Berkeley Parents Network: Tooth Decay & Nursing

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Tooth Decay & Nursing

The Parents Network > Advice > Advice about Breastfeeding > Tooth Decay & Nursing

Decayed teeth in toddler nurslings

May 2003

I have a 27 month old boy who still nurses to go to sleep at naptime and at nighttime 2-3 times. My question is for those mother's who nursed this late and later and if their child got decayed teeth because of it. A dental professional freaked me out today telling me that it causes decay and she sees it often. She says it causes decay as much as milk bottles at night do (bottle mouth) She is a teacher at the Dental School of the Pacific. Also, when to send your child to first dental visit. worried my baby will get decayed teeth and then that'll really be fuel for those, like my mother, who think I'm nursing to late. worried mama

We have 2 little ones who nursed until age 4 years (night, morning, during the night), and both have gorgeous teeth, no cavities, and even after injury ( smashing the front teeth due to bad falls, to the point of almost losing them) no problems. we recommend also our very responsive and supportive dentist, dr. vivian lopez (on telegraph). our weanlings are now 4 and 6 years, and doing great. good luck! frieda

Hi, Your child nurses more than either of my did (do). My son nursed until 3+ and his teeth are fine. My daughter now 2+ still nurses and her teeth are rotten. She has had one tooth pulled, two root canals with caps, and cavities. My advice is to keep nursing when your child is awake but stop at night just in case that is how the rot happens (dentist advice). La Leche Leauge says that kids will get cavities despite nursing not because of it. Let a dentist have a look and go from there.... anon

My older daughter nursed until 27 months, and had 4 cavities before she turned 3. Some of my friends have kids who nursed in a similar pattern and have absolutely no problems with their teeth. So yes, it can happen. For us, I'm pretty sure that halfhearted brushing and middle-of-the-night doses of Advil when she was teething were both contributing factors. Your post doesn't say whether you're religious about brushing, but I'd highly recommend that. 27 months isn't too early for a dentist visit. My daughter's first visit to our family dentist, Dr. Meeta Doshi, was completely non-traumatic. She gave my daughter a ride up and down in the chair, set her up with sunglasses for the bright light and a toy for each hand, and ''counted'' her teeth while checking each one. The whole thing took less than 10 minutes, and my daughter (2 1/2 at the time) thought it was fun. With my second child, I'm still doing some night nursing, and brushing teeth. So far so good. Jennifer

Maybe you need to find a new dentist? My daughter still nurses herself to sleep after five years (plus a lot of night-time nursing until age 4 or so). Although she did have one small cavity at 2 and another at 4 her dentist specifically said that her night nursing is probably not the cause--- he thought it was most likely genetic. Apparently, bottle-caused tooth decay has a specific form (I think it occurs behind the front teeth); he said he'd never (or rarely?) seen it in nursing kids. After the second cavity, he did seal her back teeth with some kind of sealant; no cavities for the last 3 checkups. We moved here only recently, but I imagine there must be some nursing-friendly dentists around the Bay area! I'll be reading the posts to find out myself! Karen

I nursed my first for 2.5 years- day and a lot at night, and he has perfect teeth now at 5- no cavitities. I was pretty lax about brushing his teeth until after I stopped nursing, but now I am pretty strict. However, I have a friend who also nursed a long time, and her kids teeth did decay. I think part of it is genetic. So, try to brush once a day, and don't worry to much. It seems like all health care professionals are against long nursing, and I think mostly because they do not have a lot of data, and they guess. Dentists- FIND A PEDIATRIC DENTIST. I like Wampers/Katsura. They start at 3 years old- but will see a 2.5 year old if you are really worried. Trust your instincts. Lisa

I nursed my twins until they were 27 mos. too; day and at night. One of my boys did have two cavities in his molars while the other one didn't. I personally feel that this was caused by incompletely closed molars which I had as well as my mother. Especially since only one child had them and not both. There was an article in Mothering Magazine that came out around Sept/Oct 2002 that aruged against the notion of nursing causing cavities. It made me feel a lot better. Don't other mammals nurse their young when they have teeth? Why should it be different for us? Read the article if you can get ahold of it. That's the magazine I go to for support on many of the less common child rearring practices such as co-sleepnig and nursing a toddler etc... cb

