1. Nature’s Elixir or Just Another Substrate? Investigating the Role of Breast Milk in Early Childhood Caries Ruvimbo D Chamunorwa BA (Hons) Kings College Hospital, Denmark Hill, SE5 9RS ABSTRACT The author produced a study involving a sample size of 41 children aged between the ages of 2-5. Parents were asked to answer 10 questions regarding breastfeeding habits, diet and oral hygiene. The results suggest that there is no causal link between breastfeeding and early childhood caries as 4% of the children in this study, of whom all had been breastfed, were reported to have any decay in their primary dentition. 24% of the children had been exclusively breastfed for the first six months of life and of those children only one was reported to have decay. The results suggest that oral hygiene has a greater role in the ECC story as 95% of the children were reported to have had their teeth brushed ‘when the first tooth appeared’ despite 48% of parents reporting that they introduced sugar to the child’s diet before the age of 1 year and 46% of the children still not having seen a dentist by the time they were two years old. Breast milk is widely renowned for being the ultimate nutrition for infants. Consequently and in the absence of evidence that proves otherwise, it is paramount that the mother is not discouraged from breastfeeding but is given support and guidance on how to best care for the child’s teeth during the breastfeeding years. AIM To investigate whether a definitive, evidence-based conclusion can be drawn on whether breast milk is cariogenic and rightly associated with the occurrence of early childhood caries (ECC). METHOD The author carried out a survey of 41 pre-school children aged between 2 to 5 years of age living in a largely affluent borough in London. The mothers were asked to fill out a questionnaire requiring the following information: The current age of the child Whether the child had been breast fed/ bottle fed or both The length of time the child had been breast fed exclusively and the age the child was breast fed until The age sugar had been introduced to the child’s diet The age the child had first had their teeth brushed and attended a dentist appointment Whether the child breast fed during the night Whether the child had any decayed, filled or missing teeth (due to decay) REFERENCES 1)ohiodentalclinics.com accessed September 2014 2)Columbiaapd.wordpress.com accessed October 2014 3)Oral Health Survey (OHS) of three-year old children 2013. Dental Public Health Epidemiology Programme. September 2014 4)World Health Organisation (WHO). The optimal duration of exclusive breast feeding. Press release no. 7. Geneva, WHO, 2001 5)Chaffee B.W et al. Maternal Oral Bacteria Levels Predict ECC development. Journal of Dental Research. 2014; 93(3): 238-244 6)Cockburn F et al. Maternal vitamin D intake and mineral metabolism in mothers and their new born infants BMJ. 1980: 11-14 7)Premier smiles pa.com accessed September 2014 RESULTS 4% of the children in this survey were reported to have decayed primary teeth. This figure is congruent with the results of the Oral Health Survey (OHS) 2013 3 which found that an average of 5% of three-year-old children in that same London borough had caries experience. 24% of the children in the survey carried out by the author were breast fed exclusively for the first six months of life and of those children, only one was reported to have decay. 53% of the children had been fed by both bottle and breast and the average age of the child when breast feeding stopped was 8 months. The most unexpected result of this survey was that 46% of the children surveyed had not seen a dentist by the age of two years; 2.4% still not having seen a dentist by the age of 4, yet low caries was reported. This would suggest that oral hygiene and diet are of good standard with 95% of the mothers stating that their child first got their teeth brushed ‘when the first tooth appeared’. DISCUSSION Breast milk is specifically tailored to the needs of the child and has been universally hailed as the best nutrition for infants 4. The nutrients it offers have greater bio-availability than other forms of infant milk and contain a large number of bio-active components. As breast milk plays a vital part in infant nutrition, it is important to look at all possible contributing factors in the development of ECC where breast milk is involved. It must not be overlooked that the main etiological cause of caries is streptococcus mutans bacteria. High levels of this bacteria have been found in children that have ECC 5. Maternal illness and maternal vitamin D deficiency have been found to interrupt with odontoblostic in utero development resulting in more susceptible enamel in the infant 6. Maternal smoking and traumatic birth have been found to also result in enamel that is more susceptible to caries. A study like this would not be able to take into account any of these factors. Limitations of this study relied on the mother being able to identify caries - there may have been early caries in the child’s mouth. Additionally, questionnaires of this nature are prone to maternal exaggeration, underestimation or incorrect recall of the length of time spent breast feeding. The small sample size and the fact that some questionnaires were returned incomplete may also have played a role in these results that show a low occurrence of caries and no causal relationship between breast feeding and caries. Another aspect to consider is the socio-economic status of the majority of inhabitants of the London borough the survey was taken. The OHS 2013 found that a large disparity exists in caries experience based on area and socio-economic status. This could explain the low caries experience in participants in this study. A future consideration for studies like this would be to collect data from two or more boroughs so that a comparison can be made and a more accurate conclusion reached. CONCLUSION The results of this study would suggest that there is no causal link between breast feeding and caries experience. However, no participants recorded having been breastfed for more than two years of age hence it cannot be concluded what effect a more prolonged breast feeding period may have had. 1 2 7