DOI: https://doi.org/10.

53350/pjmhs211582232
ORIGINAL ARTICLE

The Effect of Breast and Bottle Feeding on Dental Caries in

Preschool Children
ENAS OTHMAN1, TAGHREED JARADAT1, BASMA ALSAKARNA1, AYMAN F ALELAIMAT1, RANIA ALSADDI2
1
Pediatric Dentist, Royal Medical Services King Hussein Medical Center, Amman Jordan
2
DDS, Royal Medical Services Department of Dentistry, Amman Jordan
Corresponding Author: Enas Othman, Email: [email protected], Phone: +962775819448

ABSTRACT
Introduction: This study evaluates the effect of breast and bottle feeding on the severity and age of onset of
early childhood caries (ECC). This prospective study conducted at the dental clinic of King Hussein Medical
Center between March 2020 and July 2020. All preschool children who attended to the dental clinic suffering from
dental caries were included in the study.
Methodology: All preschool children who attended to the dental clinic suffering from dental caries were included
in the study. A detailed history was obtained regarding age, gender, medical diseases, dental history, duration,
frequency, and patterns of infant feeding. The patients were divided into 3 groups; the 1 st group are those with
exclusive breast feeding, the 2nd group are those with excusive bottle feeding and the 3rd group are those with
mixed bottle and breast feeding. The age of onset of the caries was recorded. The severity of dental caries using
DMFT index was explored in the groups. The obtained data was analyzed and compared with other studies.
Results: 240 patients with aged between 3 and 6 years (mean 4.6±1.1) were enrolled in the study. A bout 55% of
them was males. The commonest method of feeding for children was combined breast and bottle feeding (43%)
followed by exclusive breast feeding (34%) and bottle feeding (23%). The highest DMFT score was found among
patients with bottle feeding (4.9). The highest DMFT scores and earlier onset of caries were observed among
patients who were breast fed (5.2, 3.2) or bottle fed (4.8,3.1) for more than 2 years respectively. Patients who
were fed at night or those with frequent daily feeding at a rate of more than 6 times were associated with more
sever forms of dental caries.
Conclusion: Bottle feeding, nocturnal feeding and prolonged and frequent breast feeding were associated with
more sever forms and earlier onset of dental caries in preschool children. Therefore, exclusive daily breast
feeding at a rate not exceeding 6 times daily and for a duration not exceeding 12 months is recommended as a
habit of feeding for infants.
Key words: Breast feeding, Bottle feeding, Dental caries

INTRODUCTION were divided into three groups; the first group are those
Early Childhood Caries (ECC) is a defined as presence of with exclusive breast feeding, the second group are those
at least one decayed, missed or filled tooth surfaces in any with exclusive bottle feeding and the third group are those
primary tooth in a child less than six years of age [1]. It is a with mixed bottle and breast feeding. The age of onset of
major health problem in the world particularly in developing the caries was recorded. The severity of dental caries using
countries. There is a wide geographical variation regarding DMFT index was explored in the groups. The obtained data
its prevalence in the world. It was reported to be 24% in was analyzed and compared with other studies.
Germany and 90% in Indonesia [2,3]. Regarding regional
countries, it was reported to be 75% in Saudi Arabia and RESULTS
(62-73%) in Jordan [4,5]. A lot of risk factors were 240 patients with aged between three and six years (mean
implicated in the development of dental caries like age, 4.6±1.1) were enrolled in the study. About 55% of them
sex, race, geographic location, and social class [6]. were males. The commonest method of feeding for children
However, diet and oral hygiene remains the most important was combined breast and bottle feeding followed by
ones since they are modifiable [7]. exclusive breast feeding and bottle feeding. Table 1
There is a controversy regarding the effect of breast summarizes the rates of each method of feeding.
and bottle feeding on the development of ECC [8,9]. The
aim of this study is to explore the effect of breast and bottle Table 1, method of feeding in relation to age of caries onset
feeding on the development of ECC in preschool children and DMFT scores.
regarding severity and age of onset. Mean age of
Type of Mean DMFT
Number (%) caries onset
feeding age score
(yrs)
METHOD breast 4.5 81 (34%) 4.5 3.1
This prospective study conducted at the dental clinic of bottle 4.6 55 (23%) 3.2 4.9
King Hussein Medical Center between March 2020 and both 4.7 104 (43%) 3.9 4.1
July 2020. All preschool children who attended to the Total 4.6 240 (100%0 3.9 3.9
dental clinic suffering from dental caries were included in Almost half of the patients were breast fed only for less
the study. A detailed history was obtained regarding age, than six months durations while in bottle fed children a
gender, medical diseases, dental history, duration, duration of six to 12 months was the most encountered
frequency, and patterns of infant feeding. The patients rate. the rates of feeding durations in relation to age of