Dentists often blame nursing when a child has dental caries. This is simply not true. Go to lalecheleague.org and find good support and additonal information on the subject of nursing and dental caries. Usually genetics plays a stonger role in dental caries than anything else. I am a LLL Leader and Lactation specialist. and know this to be true in most cases. Teresa

It's genetic so nursing is not to blame; decay would happen anyway. My older son had cavities and my younger did not, and the younger actually nursed longer (stoppped at age 4). So find a nursing-friendly dentist (wasn't there a discussion on this a little while ago?) to fill the cavities, and brush a lot. Oh, and no sugary or starchy snacks (in our case, I think jellybeans played a role). By the way my dentist is not a nursing advocate so I would just smile and nod a lot when he was telling me no night nursing, then just continue. good luck

From what I have learned and studied, the nursing at night equals cavities position is actually a myth, and unfortunately one that many dentists and even pediatricians tout.

If you were to see a picture of the nipple while breastfeeding, you would see that your nipple goes way back past the teeth area of your toddler's mouth. I know it's hard to believe that it stretches back that far, but it does. The milk doesn't ''stand'' in the mouth as your dentist may have told you. This is La Leche League's stand on the issue. As they state in ''The Womanly art of Breastfeeding,'' ''Studies have shown that breastfeeding itself doesn not cause tooth decay.'' In fact according to one study they cite, breastfed children ''had lower levels of decay.'' Good brushing is strongly recommended. I would suggest that if you are concerned enough to stop nursing, than I would contact La Leche League for yourself and ask a specialist.

My son is two and a half and we have had absolutely no problems, even though my pediatrician recommended I not nurse at night, which sent me on my research. Luckily Aidan loves to brush his teeth, which is great whether nursing or not. My dentist recommends ''brushing'' with a baby's wash cloth which is a great supplement to Aidan's ''brushing.''

Good Luck, hope this helps... decisions decisions decisions.... Jaclyn

I nursed my son until he was about two-and-a-half years old. From what I remember reading and hearing at the time (this was 2 years ago) nursing to sleep did not pose a significant risk for tooth decay as bottle feeding does. First of all, your breastmilk does not tend to pool in his mouth because he has to use suction to get the milk. Second, I also seem to recall hearing something about the nature of the sugars and enzymes in formula that may be different than/more harmful than breastmilk. Try looking for information from La Leche League.

With that said, my son did develop several cavities at an early age. All of them are in his molars and every dentist that we have seen over the last 5 years have explained that for some reason his molars are not completely covered with enamel. This would have happened during pregnancy. Even the dentist we saw when I noticed his first cavity at age two assured me that breastfeeding-to-sleep was not the culprit.

If you are still somewhat concerned about your sons teeth, maybe you could try to be sure he swallows, to get rid of any breastmilk in his mouth, before you put him down or leave the room. Congratulations on your dedication to breastfeeding! Jennifer

Dentist says caries are caused by nursing

March 2003

(See Dentists Favorable to Breastfeeding for the original question.)
Whoa, this is such a hot button for me. I have the same experience with my son. The brown stains on his front teeth were the beginnings of dental carries. I did have the offices of Wampler, Katsura, et al. paint on the flouride to help strengthen them. On my second visit I clearly said that if they gave me any grief about it I was going to find another dentist. Here is my somewhat educated opinion on tooth decay. Decay is caused by bacteria. Bacteria needs food (sugar) to to grow, thrive and do it's job of attacking the tooth. There is sugar in breastmilk as there is sugar in bread, crackers, cow's milk from a cup, etc, etc, etc. During the day our saliva helps to wash our teeth and help slow the bacteria growth but at night our saliva is reduced by 80% so that we don't drown. So any sugar from any source left on the surface of the teeth will lead to decay. When a child is actively removing milk from a breast the nipple is way back in the mouth and the milk runs down the throat. It does not pool in the mouth like it can with a bottle. If a child is just leaving their mouth over the nipple and not actively sucking some milk may be pooling. However, breastmilk has antibodies and anti-bacterial and anti-fungal properties. This is an added benefit in fighting decay among all it's other varied benefits. So the only true way to help prevent decay is to agitate the bacteria through brushing and flossing any teeth after eating/ drinking before sleeping. Many, many parents do NOT do this as much as they should whether they brestfeed or not. Tooth decay is also affected by genetics. I believe they discriminate against breastfeeding. The only question they should be asking is ''does your child have their teeth brushed after eating and before sleeping every night?'' What and when we are feeding our children is none of their business! Nurse your son as long as you both enjoy it!

