including yellowed teeth, soft tooth enamel and damage to the inner ear.
http://www.betterhealth.vic.gov.au/b...s?OpenDocument
(b) During Labour

Excessive consumption of alcohol during pregnancy
Faulty enamel is an indication of possible Fetal Alcohol Syndrome

C-section


If anyone has any other info. to offer, I'd gladly accept it (must sleep now!)
TIA

[<<>>]

here is my experience....
dd1 (looks like dh) bf till 5m, got "baby bottle rot" when she was 6m. I did everything I could, and since no dentist would in my area (middle of nowhere) would see her before 18m they deteriated very badly...she got 10caps and 5 fillings at 2yo... and trust me it wasn't because I neglected her...
I did have antibiotic, no c-section


dd2 (looks like me) bf 12m no teeth problems what so ever, her smile is perfect.
I did NOT have antibiotics, no c-section


ds3 (also looks like dh) at 5m his top tooth comes down (almost 1/4 of the way down) and the tooth near the gum appears to be red/brown, a day later 1/2 the tooth chips off at the gum line, then the tooth turns white....??? I don't know why??? His bottom front teeth look like they are going to start going bad...
I did NOT have antibiotics, no c-section


My theroy, is that they have a gene from dh that makes them predisposed to bad teeth, dh is 22 and is about to get dentures, and his father, never got the dentures, (or any dental work) and all his teeth are gone, ....

so what did the dentist say,.....???
He blamed my night nursing.... and told me to apply fluride to his teeth...
I asked him how in the 5 days that his tooth was out of his gum that my milk managed to destroy that tooth...??? and why was it discolored???

his answer... well i was obviously mistaken about the discoloration, and you should never ever nurse at night... end of story...



i'm watching his teeth and hoping that his genes havent' predestined him to have teeth that are easily suseptable to decay. I'm still brushing everyday.

[Siana]

It's sad when medical professionals can't see past their personal biases.

Your children are lucky to have such a caring mother who doesn't take the word of a professional as "the law". Good for you.

You should give your dentist a copy of the article on KellyMom. The part in particular interest to his misinformation would be the part I mentioned before:

"In a study done by Dr. Torney, no correlation was found between early onset (< 2 yrs) dental caries and breastfeeding patterns such as frequent night feeds, feeding to sleep, etc. He is convinced that under normal circumstances, the antibodies in breastmilk counteract the bacteria in the mouth that cause decay. However, if there are small defects in the enamel, the teeth become more vulnerable and the protective effect of breastmilk is not enough to counteract the combined effect of the bacteria and the sugars in the milk.[stress mine] Enamel defects occur when the first teeth are forming in utero. His explanation is based on quite a large study of long-term breastfed children with and without caries.

According to this research, a baby who is exclusively breastfed (no supplemental bottles, juice, or solids) will not have decay unless he is genetically predisposed, i.e.. soft or no enamel. In a baby who does have a genetic problem, weaning will not slow down the rate of decay and may speed it up due to lack of lactoferrin."
Source: http://www.kellymom.com/bf/older-baby/tooth-decay.html

Now that I think about it, I have a question about this quote, and I hope it isn't something completely obvious that I'm not quite understanding...

I think they're saying that if a child had no breastmilk, their decay might become more rapid due to lack of lactoferrin. So how does this information translate for night weaning? I think it's that night weaning would mean no contact of breastmilk so reduced rate of decay (slower than during the day since then there is contact with food?). No night weaning would mean a (slightly?) increase or decrease in decay?? The teeth will supposedly be exposed to sugars during night feeding [I've heard the sugars are protected by anti-infective agents and don't break down until they reach in stomach acids] but will also be exposed to lactoferrin. I think Dr. Torney's point is that there is a net loss (i.e. increased decay) during night nursing? I don't think he is suggesting the need to night wean however.

Perhaps the key is to find the validity behind the claims that sugars in BM don't breakdown in the mouth? Perhaps that's why the skulls analysed from centuries ago showed very small signs of decay in young children, who were assumed to have nursed for many years. Perhaps there were less genetic factors involved (since natural selection was not superseded as it is so often now?). Genetics aside, they didn't have to deal with interventions during pregnancy and labour that increased the risk of damaged enamel in fetuses back then.

Wow. I'm not sure what my point is anymore! It seems to be, accroding to Dr. Tornet, that there is a slightly increased risk of dental carries worsening due to night nursing. Now if only someone else would study this more carefully since there are so many variables involved, and I always wonder just how much milk can get washed over the teeth during night nursing since the mechanism needed to express milk typically requires deep mouth suctioning...

And there's my ramble of thoughts on the subject. There has got to be a clearer way to say all this!

