Tooth Decay in babies and toddlers €“ Milk Caries
What Every Parents Need to Know
My baby was an early teether. When she was 6 months old we were excited to welcome her bottom teeth. By the time she was 8 months her first top teeth came down. It was around one year old when I noticed a greenish line on the top front teeth, up around where they protruded from the gum. I thought it was a temporary discoloration and tried to clean it off. But it wasn’t until a month or so later that I realised it was some sort of marking that had broken through the enamel layer. I thought that the situation would right itself and in my naiveté basically didn’t worry about it. However as the months passed the size of the etched marking became larger.
To my horror and dismay she had developed what is known as ‘milk caries’.
The markings spread along all four front top teeth near to the gum, and over time they enlarged and slowly ate them away. I watched helplessly and in horror, as I was advised that there is no way to stop the decay once the enamel has been breached, other than via dentistry. This of course was out of the question for such a young baby, unless aided by the use of an anesthetic. At this point in time it seemed an extreme action for us.
But by the age of 18 months her top front four teeth were so weakened by the decay that they were crumbling. At close to 2 years old her upper front teeth were stumps at the gum.
How did this happen?
My baby was a real ‘titty-monster’. She was not interested in eating much solid food. Even up to the age of 15 months she mostly just wanted the breast, even though she had a full set of front teeth and some molars. ; It did not seem to be a nutritional problem as she was large boned and solid bodied. My milk was obviously nutritious but seemed to be the only possible factor contributing to decay.
I am a primal mother by orientation. In other words I am attracted to the most instinctive parenting methods. ; I have been fortunate to birth both my children naturally, in my chosen home environment. ; Breastfeeding seemed and felt to be the most natural way to feed and protect my babies. ; I had already breast fed my eight-year-old to the age of 3, and she had perfect teeth.
So why did these ‘milk caries’ occur? Why do they occur in some babies whose mother’s feed them at night and not others? These questions and more plagued me. I researched as much as I could about it. I spoke to experts in Sydney, spent hours on the web, saw local dentists and finally, a pediatric dentist.
How and when:
In a 1999 review article on breastfeeding and caries, Dr. Erickson concluded, "human breast milk is not cariogenic." Breast milk actually contains enzymes that inhibit decay.
Most writers on this topic conclude that breast-feeding has only a very small risk of producing caries and that the benefits of extended breastfeeding (beyond 12 months) outweigh the low risk. Usually milk caries can result from bottle-feeding babies with formula or fruit juice. Some toddlers with a high carbohydrate diet have also been recorded with resulting caries.
The most commonly agreed causes of caries in infants are:
1. Sugar intake.
2. When and how much, decay causing bacteria is introduced into the infant’s mouth (potentially by adults or other children)
3. Low saliva flow (which is normal at night)
4. Illnesses of, or stress to, the mother or fetus during development.
5. Poor dietary habits of the family.
6. Poor oral and overall hygiene of the family.
7. Family genetics (minor contributor).
It is noted that breast milk is prevented from pooling in the infant’s mouth because the breast does not release milk unless the infant is actually sucking and swallowing.
However, my habit of falling asleep with her also asleep on the breast may have allowed a pooling of milk at the teeth. ; This creates an ideal environment for bacteria to produce acid that literally eat the teeth away. This is a common result when babies are given fruit juice, even diluted, in a bottle and allowed to fall asleep attached to the bottle, which continues to drip sweet fluid into their mouths.
So when I looked at these causal factors, a picture began to emerge to explain our dilemma.
1. Breast milk is very sweet, and the frequency of exposure was, in my case, often for an hour at a time, several times a night.
2. Frequent breast feeding and pooling of milk occurred at a low-saliva time: night.
3. Early teething meant that her newly emerging teeth were soaking in the ideal environment for bacterial growth.
4. Having an older child in the house, and her friends, may have provided more opportunities for bacteria to be transferred to the baby’s mouth.
Enamel problems may often be a causal factor in vulnerability to decay. However, according to Dr. Graham Craig, milk caries are no indication of the strength the baby’s teeth. “Under the optimum conditions it’s like battery acid eating away at metal.” ;
Why was my experience with my first child so different? I chose to breastfeed her similarly, on demand, for just over 3 years. As a newborn, she was an avid sucker and after 4 days walking around with our fingers in her mouth, I got her a dummy. She would withdraw from the breast when satiated and open her mouth for her dummy. (She happily chose to throw it out of a car window one day when she was two and a half and never looked back.)
