Breastfeeding: Can It REALLY Cause Cavities?

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As a mom of young kids, the topic of breastfeeding is something that’s very near and dear to my heart. I have experienced firsthand the frustration and disappointment when it doesn’t work out, as well as the joy and sense of accomplishment when it does.  As a pediatric dentist, I also happen to know that there is confusion and misunderstanding surrounding the relationship between breastmilk and the risk for cavities on baby teeth. 

I would like to share my professional knowledge so that moms who are nursing can continue to do so for as long as they like, yet also do so in a way that’s not putting their little ones at risk for the unintended consequence of increasing their susceptibility for tooth decay. Most people do not know that in the U.S., tooth decay (aka cavities) is the #1 chronic childhood illness, affecting approximately 50% of children by the time they enter kindergarten.   

Here’s the thing:  I’ve met many moms over the years who feel very guilty or embarrassed because they have been told that their toddler’s cavities were caused by breastfeeding. And let’s be honest, that’s a terrible thing to hear. I happen to know on a very personal level how difficult it can be to establish a successful nursing relationship. Although it’s “natural”, it’s far from easy. It often literally involves blood, sweat, and tears to get it going, so to be told at some point down the road, that breast milk has caused a disease called Severe Early Childhood Caries (aka “nursing decay”) is devastating. 

On the other hand, I’ve also met plenty of moms who are unaware that it’s possible for breast milk to contribute to cavity formation. Since breast milk is considered to be ideal nutrition, how could it possibly lead to cavities? It can’t be!  And of course, as with so many other things, it’s a nuanced situation where the specifics really matter. So let’s dive into the details to get the facts straight. 

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How Do Cavities Form Anyway? 

Let’s start with the most basic mechanism of how cavities form.  We all have tons of different bacteria inside our mouths. Even babies, shortly after they are born, begin to harbor bacteria inside of their mouths. That’s normal, and that’s ok.  And they’re not all harmful bacteria, of course, but there are a few specific types of bacteria that contribute to tooth decay by producing harmful acids that soften and weaken our teeth. Baby teeth are already at a disadvantage because they have a much thinner and less mineralized layer of enamel, which is the outer shell. This weaker shell is much easier to penetrate, and bacteria can then begin to infiltrate the weak spots and invade deeper into the teeth, creating holes (cavities). 

When and How Do Bacteria Produce Acids?

Acids are the “waste product” when certain oral bacteria metabolize any source of carbohydrates. While there are differences in the rates at which different types of carbohydrates are broken down, what ultimately matters most is the frequency of exposure to carbohydrates.  This goes for babies as well as older children, and even adults.  The more often the harmful bacteria are given “fuel” (carbohydrates) and produce damaging acids on our teeth, the more the risk for tooth decay increases. 

What Does All This Have to Do With Breastfeeding? 

Let’s make the connection here. Why is it that breastmilk is so amazing, and that it’s complete nutrition for an infant?  It’s because it contains everything, including protein, fat, and carbohydrates.  This natural source of carbohydrates is well-liked not only by our babies, but by cavity-causing bacteria as well. 

Sometimes people mistakenly think that it’s only “sugar” like table sugar that is harmful when it comes to cavity risk, but it’s not quite that simple. While table sugar is metabolized very quickly and is the most harmful, oral bacteria can also use other sugar sources, like fructose and lactose. Lactose is the “sugar” found in milk, including breastmilk. 

If you’ve ever tasted breast milk, even one little drop, you’ve surely noticed that it tastes pretty sweet, especially when compared to cow’s milk, for example. That’s because the lactose sugar content in breast milk is actually higher than cow’s milk.  Why does this matter?

It all comes back to how many harmful bacteria are on the teeth and how often these bacteria are given a source of sugar. For the purposes of this blog, we are talking about breast milk, though it’s important to note that the same is true for formula, which is made to resemble breast milk and therefore has a similar sugar content. 

What Can I Do to Prevent Cavities from Forming?

The 2 main things that are important here are:

1. Keep your baby’s teeth clean by removing the layer of bacteria that builds up daily. The name for this collection of bacteria is plaque. The better you remove the plaque, the lower your baby’s risk for tooth decay. 
2. Be mindful of the frequency of exposure to carbs, including breastmilk. In the first few months of life, frequency is not relevant, since there are no teeth. Once teeth begin to erupt, it is a good idea to move away from a completely “ad lib” pattern of nursing. This becomes especially important once solids are also introduced, and baby’s diet now has all kinds of overall sources of carbohydrates. 
   

There’s one other factor here that we have to acknowledge. Because nursing is also comforting, there are times when our babies may get breast milk, not because they are hungry or need it nutritionally, but because we are playing the role of the human pacifier.  

After your baby’s teeth have begun to erupt, try to keep middle of the night feedings to a minimum, and see if you can soothe and comfort your baby without offering a little bit of milk repeatedly throughout the night. For the record, there is nothing wrong with the use of a pacifier for children under age 1. We know that that sucking is comforting, and a pacifier can offer this comfort without the carbohydrate exposure. 
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How Do I Check My Baby’s Teeth for Cavities?

The best way to keep tabs on the status of your baby’s newly sprouted teeth is by lifting the lip and inspecting if the color and consistency of the upper front teeth looks uniform. If you see little white specks or spots, or a thin crescent-shaped line near the gums that seems whiter than the rest of the tooth, you may be looking at an area of demineralization, or essentially a “pre-cavity”. This means bacterial acids have weakened those areas, and you and your baby may need a bit of professional assistance to come up with a strong preventive plan. If you see brown spots or patches, that definitely warrants a call to a pediatric dentist who specializes in infant oral health.

If you’re nervous about having your baby or young toddler examined in a dental office and you’re concerned about how it will go, do not worry. At Shady Grove Pediatric Dentistry, we have designed a cozy room that is designed like a nursery for these early visits. It’s a great setting for our youngest patients who will feel comfortable right away in this space that was created just for them.  Getting an early start with oral care can give you the knowledge and confidence of how to properly care for your little one’s growing smile. 

In Health and Happiness,

Dr. Bana Ball