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The Effect of Breast and Bottle Feeding on Dental Caries in Preschool Children

caries onset and DMFT scores are summarized in table 2 DISCUSSION

and 3. Although breastfeeding is highly recommended by the
World Health Organization (WHO), there is variability
Table 2 , the duration of breast feeding in relation to age of among different communities regarding the response to
caries onset and DMFT scores. those recommendations [10]. In Jordan, breast feeding is
Duration of Number Mean age of DMFT culturally supported by religious people and the community
breast feeding (%) caries onset (yrs) score
and encouraged by the government. The effect of feeding
<6 months 89 (48%) 4.9 3.7
method on the rates of ECC is still not well explored. Some
6-12 months 66 (36%) 4.7 3.1
1-2 years 26 (14%) 3.9 4.2
studies reported that breast feeding is associated with
>2 years 4 (2%) 3.2 5.2 higher rates of p ECC while other studies found no
Total 185 (100%) 4.6 3.5 association [11,12]. On the other hand, a lot of studies
found higher prevalence of ECC among children who were
Table 3, the duration of bottle feeding in relation to age of bottle fed when compared with those who were exclusively
caries onset and DMFT scores. breast fed [13,14].
Duration of Number Mean age of DMFT In the present the prevalence of ECC was not
bottle feeding (%) caries onset (yrs) score investigated among children who were breast or bottle-fed.
<6 months 62 (39%) 4.8 3.2 However, earlier onset of ECC and higher score of DMFT
6-12 months 74 (47%) 4.2 3.8 were significantly associated with bottle feeding when
1-2years 17 (11%) 3.7 4.4 compared with exclusively breastfed children (P value
>2 years 6 (3%) 3.1 4.8 <0.05). In the present study the lowest DMFT scores were
Total 159 (100%) 4.3 3.7 observed in children who were breast fed between six and
The highest age of caries onset and lowest DMFT scores 12 months. Prolonged breast feeding was significantly
were found among patients with no nocturnal feeding the associated with higher DMFT scores and earlier onset of
rates of nocturnal method of feeding in relation to age of ECC (P value <0.05). This indirectly suggests the adverse
caries onset and DMFT scores are summarized in Table 4. impact of prolonged breast feeding on the development of
ECC, but the method of study may not permit for precise
Table 4, nocturnal method of feeding in relation to age of conclusion. Prolonged breastfeeding result in prolonged
caries onset and DMFT scores. contact of enamel with human milk which may induce
Nocturnal acidogenic conditions with subsequent softening of enamel
Number Mean age of DMFT
feeding Folayan et al reported higher rates of ECC among children
(%) caries onset (yrs) score
method who were breast fed for more than 1 year in Nigeria
Breast feeding 62 (26%) 3.8 3.5
[15,16]. Similar results were also achieved by Yonezu[17].
Bottle feeding 73 (30%) 3.6 4.4
Both breast and
On the other hand, Moynihan et al did not find any
85 (35%) 3.9 4.1 association between prolonged breast feeding and ECC
bottle
none 20 (9%) 5.2 2.4 when they reviewed and compared different studies
Total 240 (100%) 3.9 3.9 conducted worldwide [18]. Unlike breastfed children the
The main age of caries onset and DMFT scores in patients lowest DMFT score were recorded among patients who
who were either exclusively breastfed or bottle fed at a bottle fed for a duration of less than six months. In addition,
frequency of six times daily or less were comparable to if we compared patients who were exclusively breast fed
those who were fed at a rate of more than six times daily by with children who were exclusive bottle fed higher DMFT
the same method of feeding. The rates are summarized in score and younger onset of caries were encountered in
table 5. children with breast fed of a duration less than six months
or those with a duration of more than 12 months.
Table 5, the relationship between the frequency of feeding Lower DMFT score was reported among patients who
and the mean age of caries onset and DMFT scores. were not fed at night regardless the method of daily
Type and feeding. However, a slightly not significant lower DMFT
Number Mean age of DMFT score was observed among patients who were breast fed
frequency of
(%) caries onset (yrs) score
feeding at night when compared with those who were bottle fed.
Breast feeding ≤ The American Dental Association’s (ADA) recommends
15 (19%) 4.9 2.7
6 times/day suspending nocturnal feeding after the eruption of the
Breast feeding child’s first tooth as it may lead to an increased risk of
66 (81%) 4.4 3.2
>6 times/day
caries [19]. Olatosi et al got along with this study when they
Bottle feeding ≤
6 times/day
12 (21%) 3.9 4.6 reported a significantly higher prevalence of ECC in
Bottle feeding >6 children who were bottle-fed at night than those who were
43 (79%) 3.0 5.0 not [20].
times/day
There was no statistical difference between patients who The highest DMFT score and early onset of ECC
were breastfed, bottle-fed and those with combined breast- were observed among patients who were breast fed at a
and bottle-feeding regarding age, gender, race, geographic frequency of more than six times while patients who were
location, social, dietary habits, and oral hygiene. breast fed at a frequency of six times or less had the lowest
DMFT scores and later onset of ECC (P value <0.05).
Feldens et al also found more sever forms of ECC among
patients who were breast or bottle fed at a rate of seven

2233 P J M H S Vol. 15, NO.8, AUG 2021

 Enas Othman, Taghreed Jaradat, Basma Alsakarna et al

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