Some people may find this article too elementary since it has been proven, time and time again, that nighttime bottlefeeding does tooth decay. But recently, I had a patient (whose mother is a Baby Magazine reader at that) who was so surprised when I told her that it's the nighttime bottlefeeding of her child that caused the problem. So I found the need to go back to this very important information.
Putting your child to sleep with a bottle can cause tooth decay. Cavities are those nasty brown and black spots on the teeth that can eventually cause pain, infection and malnutrition among other things. Cavities may not seem like a big deal, and your child could be happy even with them, especially when he/she does not complain of any pain. But remember, that these are the only teeth your child will have during the years when much of his personality and self-image are formed. Even though it may seem loving to give him a bottle to go to sleep, it may be more loving to help him fall asleep in other ways.
Nighttime bottlefeeding causes decay but it is quite gradual. Over time, the teeth are weakened. Usually, the enamel is finally breached sometime between 12 and 18 months of age. It starts in the upper front teeth but the lower front teeth remains unaffected since the tongue protects the lower front teeth during a sucking action. What is it in the bottle or the milk that causes decay?
1. Food sugar content
Cavities result from the interaction between normal mouth bacteria and carbohydrates in the diet. These bacteria use food sugars to produce acids. The acid then attacks the enamel of the teeth. When there is a prolonged contact, the acid produced etches the enamel of the teeth, causing the enamel to dissolve.
Since the infant formula does contain sugar, this sugary liquid is left in the mouth for hours every night. This prolonged and constant contact is the reason why the enamel, even though it is the hardest bone in the body, dissolves as it breaks down against the acid production.
2. Decrease in salivary glands
When one falls asleep, the salivary glands fall asleep as well. Thus, the saliva production decreases rapidly. Saliva is very important because it can wash away the food particles left in the mouth, it buffers the acid produced and saliva is a carrier of the important minerals like fluoride, calcium and phosphate therefore, it promotes remineralization of the teeth. So, when saliva production decreases, the benefits of the saliva are diminished as well.
Swallowing also decreases during sleep. The liquids presents in the mouth at the time of falling asleep tend to pool for long periods of time. As stated in #1, prolonged contact of any sugary liquid will lead to the acid being etched into the enamel causing its breakdown.
3. Bottlefeeding mechanism
Milk from a feeding bottle constantly flows, even without the baby actively sucking. Therefore, when the baby falls asleep with still some unfinished milk in the bottle, the milk will constantly flow, causing the pooling of the milk in the baby’s mouth, especially around the necks of the teeth.
The cavities first appear at the gum line as subtle, white, decalcified streaks. The process then begins to speed up. In advanced cases, the crowns of the upper incisors become completely destroyed, causing pain and infection.
Breastfeeding and Tooth Decay
They say that breastfeeding is a lot more advantageous. And yes, I agree. It is more nutritious and economical; it results in a better bond between mother and child and the list can go on and on. Being a mother of four, I have always dreamed of breastfeeding past the 3 week mark that I can only manage breast feeding my newborns. That’s why I salute the mothers who really dedicate themselves to this very noble and unselfish act. But can it cause tooth decay?
For one, according to an article in the March/April 1999 issue of Pediatric Dentistry, it concluded that human breast milk is not cariogenic (tooth decay causing). Even though breast milk does contain lactose, it also contains lactoferrin, a component that actually kills the bacteria that causes tooth decay.
Second, they believe that when a baby is breastfeeding directly to the mother, breast milk doesn’t flow unless the baby is actively sucking. Hence, the pooling of the liquid in the baby’s mouth doesn’t happen, even though the baby falls asleep. If the baby is actively sucking, then he is also swallowing, so pooling breast milk is not an issue. It may become an issue though when breast milk is placed in the bottle and fed to the infant. Then pooling of the liquid can happen. Although this point needs to be studied further.
Numerous studies have been done to correlate breastfeeding and tooth decay, and they could find no correlation. In a study done by Dr. Tomey, no correlation was found between early onset (<2 years old) dental caries and breastfeeding patterns such as frequent night feeds, feeding to sleep, etc. He is convinced that under normal circumstances, the antibodies in breast milk counteract the bacteria in the mouth that cause decay. However, other factors can come into play, like defects in the enamel, at which the teeth become more vulnerable and the protective effect of breastmilk is not enough to counteract the combined effect of the bacteria and the sugars in the milk.
Much research indicates that it’s the other foods in the baby’s diet that tend to be the main problem when it comes to tooth decay. According to Brian Palmer in 2002, human milk alone does not cause caries. But infants exclusively breastfed are not immune to decay due to other factors that impact the infant’s risk for tooth decay.
Whether your baby is bottlefed or breastfed, it’s always a good idea to have good oral hygiene practices. To name a few -- brush your baby's teeth with a fluoridated toothpaste especially at bedtime; give him a sip of water after meals to wash food particles away; avoid too many sugary and starchy snacks. More effort will have to be instituted in the part of the parents of the bottlefed children – don’t let the babies fall asleep with a bottle of milk or any sugary beverage; after bottlefeeding, giving the babies a sip of water will not only wash any pool of milk but neutralizes the ph of saliva as well; wean your child from the nighttime bottlefeeding when they turn 1 year old; avoid making the bottle a "pampatulog" as this will turn into a habit. Once it is a habit, the harder it is for you to wean them. They will never fall asleep not unless they are given a bottle. When they turn a year old, it may be better to find other ways to make them fall asleep, other than that bottle.
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