[MistyMM]

"In a baby who does have a genetic problem, weaning will not slow down the rate of decay and may speed it up due to lack of lactoferrin."
"

This means that weaning will not slow down the rate of decay in defective enamal, but may in fact SPEED IT UP.

I think that considering prevention in pregnancy, when the teeth buds are forming, is key. I'm not even sure I buy the "genetic predisposition" yeah, I had bad teeth, my mom took a LOT of antibiotics in pg and in labor, and smoked. yeah, she and my dad have bad teeth, but again, their mothers took lots of anti's, and smoked in pg. Where does the antibiotic chain end?

I had antibiotics while pg with my oldest for strep throat. so far he has no decay, was bf until 14.5 mos. I also had antibiotics in labor. no c/s

I had antibiotics while pg with dd for strep throat. no decay again, and sitll nursing at 2.75 yo, no antis in labor. no c/s

I had no antibiotics while pg with ds2. he's 1. so far no teethproblems and still nursing. no antis in labor,no c/s

I think it can be both child and mom dependent. my oldest may have teeth problems in the future, but not yet, same with dd

[umum]

totally overwhelmed here

this is such a timely topic for me. I've been crying all week and trying to make sense of all the studies and info I've been coming across and it's so confusing. It's very hard for me to be objective right now! I must try to stop wallowing and find the best steps to take next.
I learned last week that my 17mo dd has the beginnings of cavities on her two top front teeth. Right now it looks like tartar buildup with white streaking across each tooth.Our family dentist will not treat, as he feels she is too young so has recommended waiting (from my understanding, it's common around these parts to wait until they are seriously decaying and then she'll have access to the children's hospital!). We will be seeing him every 3 mo and he assures us we will make sure she has no pain. At first he did not recommend weaning (recommends bf to age 2 and beyond-yay for him!), but once my husband explained to him how she pretty much spends the night at the breast, he suggested I night wean if I want to save the rest of her teeth. I met with our health unit's hygienist (very pro bf too) and she said the only prob is that when I am lying with her and she falls asleep with breast in her mouth, the milk pools. I agree as I have seen milk dribble out of her mouth while she sleeps. She was horrified when I mentioned night weaning and said as long as I feed her upright, make sure she swallows when she comes off the breast and I wipe her mouth after each bf, I should keep night nursing. It makes sense so I've been doing that but dd wakes up every hour and it's killing me! It was so much easier to lie and sleep peacefully with her.
Although when you look at my and dh's fam. histories there seems to be quite a link, I do believe our all night nursing sessions have contributed. We've always tried to practice good nutrition with dd from preconception on (she does get the occasional treat, especially from my two older ds!), she was unmed homebirth-no drugs taken during pg(although until now never thought of those things as factors) and we always tried to clean her mouth 2xdaily(though she's been putting up a huge fight the last few mo- hygienist assures me it's just dd being a toddler- not due to pain!).
While the dentist feels further decay is inevitable, and the only treatment will be to pull them, the hygienist says that if we're scrupulous, she may just be ok until she outgrows these teeth and if not, treatment could include restoration. I think we will see a pediatric dentist for another opinion.
Anyhow, I'm no academic, but I'll keep looking here for starting points for info.
Also, as I need to be focusing on management, treatment, and outcome, if anyone has experience with this, I would love it if you shared! We are really scared here, and I feel so guilty
Mel

[Siana]

I'm sorry you are going through this Mel. I was just reading an issue of LLL's New Beginnings which had a section about dental carries in breastfeeding children, and the guilt the mothers suffer. Every response from the mothers echoed the comment of Dr. Harry Torney, one of the leading reserachers in this field: Cavities happen in spite of breastfeeding, not because of it!

I hear you about how nursing your child to sleep and through the night is one of life's peaceful pleasures for you both. I was initially surprised to hear about milk pooling in your DD's mouth. But the more I think about my over supply issues with my DC1, I think that definately happened with her.

Couple of things that might make night nursing easier:
* Some mothers try to be aware through sleep of when their child stops nursing, so that you can take the breast out.
* Some tilt their childs head back so that the milk flows in to the back of the mouth and is swallowed.

To me it just seems bizzare that we are dealing with this issues when humans didn't before. I know it's very much diet related, but during pregnancy, maternal stress, low calcium levels, maternal illeness, as well as the aspects outlined in post #6 are all contributing factors over and above genetics. It's rough when breastfeeding takes a blow, because it is something that's so close to many of our hearts, and it seems to be one of the first things that takes a blow from medical professionals. I wish there would be more focus on elightening people of ways to prevent enamel problems in the first place.

I wish I could help you more. I'm hoping for the best for your family (and everyone's family who has to go through similar)