Some dentists blame tooth decay in toddlers on breastfeeding. However breastfeeding a baby or toddler with teeth is a normal and natural event and many children across the world breastfeed for many years without tooth decay. Our related article Breastfeeding and Tooth Decay looks in more detail at the lack of evidence around whether breastfeeding causes early cavities (holes in teeth) and reviews other causes of tooth decay. This article looks at recommendations for caring for your baby’s teeth and ideas to avoid or even reverse tooth decay when you’re breastfeeding a toddler.
Causes of tooth decay
Tooth decay has been linked with suboptimal nutrition such as a high sugar diet coupled with a lack of the fat-soluble vitamins and minerals needed for healthy teeth and bones.12 There is no evidence that stopping breastfeeding will prevent or stop dental decay. For a fuller discussion on other factors that may be associated with causing early tooth decay see Breastfeeding and Tooth Decay.
Preventing tooth decay in toddlers
#1 A healthy diet
A heathy diet will build strong teeth. Two books that discuss this in more detail are Cure Tooth Decay Heal and Prevent Cavities With Nutrition by Ramiel Nagel (2012) and The Dental Diet The Surprising Link Between Your Teeth, Real Food and Life-Changing Natural Health by Steven Lin (2018). Dietary suggestions for avoiding tooth decay in these books include providing foods rich in fat soluble vitamins every day (particularly A, D and vitamin K2), for example bone broths and homemade soups, grass-fed dairy products, eggs, fish, grass-fed beef and lamb plus fermented foods, cooked vegetables, and seaweeds. Foods to avoid include packaged and processed food and whole grains, oatmeal, breakfast cereal and granola, plus refined sweeteners continuing fructose. Natural sweeteners such as cane sugar, stevia, maple syrup, sweet fruits and dried fruit should be limited (Nagel, 2012 p 208).
#2 Continue breastfeeding
Breastfeeding is part of a healthy diet and breast milk is thought to be protective against the loss of minerals from tooth enamel (enamel demineralisation)3 and may protect against cavities 4. Dental health authors Lin and Nagel discuss how breastfeeding promotes correct jaw development in addition to its protective benefits (Lin, 2018; Nagel 2012). Dentist Steven Lin explains:
If there is one food that shows us how to eat for dental health, it’s breast milk. Breast milk shows us which nutrients a growing baby needs to develop a healthy body and mouth. From there, we can extrapolate what we need for a healthy body and mouth throughout our lives. what’s more, the act of breastfeeding shows us how to develop and maintain strong jaws and airways.
What about breastfeeding at night?
Some dentists may blame nighttime breastfeeding on tooth decay and suggest night weaning. The mechanics of breastfeeding at night are no different to breastfeeding during the day. It is normal to breastfeed at night for quite some time; see Baby Waking up at Night and How Long Should I Breastfeed? on this website for more information. Ramiel Nagel explains:
Night-time nursing helps protect against tooth decay. Children under the age of three who grow during the night need breast milk on cue to provide their bodies with the nutrients they need for health. Children over the age of three may need less breastfeeding at night, but still some to help them sleep well. Many children breastfeed at night and do not have cavities. Studies do not show a link between long-term breastfeeding and a higher number of cavities.
#3 Brush and check teeth regularly
Check your child’s teeth regularly and visit their dentist for routine check ups. It is generally recommended to brush teeth twice a day. The NHS (National Health Service) in the UK has information and a video to show you how to brush a baby’s teeth see; Looking After Your Baby’s Teeth (NHS, 2020). However Ramiel Nagel points out that tooth decay has less to do with the cleaning regime and more to do with the nutritional health of the mother and father before conception, the mother during pregnancy and the diet of mother and child after birth.5
White or brown spots
White or brown spots on the upper front teeth or whitish lines at the base of the teeth along the gum line can be signs of early decay which may be reversible with prompt attention to diet. White spots can also be associated with too much fluoride exposure (see below).
Lip-frenulum and decay?
The idea that a tight upper lip frenulum (the membrane connecting the upper gum to the inside of the mouth) might be associated with tooth decay is often discussed in breastfeeding support circles when the topic of dental health comes up. Although care can be taken to check for any trapped food under the top lip where the teeth meet the gums; The Australian Dental Association says there is not enough evidence to support the idea that a short or tight upper lip frenulum could increase the risk of tooth decay.6 In addition, the appearance of this frenulum changes over time.7
What about decay causing bacteria?
Decay causing bacteria (eg Streptococcus mutans) are often said to be an important cause of cavities in teeth. This led to recommendations to avoid passing items such as spoons or dummies mouth-to-mouth between parent and child to reduce the risk of transferring bacteria.89 More recently others question the idea that specific bacteria in the mouth cause tooth decay since many species of bacteria are always present and S mutans is found in healthy mouths as well as those with tooth decay (Lin, 2018; Nagel, 2012). Dentist Steven Lin discusses in his book how an excess of sugar in the diet affects the microbiome of the mouth—and hence tooth health—rather than specific bacteria being a cause of tooth decay in isolation. Lin explains that it is more a matter of maintaining balance among the different species of bacteria in the mouth microbiome than fighting back invaders (Lin, 2018).
What about xylitol?
Xylitol is a natural carbohydrate sugar substitute in chewing gum and other products that has been said to help stop bacteria sticking to teeth. One paper discusses that reducing the level of bacteria in a mother’s mouth from the mother chewing gum may lower the risk of passing them on to her baby.10 However Lin and Nagel discuss that bacteria and acids are not the root cause of tooth decay, rather it is to do with diet and Nagel includes xylitol (a sugar alcohol) as a food to be avoided when preserving teeth by diet (Lin, 2018; Nagel, 2012).
What about fluoride?
The UK’s National Health Service states that fluoride increases the quality and strength of tooth enamel, helping to re-mineralize teeth and repair early decay11. However not everyone agrees with this view since excess fluoride is a toxic substance and is associated with health issues and marks on teeth (enamel fluorosis).12 Fluoride is frequently added to water supplies and babies and toddlers are unable to spit out toothpaste containing fluoride providing a risk of over exposure to this chemical. Dr Sears’ website recommends considering how much fluoride exposure your baby already has before using toothpaste with added fluoride. He explains:
Toothpaste isn’t necessary, but if your toddler enjoys the foamy grins, use a dab of mildly flavored toothpaste. Before using a fluoride containing toothpaste, check with your dentist. If your child is already getting fluoride supplements or drinks a lot of fluoridated water, don’t use fluoridated toothpaste. If your dentist recommends fluoride toothpaste, only use a pea-sized dab. Children swallow toothpaste and too much fluoride can damage the teeth by causing fluorosis.
Breastfeeding a baby with teeth is biologically normal and is not a primary cause of tooth decay. A nutritionally poor diet that is high in sugar and/or does not have enough of the important fat-soluble vitamins essential for strong teeth and bones, are important causes of dental decay. Avoiding tooth decay in toddlers and babies involves regularly eating fat-soluble vitamins and minerals, limiting sugar intake, avoiding the bran and germ of most grains and eating plenty of protein throughout the day (Nagel, 2012 p 93 p 213).