• Evgenija Marković Department of Orthodontics, School of Dentistry, University of Belgrade, Dr Gastona Gravijea1, 11000 Belgrade
  • Dejan Marković Department of Paediatric and Preventive Dentistry, School of Dentistry, University of Belgrade, Dr Subotica 11, 11000 Belgrade
  • Rade Vuković Mother and Child Health Care Institute of Serbia “Dr Vukan Cupic”, Belgrade, Radoja Dakica 8, 11000 Belgrade
  • Tamara Perić Department of Paediatric and Preventive Dentistry, School of Dentistry, University of Belgrade, Dr Subotica 11, 11000 Belgrade
  • Biljana Kilibarda Institute of Public Health of Serbia “Dr Milovan Jovanovic Batut”, Belgrade, Dr Subotica 5, 11000 Belgrade
  • Ana Vukovic Department of Paediatric and Preventive Dentistry, School of Dentistry, University of Belgrade
Keywords: breastfeeding, dental caries, infant


Current recommendations by the European Academy of Paediatric Dentistry, American Academy of Paediatric Dentistry, and International Association of Paediatric Dentistry advocate weaning from breast milk and avoiding unrestricted breastfeeding after the eruption of primary teeth in order to lower the risk of early childhood caries (ECC). However, World Health Organization, American Academy of Paediatrics and nutritional recommendations support exclusive breastfeeding up to six months of age, following continued breastfeeding along with appropriate complementary foods, favouring unrestricted and prolonged breastfeeding even beyond the age of two. The purpose of this review is to discuss current data in the literature regarding the association between breastfeeding and ECC in order to address this problem and to provide consistent recommendations. PubMed search revealed possible link between breastfeeding and ECC, however without evidence strong enough to establish the appropriate oral health preventive recommendation. Having in mind known benefits of breastfeeding, it is advisable to adhere to current paediatric guidelines which promote unrestricted breastfeeding as long as it is mutually desired by mother and child. This recommendation doesn’t exclude but complements the prevention and timely treatment of ECC. Furthermore, there is a need to highlight the importance of education of parents and health care providers about the ECC risk factors, identification of initial lesions and consequences. Further research regarding this issue is needed.


Breasfeeding Initiatives: American Academy of Pediatrics; 2013 [Available from:

Child health - breastfeeding: World Health Organization; 2013 [Available from:

Salone LR, Vann WF, Jr., Dee DL. Breastfeeding: an overview of oral and general health benefits. J Am Dent Assoc 2013; 144(2):143-51.

Michaels KB, Willett WC, Graubard BI, Vaidya RL, Cantwell MM, Sansbury LB, et al. A longitudinal study of infant feeding and obesity through life course. Int J Obes 2007; 31:1078-85.

Kramer M, Kakuma R. Optimal duration of exclusive breastfeeding (Review). Cochrane Database Syst Rev 2002; (1):CD003517.

Petrou SP. Incontinent ileovesicostomy in the management of neurogenic bladder dysfunction. Int Braz J Urol 2003;29(2):185-6.

Matijevic D, Mladenovic Rankovic S, Kotevic A. Responsive feeding. Zdravstvena zaštita (Health Care) 2018; 1:2-11.

Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. Pediatr Dent 2017; 39(6):59-61.

Policy on Dietary Recommendations for Infants, Children, and Adolescents. Pediatr Dent 2017; 39(6):64-6.

Policy on Early Childhood Caries (ECC): Unique Challenges and Treatment Options. Pediatr Dent 2017; 39(6):62-3.

Kuhnisch J, Ekstrand KR, Pretty I, Twetman S, van Loveren C, Gizani S, Spyridonos Loizidou M. Best clinical practice guidance for management of early caries lesions in children and young adults: an EAPD policy document. Eur Arch Paediatr Dent 2016; 17(1):3-12.

Tinanoff N, Baez RJ, Diaz Guillory C, Donly KJ, Feldens CA, McGrath C, et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective. Int J Paediatr Den 2019; 29(3):238-48.

Folayan MO, Sowole CA, Kola-Jebutu A, Owotade FJ. Risk factors for rampant caries in children from southwestern Nigeria. Afr J Med Med Sci 2012; 41(3):249-55.

Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859):2163-96.

El Tantawi M, Folayan MO, Mehaina M, Vukovic A, Castillo JL, Gaffar BO, et al. Prevalence and Data Availability of Early Childhood Caries in 193 United Nations Countries, 2007-2017. Am J Public Health 2018; 108(8):1066-72.

Carevic M, Vulovic M, Sindolic M. Integrated Approach in Combating Early Childhood Caries. Balk J Stom 2009; 13:15-20.

Milenkovic A, Markovic D, Zdravkovic D, Peric T, Milenkovic T, Vukovic R. Adrenal crisis provoked by dental infection: case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 110(3):325-9.

