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COPYRIGHT 2002 Mothering Magazine
You're going to have to stop nursing your son or sacrifice his teeth!" the dentist proclaimed. "But diabetes runs rampant in my family," I sputtered, "and nursing Collins until he's ready to wean himself is one of his only defenses." "Well, it's your choice," he replied.
Not wanting to cause any more trouble, I pocketed the "Free McDonald's Ice Cream Cone" coupon the receptionist gave to me as my 18-month-old son's reward for screaming his head off during our visit and retreated to my car. How could my son have developed two cavities, plaque, and so many white lesions (precursors to cavities) on a sugar-free diet, and at such a young age? "Bottle-mouth" the dentist had proclaimed. But how could my breastfed son have "bottle-mouth"?
I decided to look for another dentist and to seek information on Medline, an on-line clearinghouse of dental and medical studies. What I discovered was surprising, validating, and guilt relieving. More than three dozen studies showed that my son's early cavities (also called caries) were not caused by nursing--breastmilk is not cariogenic--but by an infectious disease classified only recently as early childhood caries (ECC). (1) Moreover, according to the National Institute of Dental and Craniofacial Research (NIDCR), breastfed children are less likely to develop this disease than their bottle-fed counterparts, and population-based studies do not support a link between prolonged breastfeeding and ECC. (2)
The Medline studies were listed by date, an arrangement that made obvious a significant pattern: only the recent studies distinguished between bottle-fed and breastfed babies, a fact that explains old names for the disease such as "bottle-mouth," "bottle-rot," "baby bottle tooth decay," and "nursing caries." The author of a 1986 Mothering magazine article on dental caries could find no studies that distinguished between bottle-fed and breastfed babies. (1)
La Leche League International (LLLI) has stated that, "Breastfeeding is typically assumed to be a cause of dental caries because no distinctions are made between the different compositions of human milk and infant formula or cow's milk, and between the different mechanisms of nursing at the breast [with the nipple at the back of the mouth, not allowing breastmilk to pool around the teeth] and sucking on a bottle with an artificial teat.... We have only to consider the overwhelming majority of breastfed toddlers with healthy teeth to know that there must be other factors involved." (4) (See sidebar on ECC risk factors.)
The Centers for Disease Control (CDC) discarded the terms "bottle-mouth" and "nursing caries" in 1994, thereby acknowledging ECC as an infectious disease not caused by breast--or bottle-feeding. Most studies now focus on ECC's true causes, contributing factors, and even cures. (5) It's about time, too. In 1997 the American Academy of Pediatric Dentists (AAPD) declared that ECC was "currently at epidemic proportions in some US populations ... particularly among racial and ethnic minorities. The caries level in three- to five-year-old US Head Start children may be as high as 90 percent." (6)
Nevertheless, the American Dental Academy (ADA) website continues to caution, "A condition called baby bottle tooth decay can destroy a baby's teeth. Examples of bottle-fed liquids that can' cause tooth decay are infant formula, fruit juice, milk, breast milk and any sweetened liquid." (7) No new or updated policy is forthcoming, according to an ADA spokesperson.
"Most dentists and breastfeeding mothers have an adversarial relationship because dentists are likely to discount academic studies proving breastfeeding does not contribute to caries," says Kevin Hale, a pediatric dentist in Brighton, Michigan. Hale serves on the Section on Pediatric Dentistry for the American Academy of Pediatrics (AAP) and the Counsel on Pre-doctoral Education for the AAPD and is currently one of three people responsible for drafting a policy proposal for the AAP that would recommend educating dentists and pediatricians on ECC's causes and risks factors. (8)
"Breastfeeding is great," Hale told me. "I do health histories on my patients--80 a month--and it is profound, the difference between the health of the kids who were breastfed and those who were not. If a mother is breastfeeding, which...
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