Early childhood caries (ECC) is a common oral health problem, particularly in disadvantaged and developing populations. Its causes are multifaceted, including feeding practices like breastfeeding. The link between breastfeeding and ECC is unclear.

Key findings

• No significant association was found between breastfeeding and the development of early childhood caries (ECC).
• Nighttime breastfeeding was associated with an increased risk of ECC.
• Breastfeeding for less than 12 or 18 months may have a protective effect against ECC, while breastfeeding for 24 months or longer did not show a significant difference or protection.

 Aim

This systematic review and meta-analysis aims to answer the following research questions:

1. Is there an association between breastfeeding and ECC?
2. Does the prevalence of ECC differ among children breastfed for various durations?
3. Does nocturnal breastfeeding increase the risk of ECC?

Methods

• The protocol was registered in PROSPERO. It followed the JBI methodology for systematic reviews of etiology and risk, adhering to PRISMA 2020 guidelines.

•  The review included cohort and case-control studies examining the association between breastfeeding and ECC in children under six.

• Studies were identified through five electronic databases and backward citation chasing until May 2023.

• Data extraction was performed independently by two reviewers using JBI SUMARI tools, and meta-analyses were conducted using Review Manager software.

Results

Description of Included Studies

• This systematic review included 31 studies (22 cohort studies and 9 case-control studies) examining the association between breastfeeding and early childhood caries (ECC) in children under six years old.
• The studies were published between 1994 and 2023 and included a total of 15,236 preschool children.
• Most studies were conducted in middle-income countries like Brazil, with some in high-income countries.
• ECC was assessed using various measures, including dmfs, dmft, dft, dfs, and ICDAS criteria.
  

  Main Findings

  • Breastfeeding vs. Non-Breastfeeding: Meta-analyses found no significant difference in dental caries between breastfed and non-breastfed children, although sensitivity analysis suggested potential protection from breastfeeding.
  • Nighttime Breastfeeding: Nighttime breastfeeding was associated with an increased risk of ECC.
  • Duration of Breastfeeding:
    • No significant difference in ECC was found for breastfeeding durations less than 4 or 6 months.
    • Case-control studies showed fewer dental caries in children breastfed for less than 6 months compared to 6 months or longer.
    • Children breastfed for less than 12 or 18 months had fewer dental caries than those breastfed for longer durations.
    • No significant difference or a protective effect was found for breastfeeding durations of 24 months or longer.

Study citation: 

Comments: 

The study design and methodology were well-structured, following established guidelines (JBI and PRISMA). The authors conducted a comprehensive search across five databases and included a substantial number of studies (31 studies, 15,236 children), enhancing the statistical power of their analyses. However, the study’s quality is limited by significant heterogeneity in the included studies, particularly in defining and measuring breastfeeding practices and ECC. This heterogeneity could lead to biased results and limit the generalisability of the findings.

The exclusion of non-English studies and the focus on high- and middle-income countries may introduce selection and publication biases. It also did not differentiate between exclusive breastfeeding (only breast milk) and mixed feeding (breast milk and formula). Therefore, the impact of supplementing breastfeeding with formula on ECC cannot be determined from this study.

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