My son has stains on his teeth too. He got them from iron drops (prescribed for anemia when he was 12 mo.) Some kids' teeth stain more easily. In January I took him to Dr. Denise Bass-Allen in Oakland when he was 28 months old -- we were still nursing. I got a bit of a lecture, but was NOT told I HAD to wean by any means. I really liked Dr. Denise and she had a good manner with my active toddler. Her assistant who lead us through our brushing lesson wasn't as good (even though she said her son was the same age!) Just getting him checked and told his teeth looked bad, but were good was worth it. Good luck, I hope your stains are as benign. You didn't mention your nursing pattterns, but night weaning might be helpful. My son nursed to sleep at night and naps until last month when we weaned (not because of teeth concerns!), but I night weaned him at about 15 months. Try toothbrush training every day! (We are still working on it . . .) sharon

Night nursing and tooth decay

October 1998

I was just informed by my nutritionist that I should cease nursing my 1 year old son at night when he wakes up because it could cause tooth decay. I'm rather confused by this because all along my lactation consultant told me it was no problem to nurse my son to sleep. I received quite a response when I wrote about my son waking during the night like 8 times a night and the majority of parents wrote about taking him to bed with us, which we have done and works great for all three of us, we sleep great now! But now I'm worried about tooth decay. Do any of the parents that responded to family beds and nursing at night have any experience with tooth decay because of nursing at night? I'm curious if this really does happen? It seems like such a natural thing to me to nurse to sleep and seems strange that it would cause damage to my son's teeth. Anyone have an older child that was nursed at night that can give me some input? Jena

I, too, was given the admonishments about nursing at night as soon as my son's teeth started appearing. For the most part, I chose to ignore them. The decay usually occurs from fluid resting against the teeth, like a bottle in the child's mouth after s/he has fallen asleep. In my experience, once he falls asleep, the nipple usually falls out of his mouth- and in any event, he's not getting milk unless he is actively sucking, unlike a bottle. Also, he tended to only nurse for a few minutes before falling back to sleep. Somewhere around 15 months of age, we started brushing his teeth (using just water and a child-size toothbrush) right before bed every night. He continued to nurse "on demand" until around 18 months, when I limited it to right before going to sleep (which is AFTER his teeth have been brushed) and right before getting up in the morning- no in-between nursing. He is still on this schedule at a little over 22 months of age, and so far I have seen no signs of tooth decay or other problems with his teeth or gums. I agree that the "naturalness" of nursing (especially given that in a "primitive" human population it often lasts for about 4 years) seems to make it an unlikely candidate for severe problems under normal conditions. Anyone have contradictory experience? Naomi

there are rare occurences of babies who nurse and develop "bottle mouth", but it is generally formula that can rot teeth if a child sleeps with their bottle in their mouth on a regular basis which they shouldn't do just because babies can choke if they are left with a bottle propped up. I nursed all 3 of mine during the night and they all have beautiful teeth. I heard from someone about children who nursed developing bad teeth so, for awhile I would wipe off the teeth after she fell asleep but, i admit I often fell asleep too and quit bothering after awhile. I nursed my first 2 children for approx. 14 months each and my youngest for over 3 years. I did start brushing their teeth (with Tom's natural toothpaste as they were so young and bound to swallow some) as soon as they got teeth.

there is more on this at: http://www.promom.org/ under Breastfeeding Myths and Realities

Myth #14: Night nursing causes dental problems. Reality: Generally, the worries about babies getting cavities through nighttime milk consumption arise from the practice of leaving babies to sleep with bottles of formula or juice. When this is done harmful bacteria have unlimited access to these sugary mediums and will thrive in the babies mouth. The acids excreted by the bacteria cause tooth decay. Such decay has been seen occasionally in breastfed babies if these children happen to fall into a small category of people with easily decayed teeth. For most children night nursing will not be a problem. One advantage that the human nipple provides over an artificial one is that it delivers the milk further toward the back of the mouth, past the teeth. Artificial nipples deliver the milk into the front and middle of the mouth where it can cause decay. Also, the human nipple does not continue to drip milk when it is not being sucked. In contrast, bottles will drip milk all night if left in the bed with the baby. Reminder: no baby should ever be left alone with a propped up bottle! If you notice anything strange looking happening to your child's teeth consult a breastfeeding supportive dentist for help. There are many articles on this subject available through La Leche League.

