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How to prevent caries
Van was almost 2 years old when his mother Elizabeth noticed a brown speck on one of her teeth, which looked like a sticky food. When Elizabeth failed to clean the stain with a brush, she took her son to the dentist.
After an unsuccessful attempt to examine Vanin’s mouth, the boy had to do anesthesia. During the examination, the dentist discovered that all the teeth, except one, are affected by caries. Four front teeth had to be removed, two - to put the crowns, and the rest, in addition to that which was healthy, - to be sealed. The dentist told Elizabeth that breastfeeding at night is the same as bottle feeding. To save teeth, feeding at night will have to stop. Elizabeth questioned the recommendation of the dentist. "It can not be! People fed children for millennia, and their teeth were fine, she thought.
Elizabeth decided to continue feeding Vanya at night, as their family was preparing for the move, which, even without a night of weaning, was quite a lot of stress for the boy. Mom tried to wipe her teeth with a soft cloth after each night feeding, but Vanya woke up during this procedure. For several months, Elizabeth gradually ceased to feed her son at night.
Why did the dentist decide that breastfeeding, especially at night, could cause caries? Human milk contains sugar - lactose. It is well known that food and drinks containing sugar often cause tooth decay. Some studies have traced the relationship of feeding and caries, and some argue that there is no connection. The American Academy of Pediatric Dentists in 2002 recommended not to feed the child at night after the appearance of the first teeth (Pediatric Dentistry 2001-2002). Many dentists agree with this recommendation, both in the US and abroad (Editor's note - see more recent information ). Let's understand the existing contradictions in the data on children's caries.
Analysis of research results
Dr. Joyce Sinton and her colleagues conducted a comparative study of feeding methods and caries, trying to determine why researchers disagree on the effect of breastfeeding on teeth. They concluded that in many studies, during which the connection between breastfeeding and caries was found, the research methodology did not meet the standards, and the researchers came to contradictory results. Most of the articles found by researchers were not included in the final review, because were just descriptions of particular cases: it was about one or more infants who were already found to have caries at the time of the study. In these studies, it was assumed that tooth decay was caused by breastfeeding, but no evidence was given of this fact. The researchers stated that in fact they had to exclude most of the “classic” articles not about the relationship between caries and breastfeeding.
The remaining studies were very carefully compared, and concluded that the results were often controversial due to ignoring other factors affecting the occurrence of caries, for example, water fluoridation or components of the child's diet other than breast milk. Also, the researchers did not give clear definitions of the concepts of “breastfeeding” and “effective care of teeth” for parents. So, children in mixed feeding are considered breastfed in one study and artificially in the other. Confusion in the definitions leads to deceptive results, since exclusive breast and mixed feeding have a different effect on the body. The use of such inaccurate definitions indicates an unscientific approach to the study of the issue.
Reliable information about caries and breastfeeding is very important, as recently, early childhood caries is widespread. The high cost of treatment even more draws attention to the problem. Researchers claim that in some countries, the prevalence of caries at an early age has taken on epidemic proportions (Tinanoff, O'Sullivan 1997). The cost of caries treatment in children in the US costs $ 700-1200 for treatment and 200-1500 for medicines (Erickson, 1999). The cost of moral damage both for the child and for the parents, especially when it comes to abrupt weaning, can only be guessed at.
Evidence for breastfeeding
Not all dentists and scientists believe that breastfeeding, including at night, leads to tooth decay. A study by Dr. Harold Slavkin showed that "Studies based on a population survey did not reveal a link between long-term breastfeeding and caries." Dr. Konstantin Oulis and his colleagues concluded that breastfeeding can "have a preventive effect and inhibit the development of caries in children." Dr. Harry Torney examined 107 children who had breastfed for at least two years (about half of them were not weaned at the time of the study). He found no evidence to suggest that prolonged breastfeeding on demand leads to caries (Torney, 1992).
Dr. Brian Palmer is one of the most active supporters and zealous advocates of breastfeeding for caries. He is confident that caries in young children is a relatively new phenomenon. Palmer studied fossil baby skulls from various museums. Signs of destruction were found on less than 1.4 percent of the teeth. In total, Palmer examined 1344 baby teeth, of which 19 were slightly affected by caries and only 4 (0.3 percent) had serious damage. Anthropologists believe that anatomically modern humans have existed for about 100,000 years, despite the fact that modern humans appeared about 30,000 years ago. At the same time, studies of the skulls indicate the occurrence of caries at an early age only 8-10 thousand years ago, which means that the previous 92 thousand years had no caries in young children (Palmer, 2000).
