Unlike bottle feeding, breastfeeding does not cause dental caries. The reasons for this are varied.

When breastfeeding, babies suck and swallow simultaneously. Breast milk enters the mouth behind the teeth and does not pool in a baby’s mouth (Bonyata 1998).

Antibodies (IgA and IgG) in breast milk counteract bacteria in the mouth and lactoferrin actually kills streptococcus mutans (Arnold 1977).

In vitro breast milk has also been shown to remineralise artificially demineralised enamel (McDougall 1977). This was further corroborated by Erickson (1999), who soaked extracted premolar crowns in different solutions and found that the breast milk caused no decay. In fact, the tooth appeared to be stronger after immersion. Dr Tinanoff (1997) also concluded that after five minutes of breastfeeding, the pH level in a baby’s mouth was only slightly changed against being rinsed in plain water.

Eminent American dentist Brian Palmer (2000) goes further stating that "Empiric evidence does not support a causal association between breastfeeding and infant caries", concluding that: "breastfeeding truly is the best and cheapest form of health insurance"

New directives

In 1994, as a result of the earlier studies, the UK Committee on Medical Aspects (COMA 1994) published their weaning report. This publication advocated the introduction of solid foods from four to six months. The report strongly recommended that infants older than six months should be introduced to drinking from a cup and suggested that the use of bottles be actively discouraged from 12 months. While the document refers to ‘bottles and reservoir feeders’, it must be emphasised that any vessel which is designed to encourage frequent sipping has the potential to damage oral health, interfere with oral muscle development and may even have a detrimental effect on speech (Eig 2002). Only open cups can truly be seen to fulfil the criteria for encouraging drinking rather than sucking.

In 2001, the WHO changed its recommendations on weaning to advocate exclusive breastfeeding for the first six months of life, with the introduction of complementary foods and continued breastfeeding thereafter (WHO 2001).

The Scientific Advisory Committee on Nutrition (SACN 2001), the body replacing the COMA panel on child and maternal nutrition, responded to the WHO recommendations in September 2001. It now agreed that: "Mothers of infants should be particularly warned of the dangers of putting fruit juice or sugar-sweetened drinks into feeding bottles or reservoir feeders for the child to hold, especially in bed. Such practices result in almost continuous bathing of the enamel with sugars and lead to severe tooth decay".

These ‘nursing bottle caries’ are not just detrimental to a child’s physical health; the increased need to undergo surgery for tooth extraction at a young age also has obvious psychological repercussions.

In the States, the American Academy of Pediatrics (AAP 2003) do not differentiate between formula feeding and breastfeeding when they conclude that children who sleep with a bottle or breastfeed throughout the night are at risk of developing ECC. Evidence is clear regarding the vast benefits of baby-led breastfeeding and future policy needs to reflect this.

The American Academy of Pediatric Dentistry (AAPD 2003) also recommends that "nocturnal breastfeeding should be avoided after the first primary tooth begins to erupt". As this could occur before six months of age, this advice could contradict that of the WHO (2001). Consistency is vital when new directives are published and communication between agencies will help to avoid confusion for parents and professionals.

Speech difficulties?

Although evidence is mostly anecdotal, it has been suggested that there may be a link between inappropriate infant feeding and later speech development. Selley et al (1990) identified seven common factors in co-ordinated neonatal feeding and speech production, namely: rhythm, breath-control, lip tone, delicate tongue movements, speed of muscle movements, well developed sensory feedback and a relaxed feeding situation. Breastfeeding and open cup feeding fulfil these criteria by encouraging development and maturation of these factors, while promoting a positive feeding experience.

Some speech therapists still believe that the action of drinking from a lidded cup can interfere with the more complex swallow required when using an open cup. The latter action helps to build the muscles required for proper speech to develop.

Sara Rosenfeld-Johnson, a speech pathologist from Tucson, Arizona, presents seminars around the USA and is one of the most outspoken critics of the ‘sippy cup’. She does however concede that those speech anomalies are easily treated by switching back to regular open drinking cups (Eig 2002).

© Sharon Trotter

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This article can also been seen at MIDIRS Midwifery Digest 16:3 2006