2. Potential Role of Breast-Feeding in Reducing Early Childhood Caries 239
at least three dfs increased from 40.6
Figure 1
to 71.4 to 83.3 percent, with the
Average DMFS in Children Exclusively Bottle Fed 1 year or more
increases being statistically signifi-
cant based on a Chi-square test
25 (P 0.01). The children breast-fed
for part of the time but well short of
a year tended to have less decay than
20
those children exclusively bottle-fed
for at least 1.5 years. While the 12
15 children exclusively bottle-fed for
Average DMFS
over 1.5 years had a mean dfs of 25,
10 the 10 children who also had some
breast-feeding had a mean of about
16. In addition, while the 14 children
5
exclusively bottle-fed for 1.5 years
had a mean dfs of 10, the 16 children
0 who also had some breast-feeding
1 year 1- 1.5 yrs. > 1.5 years
had a mean of about 6.
Time Exlusively Bottle fed As seen in Table 1, children who
received a bottle at night had more
dfs than those who did not (nine
versus six). Among the former, 69.1
be conducted in Spanish using an health knowledge. The PDC dentist percent had at least one dfs and 54.4
English/Spanish interpreter. performed a dental examination on percent had at least three dfs, com-
This study was originally con- the child and noted in the child’s pared with 54.3 and 42.9 percent,
ceived as a case–control study, with dental chart which teeth and surfaces respectively, among the latter. These
the cases being children aged 1 to 5, were decayed, as was done with any differences were not statistically sig-
attending the clinic, and having at child seen at the PDC, irrespective of nificant. Children who drank Similac
least one decayed or filled tooth the study. The PCRA abstracted the formula were slightly more likely to
surface (dfs), and the control group pertinent information from the chart, have at least three dfs than those
being children aged 1 to 5, attending which had been recorded by the drinking Enfamil, with the difference
the clinic, and with no dfs. Cases and dentist, and entered it and the inter- not being statistically significant
controls were to be compared with view data into a database. (Table 1). Almost 59 percent of the
respect to exclusive breast-feeding children whose mothers had regular
versus bottle-feeding. However, Results dental visits had at least one dfs
because we were only able to obtain The study population consisted compared with 68.5 percent of the
seven children who were exclusively of 175 children. There were seven children whose mothers did not. The
breast-fed for more than 6 months, children who were exclusively difference was even larger for chil-
we decided to treat this as a purely breast-fed, one for 7-8 months, four dren having at least three dfs, but
descriptive study. for 9-10 months, and two for at least statistical significance was still not
The PDC dentist determined 11 months, and 168 who were not achieved (Table 1). Nearly all of the
patient eligibility for the study: a child exclusively breast-fed for more than mothers gave Juicy Juice to their
1 to 5 years old whose mother 6 months. This made it impossible to children (data not shown). Juicy
was available for an interview. She determine whether breast-feeding or Juice contains a high percentage of
referred the mother of each eligible bottle-feeding protects against ECC. natural sugar and is a supplement
child to the program coordinator/ However, it was possible to compare provided by WIC to mothers with
research associate (PCRA), who the children exclusively bottle-fed for infants.
explained the study and asked her extended periods of time (64 for 1 Over 90 percent of the participat-
whether she would like to participate year, 14 for 1.5 years, and 12 for over ing children were African-American,
with her child. Each mother agreeing 1.5 years) with each other. For these and they had about half as many dfs
to participate signed an informed children, the average dfs increased as the Hispanic/Latinos (Table 1).
