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Breastfeeding, especially for prolonged periods, has often been suggested as a potential risk factor for early childhood caries (ECC), despite a lack of supporting evidence for the claim. But a new study in the October 2007 Pediatrics1 should help to reassure nursing and expectant mothers, as well as pediatric dentists, since it found that neither breastfeeding nor its duration is associated with increased risk of early childhood caries. Rather, the study identified poverty, Mexican-American ethnic status, and maternal prenatal smoking as independent risk factors for ECC among young children. The findings were publicized by Reuters Health2, WebMD3, HealthDay News4 and others.

The study evaluated data from over 1,500 children aged 2 to 5 years who participated in the 1999-2002 National Health and Nutrition Examination Survey (NHANES), a cross-sectional health evaluation conducted by the CDC National Center for Health Statistics (NCHS). In this ethnically diverse sample of U.S. children, approximately 27 percent were identified as having early childhood caries, and nearly 60 percent were breast-fed for some period of time (from less than 1 month to over 1 year). After multivariable analyses, the authors concluded that breastfeeding history and duration were not associated with either increased risk of ECC or increased decayed and filled surfaces on primary teeth.

While breastfeeding has long been implicated as a risk factor for early childhood caries, the new study and previous population-based evaluations, including a 2004 JADA report, do not support an association. Nevertheless, early childhood caries is found throughout the general population and remains a significant public health problem in some population groups. In the newly published study, Mexican American children aged 2 to 5 had the highest levels of early childhood caries (≈42%) and severe ECC (≈18%). Lower family income and maternal smoking were also cited as risk factors for caries in primary teeth.

Given these findings, the authors emphasize the need to target children living in poverty, Mexican American children, and those whose mothers smoke or smoked during pregnancy for caries risk assessment and regular preventive dental care. In offering these recommendations, the authors also acknowledge a range of study limitations, including missing or limited data on fluoride exposure, nursing patterns and frequency, maternal oral health status, and family oral hygiene practice. The study also reported a relationship between ECC and dental visits, since children who visited the dentist within the past year were found to have higher levels of ECC. This association was attributed primarily to existing dental problems of infants in the NHANES sample, who may have required prompt attention or urgent dental care.

The ADA urges health professionals and the public to recognize that a child’s teeth are susceptible to decay as soon as they begin to erupt. It is well established that cariogenic bacteria, especially Streptococcus mutans, are transmitted soon after the first teeth erupt, and poor oral hygiene practice by the mother or caregiver can negatively impact an infant’s dental health. As recommended by the study authors, further research is necessary to improve understanding of the complex individual and environmental risk factors involved with the etiology of early childhood caries.

It should also be noted that breast milk is widely acknowledged as the most complete form of nutrition for infants. The American Academy of Pediatrics recommends human milk for all infants (except for the few for whom breastfeeding is determined to be harmful).

Dentists are encouraged to provide appropriate oral health education to parents, caregivers and children. In assessing a patient’s health history, dentists should consider a variety of factors that may influence caries susceptibility, including maternal oral hygiene practice, fluoride accessibility, nutritional habits and general medical history. Parents can also help protect the dental health of young children by promoting a healthy diet, monitoring their intake of food and drink, and by not putting children to bed with a bottle. The ADA recommends that children receive their first dental visit within six months of eruption of the first tooth and no later than 12 months of age. For additional information, visit the ADA Statement on Early Childhood Caries, the “Frequently Asked Questions” page on ECC, and the American Academy of Pediatrics policy statement on breastfeeding and the use of human milk.  


1. Iida H, Auinger P, Billings RJ, Weitzman M. Association between infant breastfeeding and early childhood caries in the United States. Pediatrics, 120(4) October 2007, e944-e952. Abstract available at: Accessed October 1, 2007.

2. Harding A. Breastfeeding doesn’t increase kids’ cavity risk. Reuters Health, October 1, 2007. Available at: Accessed October 1, 2007.

3. Warner J. Breastfeeding-cavities link disputed. WebMD, October 1, 2007. Available at: Accessed October 1, 2007.

4. Vann M. Breastfeeding doesn’t contribute to caries. HealthDay News, October 1, 2007. 

Additional Resources 

Science in the News is a service by the American Dental Association (ADA) to present current information about science topics in the news. The ADA is a professional association of dentists committed to the public's oral health, ethics, science and professional advancement; leading a unified profession through initiatives in advocacy, education, research and the development of standards. As a science-based organization, the ADA's evaluation of the scientific evidence may change as more information becomes available. Your thoughts would be greatly appreciated.

Page Posted October 2007