Devastated by 22 month old tooth decay

[Mumanddone]

my toddler went for her first dental check up today. Even before the dentist looked in her mouth she asked me about breastfeeding and told me to limit it. She said DD has decay on top teeth and referred me to the community dental nurse. I’m devastated. My daughter has never had bottles or juice or much sugar (none before 1 and occasionally has had sugar since then). We brush her teeth.

yes, we breastfeed a lot. We bedshare and she’s prone to popping on and off the boob as and when (breastsleeping means I hardly notice when she’s drinking so no idea how many times a night she does). I feel awful that our breastfeeding habits could have caused this. The dentist said only expressed milk from now on in a cup if I want her to drink breastmilk.

I have been putting limits on daytime feeding for the past couple of months and she’s been feeding just in the morning, once in the afternoon and before bed (which is great) but I have always loved feeding her at night and it’s never caused issues.

I am so concerned and I know I will have to start night weaning but I simply can’t handle tears and to be honest, I am so worried that our peaceful quiet nights are over because she’ll be crying for the boob.

I feel like I’ve failed her doing the thing everyone told me to do (breastfeeding). Has anyone experienced this? How should I move forward?

It’s likely diet or having antibiotics in pregnancy. As long as they are clean before bed then breastmilk doesn’t cause decay!

This is very encouraging. My daughter loves grapes and all sorts of fruits really. I suppose no more fruit as snacks

She can have they but st mealtimes so it's just one exposure rather than several throughout the day

Yes, all of the posts in the extended breast feeding group regarding tooth decay always show tooth decay in the front teeth which is absolutely typical of decay caused by night feeding either from a bottle or breast at night.

Extended breastfeeding Facebook groups sound like a barrel of laughs.

This is very interesting - I have not heard of this happening before with BF little ones! Mine were FF from about 4 weeks old, I was told by the dentist to cut DD's milk intake when she was a toddler as she was having a build up on her teeth. I blamed this on bottles so I took her off them. Then I binned my son's bottles the day he turned one... but that's easy for me to say - he would have taken the milk whatever way it came!! Sorry I don't have any advice but I can see why you're upset... but please try not to blame yourself.

I think the problem is having milk throughout the night, Breast or cow milk ..milk after teeth being brushed every night isn’t good.
my daughter is 3 and eats lots of fruit, I brush her teeth morning and night and she has been to the dentist twice with no issues reported. I really don’t think you should be cutting fruit out of diet when at 22 months baby is old enough to not feed in the night.

so do you! I wish you’d just give up steering the topic off course. Clearly you think breastfeeding mums are just hemp wearing hippies in bivouacs or something. Just leave it now.

Shouldn't brush teeth as often as possible, just morning and evening as too much brushing can cause damage too. The important thing to remember is not too brush straight after eating, always wait at least half an hour after last meal of the day to brush, and in the mornings brush before breakfast.

I know. She doesn’t need to feed. I need to be firm with myself and limit it.

There's a surprise, another thread turned into bashing breast feeding.

I don't have a clue about tooth decay OP, but I am a huge advocate for breastfeeding, and well done for what you have achieved. It will have benefitted your DC in so many ways

OP PLEASE READ - I didn’t want to read and run.

I am a Paediatric dentist, and also have a degree in oral microbiology. There is a lot of incorrect and unhelpful advice from a lot of posters here, which I would like to correct.

1. There is 100% a link between breastfeeding and anterior dental caries. I have studied many papers and journals for my msc research. It is also supported by the BSPD, the WHO and the SDCEP among hundreds of other health organisations. This is due to the carbohydrate (sugar) content of breastmilk vs cows milk/alternatives. It’s also due to the specific latch between babies mouth and breast, which is different to babies mouth and bottle. This affects the anterior teeth at a more significant rate due to the lack of oral clearance. Prolonged on-demand breastfeeding -ie. constant low levels of sugar/fermentable carbohydrate in the oral environment - is clearly going to lead to decay. It is not different than a child sucking on sweet all day and night.
2. Even small amounts of fruit may push her oral pH above the neutral zone, from around 5.5 to 6.5 which then means the saliva, and therefore oral environment, is constantly ‘acidic’ allowing bacteria to metabolise.
3. The problem is the frequency of sugar I take, not the quantity. It would be better (dentally speaking) to eat 100 Maltesers in five minutes, then it would be eat 100 Maltesers in eight hours, as the oral pH never gets a chance to recover and return to neutral.
4. You have said she will share ice cream etc. This is not well known, but is a big factor in paediatric decay - sharing utensils with adults who have cariogenic bacteria (bacteria that causes decay - most adults oral miorobiome will have it even if not active decay) passes the bacteria to the child’s oral environment. This bacteria, coupled with a sugary oral environment, is the perfect combination for decay to start.
5. Although many health organisations agree that PROLONGED ON DEMAND breastfeeding can cause decay, they are very averse telling women that they should stop breastfeeding either, as that is very beneficial and often life saving in counties such as Africa where the WHO (world health organisation) are very active.

Moving forward, my advice would be to continue breastfeeding if you wish, but try to rub some fluoride toothpaste around afterwards. Also, ensure she is having no more than three sugary intakes a day (including fruit and juices), and you are brushing her teeth for her first thing in the morning and last thing at night wit a fluoride toothpaste. Absolutely no sugary drinks, not even ‘sugar free’ (as they are never actually sugar free). You can stop the decay progressing if you do these things.