consent form and was interviewed by from six for 1 year, to 10 for 1.5 Among the African-Americans, 63.3
the PCRA then or at a more con- years, to 25 for over 1.5 years percent had at least one dfs and 49.3
venient time. The interview in- (Figure 1). The percentage of these percent had at least three dfs, com-
cluded questions on the child’s birth, children with at least one dfs rose pared with 87.5 and 75 percent,
medical and feeding histories, tradi- with the increasing length of exclu- respectively, among the Hispanic/
tional ECC risk factors, frequency of sive bottle-feeding from 59.4 to 78.6 Latinos. The Hispanic/Latinos were
the mother’s dental visits, and her oral to 91.7 percent. The percentage with more likely than the African-
3. 240 Journal of Public Health Dentistry
Table 1
Dental Decay by Potential Risk or Protective Factors for Early Childhood Caries among
Children Aged 1 to 5
Variable Number of subjects Average number of dfs % with 1 dfs % with 3 dfs
Taking medication(s)
Yes 112 8 60.7 46.4
No 59 10 76.3 62.7
Medical problem(s)
Yes 74 8 60.8 48.7
No 94 9 69.2 53.2
Taking bottle at night
Yes 136 9 69.1 54.4
No 35 6 54.3 42.9
Mom brushes child’s teeth
Yes 122 8 65.6 48.4
No 47 10 66.0 59.6
Delivery
Full term 26 9 57.7 46.2
Premature 142 9 67.6 52.8
Formula
Enfamil 64 8 62.5 46.9
Similac 77 9 66.2 54.6
Both 10 7 60.0 50.0
Mother’s dental visit frequency
Rare 130 9 68.5 55.4
Regular 41 9 58.5 41.5
Race/ethnicity
African-American 150 8 63.3 49.3
Latino/Hispanic 16 16 87.5 75.0
Unknowns are excluded for each potential risk or protective factor, so the total numbers of participants for each factor may be less than 175.
dfs, decayed or filled tooth surface.
Americans to have at least three dfs the fact that all women and children among the mothers translates into
in both their front and rear teeth involved in the study were WIC better dentition for their children.
(front: 62.5 versus 35.3 percent; rear: recipients. A recent report showed Conducting another study with
75 versus 47.3 percent; data not that women on public insurance were many more children who have been
shown). These differences were not one-third less likely to breast-feed exclusively breast-fed for various
statistically significant. than privately insured women (6). lengths of time would be useful.
Despite its inability to shed light Because in this study over 25 percent
Discussion on the question on whether breast- of the Latino children were ex-
In planning the study, we took feeding is beneficial in preventing clusively breast-fed compared with
into account that African-American ECC because of the small number of less than 5 percent of the African-
women are far less likely than White exclusively breast-fed children, this American children, it would be
women to breast-feed their children study did yield some interesting find- expected that recruitment of recently
(30 versus 65 percent) (5). However, ings that warrant further exploration. immigrated subjects from local Latino
it was hoped that the inclusion of The finding that children drinking clinics might provide more exclu-
Hispanic women, who are more Similac were slightly more likely to sively breast-fed children. The moth-
likely to breast-feed, as well as the fact have at least three dfs than those er’s perception of the importance
that Grady Hospital, an Atlanta city drinking Enfamil might be important of her teeth, the effects of parents
hospital where many of the PDC- as the US government-sponsored brushing their children’s teeth, the
treated children are born, has an WIC program promotes both types of use of a “sippy” or training cup by
active lactation-promotion program, formula to program participants, and the child to drink sugared beverages
would enable us to enroll an both formulas contain the same per- such as Juicy Juice, and the type of
adequate number of exclusively centages of carbohydrate and fat. The formula consumed are all factors that
breast-fed children. Unfortunately, finding that children whose mothers warrant further examination.
that proved not to be the case. The had regular dental visits had fewer Our results suggest several mea-
paucity of exclusively breast-fed chil- caries than children whose mothers sures that might reduce the risk of
dren may, in part, be attributable to did not suggests that dental care ECC. One such measure might be for
4. Potential Role of Breast-Feeding in Reducing Early Childhood Caries 241
the WIC to reduce the amount of 3. Vargas CM, Crall JJ, Schneider DA. Socio-
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its potential role in ECC. WIC’s pro- Services, National Institutes of Health,
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National Institute of Dental and Cranio- Dentist. 1998 Jan/Feb;18(1):40-5.
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water. It is imperative that medical 2. Edmunds M, Coye MJ, editors. America’s for research purposes. J Public Health
children: health insurance and access to Dent. 1999;59:192-7.
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Insurance and Access to Care, Division feeding. Pediatrics. 2006 Oct;118(4):
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