|Year : 2022 | Volume
| Issue : 5 | Page : 447-453
Breastfeeding and bottle-feeding as risk factors for dental caries and malocclusions in children with deciduous dentition: A scoping review
Jazmin M Amores-Esparza1, Victoria Altamirano-Mora2, Inés Villacís-Altamirano3, Camila Montesinos-Guevara2
1 Posgrado de Odontopediatría, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
2 Centro de Investigación en Epidemiología Clínica y Salud Pública (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
3 Posgrado de Odontopediatría, Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador; Facultad de Odontología, Universidad Central del Ecuador, Quito, Ecuador
|Date of Submission||22-Apr-2022|
|Date of Decision||09-Aug-2022|
|Date of Acceptance||17-Aug-2022|
|Date of Web Publication||31-Oct-2022|
Ms. Camila Montesinos-Guevara
Rumipamba and Bourgeois, Universidad UTE, Quito 170147
Source of Support: None, Conflict of Interest: None
Aim: To identify the available evidence on the effects that breastfeeding and/or bottle-feeding may have on the presence of early childhood caries (ECC) and malocclusion in children with deciduous dentition. Materials and Methods: A systematic search was carried out in different databases, including PubMed, Cochrane Library, Lilacs, and Epistemonikos, up to January 6, 2022. Studies were independently selected by two reviewers according to title, abstract, and full-text analysis. Disagreements were solved by a third reviewer. Results: A total of 1343 studies were found from the initial search, of which 42 studies were included in this study. Results are controversial, 14 studies concluded that prolonged breastfeeding and bottle-feeding at night increase the risk of caries, 7 studies mentioned that breastfeeding could be a protective factor for dental caries development in children under 6 years, 20 studies concluded that children who were breastfed for less than 6 months have a higher risk of developing malocclusions compared with children who were breastfed for a longer time and children who were bottle-fed compared with children who were breastfed had a higher prevalence of malocclusions, mainly anterior open-bite. Four studies found no significant association between breastfeeding and/or bottle-feeding with the development of dental caries and malocclusion. Conclusion: Most included studies concluded that the presence of ECC may be associated with bottle-feeding and prolonged breastfeeding, but reasons still need further development. Regarding malocclusions, most studies concluded that prolonged breastfeeding could be a protective factor for its development, whereas a high frequency and duration of bottle consumption could lead to deformations in the maxillary bone, mainly anterior open-bite. However, results are still controversial.
Keywords: Bottle-feeding, Breastfeeding, Dental Caries, Malocclusions
|How to cite this article:|
Amores-Esparza JM, Altamirano-Mora V, Villacís-Altamirano I, Montesinos-Guevara C. Breastfeeding and bottle-feeding as risk factors for dental caries and malocclusions in children with deciduous dentition: A scoping review. J Int Oral Health 2022;14:447-53
|How to cite this URL:|
Amores-Esparza JM, Altamirano-Mora V, Villacís-Altamirano I, Montesinos-Guevara C. Breastfeeding and bottle-feeding as risk factors for dental caries and malocclusions in children with deciduous dentition: A scoping review. J Int Oral Health [serial online] 2022 [cited 2022 Dec 6];14:447-53. Available from: https://www.jioh.org/text.asp?2022/14/5/447/359973
| Introduction|| |
Early childhood caries (ECC) is considered one of the most prevalent non-communicable diseases in childhood, which leads to a rapid destruction of primary tooth surfaces; it is defined as the presence of caries, white spot lesions, and/or tooth loss due to caries and restorations on one or more temporary teeth in children under 6 years. The indiscriminate use of baby bottles is considered a main risk factor for the development of ECC due to the high cariogenic potential of the liquids introduced in the bottles, especially those that contain sugar as its consumption is correlated with the development of dental caries.,
In contrast to bottle-feeding, breastfeeding is a protective factor in the first 6–12 months of life., Nutritional components of breastfeeding such as fats, sugars, and proteins support a healthy development of the immune and nutritional system of the child and offer benefits to their oral health. The World Health Organization (WHO) recommends breastfeeding alone for the first 6 months of life and considers it a complementary diet up to 2 years.
Malocclusion is a developmental disorder caused by genetic and environmental factors, generally affecting the maxillofacial system (jaw, tongue, and soft facial tissues). Most stomatognathic system’s problems originate in the first year of life during first dentition development and orofacial growth, when teeth and bones are establishing a normal and balanced formation.