Unfortunately, some children are more prone than others, like so many things in life. Please do not feel like this is your fault. You have done your absolute best. I see this in my clinic multiple times a day and you are not alone. ❤️ It’s not the end of the world, just a learning curve and if you act now, you can prevent her developing any major problems/pain from them. Xxx

“It’s also due to the specific latch between babies mouth and breast, which is different to babies mouth and bottle. This affects the anterior teeth at a more significant rate due to the lack of oral clearance.”

this is interesting to me - because I always understood that the breastfeeding latch meant that the nipple was drawn further back into the baby’s mouth than a bottle, so the milk goes more directly to the back. I realise that as children grow and their mouths get bigger this will lessen, but is it more than a bottle or is “extended bottle feeding” less of a thing? It makes sense to me that the back teeth might be affected but less so the front teeth. I’m interested to hear more. I don’t have any skin in this game beyond nosiness - I fed my children way into toddlerhood but night weaned at a certain point so did not have to consider this issue

Thank you so much for this. It’s so helpful and kind. I will take it on board. My daughter is everything to me and I can’t fail her

Interesting what you say about sharing utensils etc. also she has never had sugared drinks or juice (I felt if she was getting the sugar intake it should be from whole fruit) but I will be very vigilant about this.

thank you again

I believe that bf alone is not the cause but frequency once the teeth are through. We have known for many years that bathing teeth continuously in cariogenic liquids milk, breast milk, fruit juice, smoothie, fizzy drinks etc exposes teeth to continuous sugar supply.
I saw huge numbers of bottle caries when I first qualified. Through education of health care professionals the correct advice led to a decrease in these cases. Bottle propping was a real problem, that and feeding all fluids in a bottle until late toddler age.
BF caries is fairly new because for generations FF has dominated. In the late 80s when I qualified it was not popular.
As dentists and healthcare professionals we need to give good advice once babies have teeth. DS’s teeth didn’t start erupting until he was 12 mnths ( there may be a connection to extended breast feeding ) the delay definitely protected his teeth because by the time they were through he was only feeding at bedtime and in the morning. Two feeds a day reduces the risk considerably. This may be why some toddlers have no decay when others do.
Don’t beat yourself up op. We are always learning as parents and you have time to change dietary habits so that her permanent dentition are not affected.
The other thing that can cause bottle/bf caries like appearance is reflux. This is often misdiagnosed by dentists if they don’t do a comprehensive medical history.

The dentist is not talking rubbish. This is a link to a recent study which deals with exactly what you were doing and shows that those children who were fed like this have a higher rates of cavities. The summary is that breastfeeding at night from 18 months onwards is considered a risk factor for early childhood cavities. It's not to say every child will be affected but there is an increased risk.
www.ncbi.nlm.nih.gov/pmc/articles/PMC8067957/

All you can do now is to do everything you can to protect her second teeth - you get a second chance. I don't know whether she is too young to use tooth mousse. You might want to ask your dentist - it's not heavily advertised but it is a sort of paste which you stick on the teeth and it will strengthen enamel. The strawberry flavour I think is the nicest. I think they make a junior version as well nowadays. Check with your dentist if this is right for you to use. One of my children had flaws in their enamel and got fillings in their second teeth. Once we started using this stuff he stopped having cavities and have had nothing done since and he's now in his mid twenties.

You've done a great job OP, a wonderful breastfeeding journey that made you both happy is a brilliant thing. I'm not sure why others on here would want to tear that apart.

In case it helps at all we did a lot of breastsleeping to save everyone's sanity, I went away with work for a few nights and weaning was very quick and fuss free so far. I honestly thought it would be a battle, so you may be pleasantly suprised. And your thread has reminded me that as my LO has had quite a lot of antibiotics then that probably is the right thing for us so thank you

Breast milk doesn’t cause tooth decay. Sugar does, even fruit sugars and those found naturally in other foods.

@Mummummummumyyyyy see the link upthread. Breast milk is 7% sugar!

I breast fed my three until around two years, all of them. No problems with tooth decay. However, when one was around four years old he had to have four bottom incisors removed as they came through badly discoloured and crumbly. The dentist inquired about whether he had taken antibiotics as a baby and I remembered he had, for a nasty ear infection when he was only a few months old. This can affect early tooth development apparently. Fortunately his adult teeth were perfect and this child has better quality teeth than his siblings, I feel because he has genetically inherited my teeth rather than his father’s, which the other two have. Small and wearing away quickly.

Hi @Mumanddone I’ve not read all the replies, but I’m shocked and actually don’t believe that you didn’t realise that exclusively breast feeding until this age would do this to her teeth. Especially if you still feed her at night. Sucking on a bottle or boob will do this as milk will collect and stay. Still, there must be sugar in her diet. She must be having juice, biscuits etc and then if she has breast milk on top without brushing after will do this.

@Mumanddone I didn't want to read without replying.

If you want to night wean we had success with just offering water and a cuddle instead, no tears involved but I didn't feed as long as you have (we managed 15 months). I have heard some people have had success with the book "nursies when the sun shines" too. Honestly the thought of night weaning terrified me, but actually it was quite uneventful, I hope it's that way for you as well.

Please try not to blame yourself, you've done everything you can to give your daughter the comfort she seeks.

Oh my. Please find a different dentist

breastfeeding is natural and has been happening since humans were around, if breastfeeding caused tooth decay then every breastfed baby would be going around with bad teeth but they aren’t! Please, please don’t stop feeding your baby because of what your dentist said. I fail to see how this has caused tooth decay but they’re advising you bottle feed 😳

What an excellent, informative post

Breastfeeding is natural, but a 2yr old sleeping latched on for hours at a time and feeding repeatedly through the night is not. That's what's causing the decay, the prolonged night feeds, not breastfeeding itself.