What happened 8-10 thousand years ago? Humanity began to process food and eat differently. Presumably, babies in prehistoric times sucked their breasts all night long and for 2-3 years or longer. On this basis, the idea that breast milk leads to tooth decay seems implausible. If this were so, traces of caries would be found on teeth older than 10 thousand years. In addition, as Dr. Palmer says, "if breast milk resulted in tooth decay, it would be an evolutionary suicide."
There are data from two more studies that compared the effect of modern artificial breast milk substitutes (mixes) and breast milk itself on factors that are considered to be the cause of caries. These studies revealed significant differences between human milk and most blends. First, it was found that breast milk practically does not reduce the level of acidity in the mouth, while almost all brands of mixtures - reduce. Streptococcal bacterium, which is blamed for the destructive effect on the teeth, is best reproduced in a low-acid environment. Secondly, most of the mixtures contributed to the active growth of bacteria, and in breast milk this growth was much slower. Thirdly, it turned out that the mixture dissolves tooth enamel, while breast milk, on the contrary, remineralizes it (i.e., “supplies” calcium and phosphorus to teeth). Also, the researchers came to the conclusion that human milk does not lead to caries, if there are no other source of carbohydrates on the teeth, in which bacteria multiply. Most of the artificial mixtures tested cause caries (Erickson, 1999).
These studies show why accurate definitions are so important. A mixed-fed infant should be considered separately from infants in studies on children's caries, since the mixture dissolves tooth enamel, while breast milk, on the contrary, remineralizes it.
Streptococcus mutans
Most often, children become infected with Streptococcus mutans (a type of streptococcal bacteria) from parents or other people who care for children. Infection occurs through kisses, playing with the parental toothbrush, or using common forks. Once in the baby’s mouth, Streptococcus mutans (S. mutans) begins to multiply rapidly. This bacterium has properties that prevent the growth of similar bacteria and many other microorganisms, and thus can become the predominant bacterium in a child’s mouth (Slavkin, 1999)
S. mutans can be fought with preventive methods. One study found that “If pregnant women rinse their mouths daily with sodium fluoride and chlorhexidine during the seventh month of pregnancy, the population of their children’s mouth bacteria was delayed by an average of 4 months” (Slavkin, 1999). Like all drugs, sodium fluoride and chlorhexidine should be prescribed by a doctor. However, the use of these drugs is associated with certain side effects, so the need for these tools is questionable. Before taking medications, you should consult with your doctor and weigh the balance of benefits and risks.
The later the child encounters S. mutans, the less likely it is the occurrence of caries at an early age. Avoid using common cutlery and toothbrushes. Never lick artificial nipples or pacifiers. Knowing that S. mutans breeds best with low acidity, maintain an increased level of acidity in the mouth. This will help maintain a healthy bacterial ecosystem in the mouth (Slavkin, 1999). As mentioned above, the mixture lowers the level of acidity in the mouth, unlike breast milk, so it is better not to feed the children with the mixture. If supplementation is unavoidable, be sure to brush your baby immediately after feeding the mixture.
In the process of digestion, the level of acidity in the mouth usually decreases, gradually increasing after swallowing food. When we eat or drink, saliva starts breaking down food into simpler sugars, which are found in all foods. Sugar, in turn, gets on the teeth, nourishing the bacteria, promoting their reproduction and reducing the level of acidity in the mouth. At decrease in level of acidity, minerals are washed out from a tooth enamel. Between meals, saliva restores normal acid balance. As already mentioned, breast milk remineralizes tooth enamel, strengthens children's teeth and helps prevent tooth decay.
Dr. Palmer notes that “some components of breast milk can also protect teeth from caries. Thus, IgA and IgG immunoglobulins are able to inhibit the growth of S. mutans. Also S. mutans is very sensitive to the bactericidal action of lactoferrin, the main component of breast milk. ”
Sucking process
Breast milk does not last long in the mouth during breastfeeding. When the baby sucks the breast, the nipple is deep in the baby's mouth, and the milk is injected practically into the throat. In addition, the sucking process includes mandatory swallowing - before the child continues to suck, the baby must first swallow the milk. If the baby drinks milk, juice or a mixture from a bottle, the liquid continues to flow into the mouth, even if the child does not actively suck the bottle. If the child does not swallow, fluid accumulates in the mouth, washing the front teeth. Liquid flowing through the short nipple also rinses the teeth before getting into the throat.
