Caries
Alexandra Penta, DMD
PGY2 Resident
University of Pennsylvania School of Dental Medicine, Philadelphia, PA
University of Pennsylvania / Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Evlambia Hajishengallis, DDS, DMD, MSc, PhD
Division Chief of Pediatric Dentistry and Director of the Postdoctoral Pediatric Program at Penn Den
University of Pennsylvania School of Dental Medicine
Philadelphia, Pennsylvania, United States
Diane L. Spatz, PhD, RN-BC, FAAN
Professor of Perinatal Nursing
Penn Nursing/CHOP
Philadelphia, Pennsylvania, United States
Evlambia Hajishengallis, DDS, DMD, MSc, PhD
Division Chief of Pediatric Dentistry and Director of the Postdoctoral Pediatric Program at Penn Den
University of Pennsylvania School of Dental Medicine
Philadelphia, Pennsylvania, United States
Diane L. Spatz, PhD, RN-BC, FAAN
Professor of Perinatal Nursing
Penn Nursing/CHOP
Philadelphia, Pennsylvania, United States
Caries Development Contributing Factors in Children Breastfed Beyond Age 1-Year
Spatz, D., Hajishengallis, E., Penta, A
Purpose: The association between extended breastfeeding (defined as breastfeeding beyond one year of age) and the development of Early Childhood Caries (ECC) has traditionally been one of debate and controversy. The aim of this pilot study was to determine the lifestyle factors most associated with development of ECC in ASA 1 children between the ages of 1 and 6 years who were breastfed beyond 1 year of age.
Methods: This study was developed at the University of Pennsylvania School of Dental Medicine and approval was obtained by the University of Pennsylvania Institutional Review Board (IRB). A 30 question survey was developed and given to consented primary caregivers of healthy children aged 1-6 years who were breastfed beyond one year of age and who are patients in the Pediatrics clinic at Penn Dental Medicine. The survey asked questions pertaining to the child’s diet, feeding habits, oral hygiene, sleep/airway, family history, and the primary caregiver’s thoughts on breastfeeding. Information was also gathered from the child’s Electronic Health Record including insurance type (Medicaid or non-Medicaid), date of birth, allergies, and DMFT score. Means, standard deviations, and proportions were calculated to extract data and potential correlations between survey responses and DMFT score.
Results: 23 survey responses were recorded and analyzed. 14 surveys described patients with DMFT ≥1 (61%) and 9 surveys described patients with DMFT 0 (39%). The small sample size limited the type of data analysis rendered in this study. The average DMFT score for the population group was 5.4. The average age for both control and population groups was approximately 3 years old. There were 19% more patients with Medicaid dental insurance in the DMFT ≥1 group than the DMFT 0 group. Although not statistically significant, the following observations were made regarding the different lifestyle factors analyzed in this study. There were no meaningful differences observed between the control and population groups for dietary habits or oral hygiene practices. With respect to breastfeeding habits, 12% less children with DMFT ≥1 had less than 5 feeds per day, the proportion of children with DMFT 0 and DMFT ≥1 who had 5-10 feeds per day was nearly equal, 36% more children with DMFT ≥1 had 10-15 feeds per day, and 22% less children with DMFT ≥1 had over 15 feeds per day. The number of overnight feeds did not seem to be correlated with DMFT score. In relation to sleep and airway, 44% of children with DMFT 0 and 14% of children with DMFT ≥1 were reported to snore at night, while the opposite trend was noted for predominant mouth breathing (11% and 21% respectively). There were less children in the DMFT ≥1 group who had a family history of hypoplastic teeth or caries. In children with DMFT ≥1, parents were slightly less comfortable discussing breastfeeding with their child's pediatric dentist, regardless of who initiated the conversation (dentist or parent). 100% of caregivers of children with DMFT 0 felt that it was important to discuss the relationship between breastfeeding and caries at their child's first dental visit, while only 85% of caregivers of children with DMFT ≥1 felt the same. Anecdotal feedback from caregivers indicated an interest in this discussion occurring at birth, as well as learning more about how the length of breastfeeding can impact the overall oral health and development of the permanent dentition in their children.
Discussion: Results from this pilot study indicate that there is still much ambiguity as to which lifestyle factors most heavily impact the development of ECC in children who experience extended breastfeeding. Due to the small sample size included in this pilot study, the ability to perform advanced statistical analysis was limited. No significant associations were found between DMFT score and dietary habits, oral hygiene practices, breastfeeding habits, sleep/airway observations, or family history. There may be associations between DMFT score and caregivers' comfort in discussing breastfeeding with their child's dentist as well as when this conversation occurs. Moving forward, there are several improvements that can be made. The exact number of months that a child was breastfed beyond one year was not calculated, and should be calculated as more data is collected in the future. Additionally, increasing the number of personnel available to collect data would prevent potential candidates from being missed. Goals for the future include building a larger data set through continued data collection, and for this study to demonstrate the importance of creating space in dental visits for conversations regarding the relationship between breastfeeding and dental caries.
Conclusions: There are many lifestyle factors that contribute to the prevalence of ECC in children who are breastfed beyond 1 year, and at this time it is not possible to determine which has the largest impact. While there may be an association between the development of ECC and a caregivers' comfortability in discussing the relationship between caries and breastfeeding with their child's dentist as well as their opinion on when this conversation occurs, more data is required to determine the significance of this correlation.