Letter to a dentist
Here’s a letter a client of mine wrote to her dentist with evidence-based information about breastfeeding into toddlerhood
“It would be evolutionary suicide for breastmilk to cause decay"
Unfortunately there is a common belief amongst British dentists that breastfeeding causes tooth decay in older nurslings. In the U.K., dentists don’t usually receive any training in breastfeeding. According to British dentist Richa Sharma: “We were taught to advise parents to stop all milk at night after the first year to avoid bottle caries…Breastfeeding itself does not cause caries, that would defy evolution as cave men did not give their children milk from other animals, let alone formula. The issue is the modern Western diet, whereby we consume very high amounts of sugar. If we restrict sugar intake to a reasonable level (in my opinion and experience that is fruit after meals and very occasional refined sugar products on special occasions), there is no issue with breastfeeding on demand. Offering cow’s milk or infant formula on demand once baby teeth have erupted is a much greater issue as our teeth are not designed to consume them.”
Here’s the letter my client wrote to her dentist when he told her to reduce night feeds to avoid caries:
Today I brought my 1 year old son to have his first check up. I had chosen to attend your clinic after hearing that you were a baby-friendly practice. X was absolutely lovely with him - gentle and reassuring.
However, I have an issue with one piece of advice we were given. We are breastfeeding and I would like to continue doing so for the foreseeable future. Therefore, although I was very happy with the majority of the consultation we had, I was disappointed to hear X’s recommendation to reduce night feeds to lessen the risk of decay.
I explained to X that I have read research showing that breastfeeding at night does not cause caries. During breastfeeding, the nipple squirts milk up and away from the teeth to the back of the mouth where it is swallowed immediately so it doesn't pool. In addition, the sugar in breastmilk, lactose, is different to the kind of sugar in the foods we eat. Furthermore, there is evidence that most childhood tooth decay is caused by 1) poor dental hygiene, 2) the high sugar content of the modern diet, 3) sugar washing over a baby’s teeth when they suck on food in pouches or when sucking on a bottle, 4) by the transfer of adult mouth bacteria (Streptococcus mutans) into the baby's mouth when adults share cutlery with a baby, or suck on their dummy in a misguided effort to clean it.
He then suggested expressing my breastmilk and diluting it with water and giving it in a bottle. This seems counter-intuitive when an artificial teat is often the cause of decay. It also doesn't make sense given the time it would take me to express milk. And in any case, my baby has been breastfed since birth and has never taken a bottle, and is therefore very unlikely to take a bottle at this stage.
From a oral development point of view, I've read that breastfed babies often have a better chance of oral health not just because of the protection the milk itself offers, but because of the impact on the development of the oral cavity and arch due to the sucking motion.
From an overall health point of view, diluting breast milk will dilute the health benefits of the milk itself, not to mention the calories.
Also worth mentioning is the contribution of breastfeeding to the emotional well-being and development of a child, which moving to a bottle at night would disrupt.
In the U.K. we have the worst breastfeeding rates in the world (0.5% of babies in the UK are receiving any breast milk at 12 months). I am a confident and well-informed breastfeeder but there are many women struggling to breastfeed or feeling vulnerable or targeted because of their decision to breastfeed, who on receiving advice such as X gave me, may feel scared or pressurised into early cessation of breastfeeding. Therefore I felt it important to write to you both today in the hope that you may reconsider giving such advice in the future.
Below is La Leche League's response to the BSPD's statement on infant feeding. I hope this will be of interest as it addresses many of the points touched on above.
https://www.laleche.org.uk/lllgb-responds-to-bspd-statement/
Here is an article by IBCLC lactation consultant Emma Pickett on breastfeeding after 12 months and dental decay:
Further links:
https://www.instagram.com/p/CtQtUp2AYPW/?igshid=NTc4MTIwNjQ2YQ==