My now 5-year-old nursed for 2 years and for much of that time had at least one middle-of-the-night feeding. He has never had any cavities and his dentist is pleased with his teeth. Fran

My son has had 16 teeth since he was 11 months (he's now 16 months), so keeping his teeth healthy is something that we've been concerned about too. I nurse my son to sleep and we have a family bed, so he nurses throughout the night when he needs too. He has already been to his first dentist appointment and has no problems with his teeth. The dentist strongly emphasizes good teeth brushing habits, but seemed okay with the baby falling asleep nursing. I concluded, that as long as his teeth are being brushed well, it's okay for us to continue nursing as we have been. If you are really concerned, I would consult a dentist.

It is my understanding that what causes the really bad tooth decay is leaving a pool of milk in the baby's mouth. That's because bacteria love the milk as much as your baby does, and when they have a good food source they can multiply over the course of a few hours. It happens most often as a result of parents propping a bottle up *in* the baby's mouth and leaving it there for long periods of time *while the baby is sleeping*. (This is obviously dangerous not only from the standpoint of tooth decay.) I suppose the same could happen if you left your breast in your baby's mouth while you both went to sleep, allowing a slow trickle of milk to enter and pool there over the course of the evening. But if your baby simply nurses before sleeping, (s)he will swallow most of it and then continue to salivate, diluting out the rest. Sometimes you might dose off while nursing, but if you wake up a few minutes later and remove your nipple, you are fine. Please do not worry about nursing in bed. It is good for your baby. It is good for you. I did it and mine has healthy teeth. Sybil

There was an article in one of the more recent LLL Magazines by a woman whose child had caries from night nursing. She had a very understanding dentist and the article talks about how she managed to continue night nursing while at the same time being cautious about her son's teeth. If you go to their website and do a search I'm sure you'll find it.

In general though, nursing at night is not the same thing as "bottle-mouth" because when a child nurses they take the breast deep into the mouth preventing the milk from pooling at the teeth. So, even though breastmilk can cause tooth decay, it usually isn't a problem except in those kids that happen to be more prone to it. Also, many of the advantages of night-nursing and co-sleeping outweigh the dental risk IMHO. Sophie

I nursed my first two children for over 3 years each. They slept in the family bed and nursed many times during the night. They both have lovely teeth now--at ages 6 and 9. My third child is now 18 months old, and like with my other children, he nurses multiple times during the night. At a recent visit to the dentist we discovered that he has pre-cavity deposits (white deposit) all along the gum line of his two front teeth. These are areas that are hard to repair, according to our dentist. The dentist was very concerned and I felt very guilty. We had been brushing his teeth once a day. Now we are brushing them twice a day. The dentist also treated his teeth with fluoride. We'll see if we can arrest the development of the cavities.

When I was concerned about night nursing with my first child, I had heard that you need to have a nursing episode end with a suck (pull nipple out, child swallows). If the child falls asleep with the nipple in the mouth, before s/he swallows, then a small accumulation of decay-causing milk will stay in the mouth. It doesn't need to keep dripping in the mouth to cause damage--there just needs to be an accumulation. Even though I have known this, it is hard to implementthis practice when a child has free access to the breasts all night. While there are nights when he just nurses once and I am awake, there are other nights when he nurses many times and I am only quasi-awake. I guess my great survival trait of being able to mostly sleep through the many nursing interruptions has had its downside.

I don't regret nursing him and will continue. My nights are much less restful as I try to wake up and "finish" him off before I fall asleep again. This has been only partially successful as it seeems to have breeded a greater need--he sucks with renewed vigor whenever I try and withdraw the nipple. So now he seems to be nursing more than ever. Perhaps the most striking lesson is that it was fine for two kids and not for the third. This is consistent with all of the messages that stated that night nursing is fine for *most* kids. And we can't know our kids decay-proclivities until something like this happens.

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