Most parents do not take their child to a dentist during the breastfeeding period or when the child’s teeth first come in, which is a problem in the long term as these periods are essential to diagnose and to apply the first therapeutic or preventive measures. For this reason, it is important to summarize the existing evidence on the oral effects of breastfeeding and/or bottle-feeding on the development of dental caries and malocclusions to guide parents and prevent future stomatological problems. Therefore, the objective of this study is to identify the available evidence on the effects that breastfeeding and/or the use of baby bottle may have on the development of dental caries and malocclusion in children with deciduous dentition.
| Materials and Methods|| |
This review was conducted according to the Joanna Briggs Institute’s Reviewers Manual for JBI Scoping Reviews. This study’s protocol was developed and registered at OSF on November 11, 2021, and it is available at https://osf.io/wdsc3/.
A systematic search was performed up to January 6, 2022 in databases such as Medline/PubMed, Cochrane Database of Systematic Reviews, Lilacs, and Epistemonikos. An additional search was performed on Google Scholar as part of the gray literature. We did not apply any filter by dates [Table 1].
Studies were included if the population was children aged 1–5 years with deciduous dentition who were fed by bottle and/or breast (exclusive and complementary). We only included studies which were observational (cross-sectional or studies of prevalence, case reports, cohort studies, and case–control studies), a systematic review or a randomized clinical trial. Included studies had to be published in English, Portuguese, or Spanish. Studies on permanent dentition and children with any disability were excluded.
Studies that met the inclusion criteria were independently selected by two reviewers (JMA-E, VA-M), according to title, abstract, and full-text analysis. Disagreements were solved by a third reviewer (CM-G). The selection process was carried out in Rayyan Systems Inc.
Two reviewers (JMA-E, VA-M) independently performed data extraction in an Excel spreadsheet and in case of disagreements, these were solved by a third reviewer (CM-G or IV-A). Data extraction included author, year of publication, country where the study was carried out, purpose of the study, population’s age and sample size (when applicable), study design, type of intervention/comparison, duration of the intervention, main results (in terms of caries and malocclusions), and conclusions of the scoping review.
| Results|| |
About 1343 studies were obtained from the systematic search, and 70 studies were excluded for being duplicates. A total of 1273 studies were screened by Title/Abstract, from which 1195 studies were excluded for reasons such as publication type or wrong population, among others. Seventy-eight studies were selected for full-text screening of which 36 did not meet inclusion criteria. Finally, 42 studies were included in this scoping review as shown in the PRISMA flowchart [Figure 1].
|Figure 1: PRISMA flow diagram showing the screening process of the included studies|
Click here to view
Included studies were published between 1999 and 2021. Eighteen out of 42 studies were from Brazil,,,,,,,,,,,,,,,,,, 5 from India,,,,, 4 from Japan,,,, 3 from Australia,,, 2 from China,, and the remaining from countries such as Thailand, Nigeria, Italy, Canada, Finland, Greece, United States,, Iran, and Spain.
Additionally, most studies (60%) were cross-sectional.,,,,,,,,,,,,,,,,,, About 19% were cohort studies,,,,,,,, 14% were systematic reviews,,,,,, and 7% studies were longitudinal.,, The age of the participants included in the studies varied between 0 months and 6 years of age, and the most common age range was 3–5 years. Finally, the main objective of half of the 42 included studies was to evaluate the relationship of breastfeeding or bottle-feeding and the development of early childhood caries,,,,,,,,,,,,,,,,,,,,, whereas the other half of the included studies had as their main objective to evaluate the use of bottle or breastfeeding and the development of malocclusions, mainly cross-bite,,,,,,,,,,,,,,,,,,,, [Table 2].
Conclusions of the included studies are controversial. Fourteen studies,,,,,,,,,,,,, concluded that prolonged breastfeeding and bottle-feeding at night increase the risk of caries. However, seven studies,,,,,, mentioned that breastfeeding is a protective factor for dental caries development in children under 6 years. Furthermore, 20 studies,,,,,,,,,,,,,,,,, that assessed feeding methods and the presence of malocclusions concluded that children who were breastfed for less than 6 months have a higher risk of developing malocclusions when compared with children who were breastfed for a longer time and children who were fed by bottle, especially in terms of anterior open-bite and posterior cross-bite. Four studies,,, found no significant association between breastfeeding and bottle-feeding with the development of dental caries and malocclusion.
| Discussion|| |
Over the years, much controversy has been generated regarding breastfeeding and/or bottle-feeding and their relationship with the risk of caries development or the presence of malocclusions. Most studies included in this scoping review mention that prolonged breastfeeding is a risk factor for caries development, with the highest rate of caries in children who were breastfed for more than 18 months and less than 6 months., It is worth mentioning that these studies are cross-sectional, and the results could probably be associated with other confounding factors that were not considered such as the high sugar content in complementary feeding, which usually begins after 6 months of age.
