Does Breastfeeding Cause Tooth Decay?

Many families wonder what to do when those first baby teeth come in. Can babies really get cavities? Should we brush our baby’s teeth? If so, should we use toothpaste? Floss? How often? If my baby does get cavities, then what?

I do not have all the answers, but hope that the tips and links below will be enough to get parents pointed in the direction of useful resources as they begin to explore this topic.

The big question - does breastfeeding cause tooth decay? - is not as straightforward as it might seem. From various sources I have compiled the following:

  • Some babies are born with teeth that will be particularly vulnerable to cavities. Some of the factors that may cause babies to have susceptible teeth include genetics, the extent of pitting and grooving of the teeth, the strength of the enamel, preterm birth, having a mother who had a fever or who smoked during the pregnancy and many more. As you can see, the factors are so many and varied, it can be very difficult to tell if your baby is at increased risk or not.
  • S. mutans is a bacteria that many people have in their mouths. It is present in plaque and is a major contributor to tooth decay. To prevent exposing baby to S. mutans, many dentists and other health professionals suggest that parents do their best to avoid sharing cups or spoons with their baby, and avoid having adults or other children put baby's pacifiers in their mouths.
  • "Sugar intake is the primary cause of decay. This includes sugar in otherwise nutritious foods such as juices, cereals, breads, raisins, etc. It also applies to sweetened medications. It is very important to understand that it is not the amount of sugar or carbohydrates to which the teeth are exposed, but rather the frequency of exposure that is the key to the development of decay." (Source)
  • An acidic environment in the mouth also contributes to tooth decay. S. mutans breaks down sugars in foods and creates acids, and acidic drinks and foods can contribute to this as well.
  • Breastmilk is not considered to be a cariogenic (cavity causing) food. It has sugar in it, lactose, but it also has lactoferrin, which kills S. mutans. It also has bioavailable sources of calcium and phosphate which can remineralize teeth and help harden enamel so overall it is not considered to be a contributor to tooth decay.
  • Breastmilk on its own does not cause decay, but if decay is already present in the mouth, and in particular if other foods are in the baby’s mouth, it can contribute.
  • Most experts agree that children need a source of fluoride, which will help harden the enamel. Some recommend starting it at age two and others recommend starting earlier.

So without waiting to see if your child is at risk, what can you do to take care of your breastfed baby’s teeth?

  • As soon as your baby gets that first tooth, get in the habit of brushing twice a day. Many doctors or dentists will recommend a xylitol toothpaste or perhaps even a fluoride toothpaste if there is a family history of cavities.
  • Consider flossing gently (individual flossers work well) if your baby’s teeth are close together.
  • If your baby is already having solids, give your baby water after meals and consider wiping the teeth with a xylitol wipe.
  • Limit juice intake, and keep other beverages like cow or other animal milks strictly for meal times. Offer water as a between meals drink.
  • Avoid sugary foods that stick to the teeth including candy, dried fruits like raisins, and fruit leather or fruit rolls.
  • Check your baby’s teeth for any build up of plaque or discolored areas. If you see any, make an appointment with a pediatric dentist.

Babies and young children, breastfed or not, can get cavities. If left untreated, they can be a significant source of pain, infection, and low self esteem for children. Many times if caught early, decay can be slowed or stopped with fluoride or other treatments, and a watch and wait approach can be taken until the child is old enough to sit still and get fillings in a dentist’s office. If decay has progressed too far and is causing problems, general anesthesia may be used so that the baby’s cavities can be filled earlier.

To answer the original question - does breastfeeding cause tooth decay? - Probably not, but in some cases it may contribute if decay is already present. Infant dental hygiene as described above may stop cavities from starting, and prevent decay from progressing if it is already present. If you have questions about your baby’s teeth or your specific situation, ask around for a breastfeeding-friendly pediatric dentist in your area.

Some useful articles: