Total Breast-Feeding Duration and Dental Caries in Healthy Urban Children



      To determine if there is an association between longer breast-feeding duration and dental caries in healthy urban children.


      We conducted a cross-sectional study of urban children aged 1 to 6 years recruited through The Applied Research Group for Kids (TARGet Kids!) practice-based research network between September 2011 and August 2013. The main outcome measure was parental report of dental caries.


      The adjusted predicted probability of dental caries was 7%, 8%, 11%, and 16% with total duration of breast-feeding duration of 12, 18, 24, and 36 months, respectively. In the adjusted logistic regression analyses, relative to breast-feeding 0 to 5 months, the odds of dental caries with total breast-feeding duration >24 months was 2.75 (95% confidence interval 1.61–4.72).


      Among healthy urban children, longer breast-feeding duration was associated with higher odds of dental caries. These findings support heightened awareness and enhanced anticipatory guidance for preventive dental care, particularly among children who breast-feed beyond 2 years of age.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Marcenes W.
        • Kassebaum N.J.
        • Bernabe E.
        • et al.
        Global burden of oral conditions in 1990-2010: a systematic analysis.
        J Dent Res. 2013; 92: 592-597
        • Barbosa T.S.
        • Gaviao M.B.
        Oral health-related quality of life in children: part II. Effects of clinical oral health status. A systematic review.
        Int J Dent Hyg. 2008; 6: 100-107
        • Jackson S.L.
        • Vann Jr., W.F.
        • Kotch J.B.
        • Pahel B.T.
        • Lee J.Y.
        Impact of poor oral health on children's school attendance and performance.
        Am J Public Health. 2011; 101: 1900-1906
        • Pitts N.
        Understanding Dental Caries–from Pathogenesis to Prevention and Therapy.
        Springer, 2016: 3-9
        • Tham R.
        • Bowatte G.
        • Dharmage S.C.
        • et al.
        Breastfeeding and the risk of dental caries: a systematic review and meta-analysis.
        Acta Paediatr. 2015; 104: 62-84
      1. World Health Organization. 55th World Health Assembly. Agenda Item 13.10: Infant and Young Child Nutrition. Available at: 2002. Accessed December 2, 2015.

        • Kramer M.S.
        • Kakuma R.
        The optimal duration of exclusive breastfeeding: A systematic review.
        Adv Exp Med Biol. 2004; 554: 63-77
      2. US Department of Health and Human Services. The Surgeon General's call to action to support breastfeeding. Available at: 2011 Accessed December 15, 2015.

      3. Health Canada. Nutrition for healthy term infants: Recommendations from six to 24 months. A joint statement of Health Canada, the Canadian Paediatric Society, the Dietitians of Canada, and the Breastfeeding Committee for Canada. Available at: Accessed May 15, 2016.

      4. Scientific Advisory Committee on Nutrition; Subgroup on Maternal and Child Nutrition. Agenda item 3: Paper for discussion: Introduction of solid foods. Available at: Accessed February 2, 2016.

        • Kim Seow W.
        Environmental, maternal, and child factors which contribute to early childhood caries: A unifying conceptual model.
        Int J Paediatr Dent. 2012; 22: 157-168
        • Ip S.
        • Chung M.
        • Raman G.
        • et al.
        Breastfeeding and maternal and infant health outcomes in developed countries.
        Evid Rep Technol Assess. 2007; 153: 1-186
        • Victora C.G.
        • Bahl R.
        • Barros A.J.
        • et al.
        Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect.
        Lancet. 2016; 387: 475-490
        • Belanoff C.M.
        • McManus B.M.
        • Carle A.C.
        • McCormick M.C.
        • Subramanian S.V.
        Racial/ethnic variation in breastfeeding across the US: A multilevel analysis from the National Survey of Children's Health, 2007.
        Matern Child Health J. 2012; 16: S14-S26
        • Kramer M.S.
        • Vanilovich I.
        • Matush L.
        • et al.
        The effect of prolonged and exclusive breast-feeding on dental caries in early school-age children. New evidence from a large randomized trial.
        Caries Res. 2007; 41: 484-488
        • Iida H.
        • Auinger P.
        • Billings R.J.
        • Weitzman M.
        Association between infant breastfeeding and early childhood caries in the United States.
        Pediatr. 2007; 120: e944-e952
        • Dini E.L.
        • Holt R.D.
        • Bedi R.
        Caries and its association with infant feeding and oral health-related behaviours in 3-4-year-old Brazilian children.
        Community Dent Oral Epidemiol. 2000; 28: 241-248
        • Carsley S.
        • Borkhoff C.M.
        • Maguire J.L.
        • et al.
        Cohort Profile: The Applied Research Group for Kids (TARGet Kids!).
        Int J Epidemiol. 2014; 44: 776-788
      5. StatsCan. Canadian Health Measures Survey (CHMS). Available at: Accessed November 23, 2015.

        • Li R.
        • Scanlon K.S.
        • Serdula M.K.
        The validity and reliability of maternal recall of breastfeeding practice.
        Nutr Rev. 2005; 63: 103-110
        • Talekar B.S.
        • Rozier R.G.
        • Slade G.D.
        • Ennett S.T.
        Parental perceptions of their preschool-aged children’s oral health.
        J Am Dent Assoc. 2005; 136: 364-372
        • Pahel B.
        • Rozier R.G.
        • Slade G.
        Parental perceptions of children's oral health: The Early Childhood Oral Health Impact Scale (ECOHIS).
        Health Qual Life Outcomes. 2007; 5: 6
        • Jamieson L.M.
        • Thomson W.M.
        • McGee R.
        An assessment of the validity and reliability of dental self-report items used in a National Child Nutrition Survey.
        Community Den Oral Epidemiol. 2004; 32: 49-54
        • Little R.R.
        • DB
        Statistical Analysis with Missing Data.
        2 ed. Wiley, Hoboken, NJ2002
        • van Buuren S.
        • Groothuis-Oudshoorn K.
        MICE: Multivariate Imputation by Chained Equations in R.
        J Stat Softw. 2011; 45: 1-67
        • The Canadian Dental Association
        Does Breastfeeding Increase Risk of Early Childhood Caries?.
        J Can Dent Assoc. 2013; 79: d123
        • Valaitis R.
        • Hesch R.
        • Passarelli C.
        • Sheehan D.
        • Sinton J.
        A systematic review of the relationship between breastfeeding and early childhood caries.
        Can J Public Health. 2000; 91: 411-417
        • Tham R.
        • Bowatte G.
        • Dharmage S.
        • et al.
        Breastfeeding and the risk of dental caries: A systematic review and meta-analysis.
        Acta Paediatr. 2015; 104: 62-84
        • Hong L.
        • Levy S.M.
        • Warren J.J.
        • Broffitt B.
        Infant Breast-feeding and Childhood Caries: A Nine-year Study.
        Pediatr Dent. 2014; 36: 342-347
        • Kato T.
        • Yorifuji T.
        • Yamakawa M.
        • et al.
        Association of breast feeding with early childhood dental caries: Japanese population-based study.
        BMJ Open. 2015; 5: e006982
        • Chaffee B.W.
        • Feldens C.A.
        • Vitolo M.R.
        Association of long-duration breastfeeding and dental caries estimated with marginal structural models.
        Ann Epidemiol. 2014; 24: 448-454
        • Tanaka K.
        • Miyake Y.
        Association between breastfeeding and dental caries in Japanese children.
        J Epidemiol. 2012; 22: 72-77
        • Okawa R.
        • Nakano K.
        • Yamana A.
        • et al.
        Evaluation of factors related to nursing caries in 18-month-old Japanese children.
        Pediatr Dent J. 2011; 21: 49-55
        • van Palenstein Helderman W.H.
        • Soe W.
        • van 't Hof M.A.
        Risk factors of early childhood caries in a Southeast Asian population.
        J Dent Res. 2006; 85: 85-88
      6. European Academy of Paediatric Dentistry. Guidelines on Prevention of Early Childhood Caries: An EAPD Policy Document. Available at: Accessed March 28, 2015.

        • Bowen W.H.
        • Lawrence R.A.
        Comparison of the cariogenicity of cola, honey, cow milk, human milk, and sucrose.
        Pediatr. 2005; 116: 921-926
        • Nakayama Y.
        • Mori M.
        Association Between Nocturnal Breastfeeding and Snacking Habits and the Risk of Early Childhood Caries in 18-to 23-Month-Old Japanese Children.
        J Epidemiol. 2015; 25: 142
      7. U.S. Department of Health and Human Services. Healthy People 2020 Summary of Objectives: Maternal, Infant, and Child Health Objectives. Available at: Accessed June 30, 2014.