Dry mouth is another cause of tooth decay in young children. Saliva maintains a normal level of acidity in the mouth. At night, salivation decreases, especially if the person breathes through his mouth. This is one explanation why brushing your teeth before bedtime reduces the risk of caries. If the baby sucks often at night, he continues to produce enough saliva to prevent the mouth from drying out.
Family matters
Heredity plays an important role in the occurrence of caries. We cannot change the genes of a child, but it is important for parents to pay attention to the prevalence of caries and other dental problems in the family. Armed with the necessary information, parents can engage in the prevention of children's caries during pregnancy.
Oral hygiene plays an important role in the prevention of caries. Parents who regularly brush their teeth not only set a good example for their children, but also reduce the number of bacteria in their mouths, thereby reducing the likelihood of transmitting S. mutans. Joint visits to the dentist make it possible to get used to the setting of the dental office from early childhood and become familiar with what is happening during preventive visits. In families with a genetic predisposition to caries of children, it is recommended to show the dentist every six months from the time the first teeth appear. An early visit to the dentist will help detect any defects in the enamel.
Brushing your baby's teeth should start as soon as they appear. At first it can be done with a piece of gauze or a soft cloth. Children should learn to brush their teeth as early as possible, but at the same time, parents should continue to brush their teeth themselves at least 2 times a day until the child can brush his teeth thoroughly enough.
A full and varied diet is an important component of caries prevention. A healthy diet increases the body's resistance to microbes and bacteria. Give your child to drink water, not juice or other liquids. Water does not reduce the level of acidity, and there is no sugar in the water, which has a destructive effect on the teeth.
Avoid foods that are long in the mouth or stick to the teeth. For example, when a child sucks a lollipop for quite a long time, during all this time the level of acidity in the mouth decreases. Sugar gets on the teeth, bacteria begin to multiply actively, enamel demineralization begins. Until the child brushes his teeth or saliva does not wash away all the sugar from the teeth and does not restore acidity, the teeth are at risk of destruction. But if a child eats an apple, chewing and swallowing promote the washing of teeth with saliva. However, some useful products, such as dried fruits, stick to the teeth and can begin demineralization.
Dr. Palmer believes that heredity is not the only factor influencing the development of caries. Parents can take care of dental health long before the baby is born. According to Palmer, there are four factors that increase the risk of children's caries: stress during pregnancy, especially associated with the loss of a loved one; lack of dairy products in the mother’s diet; serious maternal illness or taking antibiotics during pregnancy.
Of course, not all of the above circumstances can be controlled by a woman. People get sick and die beyond our knowledge. At the same time, a decrease in the general level of stress is often in our power and has a positive effect on both the mother and the child. Regular monitoring of a woman during pregnancy helps to improve maternal nutrition and reduces the likelihood of illness. If you still get sick, sometimes you need to resort to antibiotics. In this case, each woman needs to assess her specific situation and discuss with her doctor how much the benefits of taking antibiotics exceed the risk. It is impossible to foresee and avoid all risk factors for caries, but, having all the necessary information, a woman can make the maximum possible efforts to prevent the disease.
Treatment
The treatment regimen depends on the parents, who find it easier to decide exactly which methods are acceptable for their child. This article describes several possible treatment options. Additional options were published in the Toddler Tips section of the New Beginnings magazine (July-August 2000 issue).
In the early stage of damage, teeth can be remineralized due to the use of food additives and the use of fluoride. That is why children at risk are particularly recommended early prevention, diagnosis and treatment.Regular brushing in the mouth. Recently, S. states were successful with antibacterial mouthwash solutions (Raegan, 2000).
If it’s a carrot, it’s limited by filling or removal. It should be noted. Together with the anesthesiologist, you can develop the most gentle abstinence for the child before the operation.
Often parents have to look at a good children's dentist. If you are a dentist, try infants, try research.
Key points in research on the relationship between breastfeeding and caries
Was it necessary to wean Vanya? According to Dr. Palmer, he is not a doctor.
- Surveys population-based surveys have not been established between linking prolonged breastfeeding and caries (Slavkin, 1999)
- Prolonged breastfeeding on demand doesn’t lead to the spread of caries (Weerheijm, 1998)
- Breastfeeding carriage in children (Oulis, 1999)
- Lactose, for carcass (Rugg-Gunn, 1985).
Conclusion
I was the one who was told the baby. Catherine feeds the 18-month-old daughter Yulya. The children's dentist is insisted on immediate cessation of breastfeeding before the start of caries treatment. Catherine found a dentist who decides to not decay, but doesn’t have to reduce the rate of caries. And of course, Julia after unpleasant dental treatment procedures!
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