In contrast, other studies indicate that the causal effects of breastfeeding for the development of dental caries have not yet been identified.,,, However, most of the studies are also cross-sectional and are carried out in short periods of time, thus some variables that can affect the development of caries in the long term, such as the incorporation of sugary foods or the lack of dental hygiene, have not been considered. The Spanish Association of Pediatric Disease corroborates this by indicating that several studies do not mention factors regarding the risk of dental caries due to breastfeeding.
Other studies,, indicate that breastfeeding has a caries-protective effect as it guarantees better health and physical and mental development of children, especially because breast milk provides them with greater protection from diseases and a better nutritive feeding practice due to its mineral contents such as phosphorus and calcium and proteins such as casein that help with teeth remineralization.
With respect to the use of the bottle, two studies, mentioned that children who sleep while drinking a bottle develop more dental caries due to the amount of sugar content in the bottle and due to the limited dental hygiene [not using a toothbrush and toothpaste with fluoride (1000 ppm) as recommended by several dental associations such as the American Dental Association—ADA]. In addition, two studies mentioned that there is a significant difference regarding the contents of the bottle, which generally include fruit juices, cow’s milk, or formula milk. Fruit juice is the most harmful due to its natural sugar content (fructose) and other additives., A study also concluded that night consumption of the bottle has a negative impact for the development of cavities because during sleeping acidity levels increase while saliva decreases and there is a higher tendency for biofilm to grow.
Regarding malocclusion, three studies mentioned that children who suck the bottle’s pacifier for too long have a tendency toward deformations in the maxillary bone. Therefore, they are prone to present anterior open-bite or cross-bite and posterior cross-bite malocclusions; anterior open bite being the most frequent.,, In contrast, other studies showed that there is a lower risk of malocclusions among children who have been breastfed for a prolonged time, specifically those who were breastfed for more than 12 months.,
In terms of this study’s strengths, an exhaustive systematic search was carried out, which included studies published in English, Spanish, and Portuguese. Most of the included studies were performed in Brazil, showing the development and focus that Brazil has on this topic, and the need for carrying out more studies on this subject in other countries in order to provide a worldwide perspective. In addition, due to the wide inclusion criteria in terms of the study design, several cross-sectional studies (n = 25) were included, such as survey-based studies, followed by other longitudinal studies. Thus, more prospective cohort studies with longer-term follow-up are needed to obtain more reliable data and to assess other possible risk factors that may affect children’s dental health.
One limitation of this scoping review is language restriction. Although we included articles in English, Spanish, and Portuguese, we did not widen our search to other languages, leading to a potential reporting bias due to the limited access to articles published in other parts of the world that have not been published in the included languages. Another limitation of this study is that conclusions are limited in terms of bottle-feeding’s relationship with dental caries as most studies did not specify the content of the bottle. Some studies mentioned that bottle-feeding is a risk factor for the development of dental caries. However, they did not consider the sugar content, time, and frequency of use, which should be taken into account in future studies.
| Conclusions|| |
Most studies included in this scoping review concluded that early childhood dental caries may be associated with bottle-feeding and prolonged breastfeeding, in the former, possibly due to the bottle’s content in terms of sugar, and in the latter, reasons have not been explained. Regarding malocclusions, most studies concluded that prolonged breastfeeding could be a protective factor for malocclusion’s development, whereas a high frequency and duration of bottle consumption could lead to deformations in the maxillary bone, frequently anterior open-bite. However, there is still controversy regarding these results based on the included studies. More prospective cohort studies with long-term follow-up are needed to obtain more reliable results. Finally, in dental practice, it is usually recommended to promote breastfeeding and bottle-feeding along with correct nutrition, feeding frequency, and dental hygiene. We consider that further studies are needed to support this clinical practice and ensure that these recommendations are evidence-based.
The authors of this study would like to thank Mark Hartvigsen for his linguistic editing suggestions.
Financial support and sponsorship
This study did not receive any funding.
Conflicts of interest
The authors state no conflicts of interest.
JMA-E was involved in all the stages of this study: study conception, data collection, data acquisition and analysis, data interpretation, manuscript writing; VA-M: data collection, data acquisition, and analysis; CM-G: study conception, data analysis, data interpretation, and manuscript writing; IV-A: manuscript writing. All authors approved the final version of the manuscript for publication. All the requirements for authorship have been met and each author believes that the manuscript represents honest work.
Ethical policy and Institutional Review Board statement
Patient declaration of consent
Data availability statement
The data set used in the current study is available upon request from the corresponding author.
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[Table 1], [Table 2]