Ironically I had always felt embarrassed at her use of the dummy and was determined not to use it with my second child. Perhaps I over-availed my breast in my earnest desire to not use a dummy. It appears that the use of the dummy enabled the saliva to wash away any milk sugars.
Recently my second child’s top lip suddenly and painfully swelled up. She had an abscess forming where the bacteria had infiltrated through the front tooth into the gum. We were motivated by this to seek the advice of a Pediatric Dentist. Only when I could see the full extent of our baby’s tooth decay did I realise we had to take the drastic step of dental surgery under anesthetic. Just before her 2nd birthday, her four front stumps were extracted and the first four molars capped with a stainless steel cover. Two ‘pulpotomies’ were needed (like a root canal) and two were still viable. The second set of molars were ‘fissure sealed’.
It sounds like an extreme procedure, but I am so relieved to have acted to remove all sources of decay from her teeth. I wish that I had overcome my terror of putting her under anesthetic and acted earlier, because it is clear we would have been able to save her front teeth. However we were able to save her molars and we now pursue a program of careful monitoring and maintenance. I weaned her at night at the time of the operation, and after her last feed I give her a sip of water. We brush her teeth morning and night, and avoid sticky sweet foods like dried fruit, lollies etc. We give her a daily supplement of calci-fluor tissue salts. I continue to breast feed her during the daytime. I am writing this 4 months after her operation and there are no signs of decay.
My conclusion is, when feeding your baby, with breast or bottle; please keep these recommendations in mind, and save your baby’s teeth!
;
1. Once the first teeth begin to show, never allow your baby to fall asleep on the breast or bottle. Gently extract them just as they begin to drift off and it is clear they are no longer feeding.
2. Neutralise the effects of sweet foods such as breast or bottle milk by offering them a sip of water after feeding in the daytime. Avoid fruit juice, even watered down, especially at night. Get your baby used to the thirst quenching delight of water.
3. Introduce the use of a toothbrush as early as possible. Make it fun and interesting for your toddler. It is not necessary to use any toothpaste. ; Water and a soft toothbrush are sufficient. The most effective brushing motion is a gentle flicking motion from the gums, down along the height of the teeth, as well as the regular lengthwise motion along the chewing surface of the molars. This aims to break-up the bacteria colonies, which take 24 hrs to establish a colony. Brushing morning and night ensures they will be unable to form decay sites
4. Make regular observations inside your baby’s mouth, even if they protest vehemently (as mine did and often still does). Try tipping them upside down, whilst hugging them. If you do notice any indentations in the enamel, visit your local pediatric dentist as soon as possible and get expert advice. These people specialise in babies and children and are worth the extra time and money just to get knowledgeable advice.
My research indicates that it is a relatively rare event for breast-feeding to create dental caries. It is more a combination of optimum conditions that can be avoided with knowledge and awareness.
References:
1. Craig, Dr. Graham of Dental Outlook Publications, Sydney
2. P.R. Erickson and E. Mazhare Investigation of the role of human breast milk in caries development. Pediatr Dent 1999;21:86-90.
3. P.R. Erickson and K.L. McClintock Green N, et al. J. Estimation of the caries-related risk associated with infant formulas. Pediatric Dent 1998;20:395-403.
4. Sinton J, Valaitis R, Passarelli C, et al. A systematic overview of the relationship between infant feeding caries and breast-feeding. Ont Dent 1998;75:23-27. ;
5. Smith, Linda J. BSE, FACCE, IBCLC Extended Breastfeeding Non-Risk #2: DentalCaries, 1994
;
Author - Sharon Shostak
Sharon Shostak founded the Mullumbimby Yoga Studio and has taught yoga classes since 1991. She has degrees in psychology and filmmaking and specialises in mosaic art.
<< Previous Tiny Hands Can Talk - Using Sign Language with Young Children | Back to Baby Health and Development | Next >> What Babies Want - and interview with Debby Takikawa