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(6):411-7.

Matee MI, Mikx FH, Maselle SY, Van Palenstein Helderman WH. Mutans streptococci and lactobacilli in breast-fed children with rampant caries. Caries Res 1992; 26(3):183-7.

Peres RC, Coppi LC, Volpato MC, Groppo FC, Cury JA, Rosalen PL. Cariogenic potential of cows', human and infant formula milks and effect of fluoride supplementation. Br J Nutr 2009; 101(3):376-82.

Bowen WH, Lawrence RA. Comparison of the cariogenicity of cola, honey, cow milk, human milk, and sucrose. Pediatrics 2005; 116(4):921-6.

Prabhakar AR, Kurthukoti AJ, Gupta P. Cariogenicity and acidogenicity of human milk, plain and sweetened bovine milk: an in vitro study. J Clin Pediatr Dent 2010; 34(3):239-47.

Thomson ME, Thomson CW, Chandler NP. In vitro and intra-oral investigations into the cariogenic potential of human milk. Caries Res 1996; 30(6):434-8.

Azevedo TD, Bezerra AC, de Toledo OA. Feeding habits and severe early childhood caries in Brazilian preschool children. Pediatr Dent 2005; 27(1):28-33.

Aida J, Ando Y, Oosaka M, Niimi K, Morita M. Contributions of social context to inequality in dental caries: a multilevel analysis of Japanese 3-year-old children. Community Dent Oral Epidemiol 2008; 36(2):149-56.

Sakuma S, Nakamura M, Miyazaki H. Predictors of dental caries development in 1.5-year-old high-risk children in the Japanese public health service. J Public Health Dent 2007; 67(1):14-9.

Tanaka K, Miyake Y. Association between breastfeeding and dental caries in Japanese children. J Epidemiol 2012; 22(1):72-7.

Zhou Y, Lin HC, Lo EC, Wong MC. Risk indicators for early childhood caries in 2-year-old children in southern China. Aust Dent J 2011; 56(1):33-9.

Campus G, Solinas G, Strohmenger L, Cagetti MG, Senna A, Minelli L, et al. National pathfinder survey on children's oral health in Italy: pattern and severity of caries disease in 4-year-olds. Caries Res 2009; 43(2):155-62.

Folayan MO, Sowole CA, Owotade FJ, Sote E. Impact of infant feeding practices on caries experience of preschool children. J Clin Pediatr Dent 2010; 34(4):297-301.

Hallett KB, O'Rourke PK. Early childhood caries and infant feeding practice. Community Dent Health 2002; 19(4):237-42.

Jigjid B, Ueno M, Shinada K, Kawaguchi Y. Early childhood caries and related risk factors in Mongolian children. Community Dent Health 2009; 26(2):121-8.

Chaffee BW, Feldens CA, Vitolo MR. Association of long-duration breastfeeding and dental caries estimated with marginal structural models. Ann Epidemiol 2014; 24(6):448-54.

Yonezu T, Yotsuya K, Yakushiji M. Characteristics of breast-fed children with nursing caries. Bull Tokyo Dent Coll 2006; 47(4):161-5.

van Palenstein Helderman WH, Soe W, van 't Hof MA. Risk factors of early childhood caries in a Southeast Asian population. J Dent Res 2006; 85(1):85-8.

Peres KG, Nascimento GG, Peres MA, Mittinty MN, Demarco FF, Santos IS, et al. Impact of Prolonged Breastfeeding on Dental Caries: A Population-Based Birth Cohort Study. Pediatrics 2017; 140(1). pii: e20162943.

Jones K. Caution needed over breastfeeding advice. Br Dent J 2018; 225(4):275.

Milnes AR. Description and epidemiology of nursing caries. J Public Health Dent 1996; 56(1):38-50.

Tinanoff N, Kanellis MJ, Vargas CM. Current understanding of the epidemiology mechanisms, and prevention of dental caries in preschool children. Pediatr Dent 2002; 24(6):543-51.

Tham R, Bowatte G, Dharmage SC, Tan DJ, Lau MX, Dai X, et al. Breastfeeding and the risk of dental caries: a systematic review and meta-analysis. Acta Paediatr 2015; 104(467):62-84.

Victora CG, Bahl R, Barros AJ, Franca GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016;387(10017):475-90.

LeBouder E, Rey-Nores JE, Raby AC, Affolter M, Vidal K, Thornton CA, et al. Modulation of neonatal microbial recognition: TLR-mediated innate immune responses are specifically and differentially modulated by human milk. J Immunol 2006; 176(6):3742-52.

Erickson PR, Mazhari E. Investigation of the role of human breast milk in caries development. Pediatr Dent 1999; 21(2):86-90.

Geddes DT, Kent JC, Mitoulas LR, Hartmann PE. Tongue movement and intra-oral vacuum in breastfeeding infants. Early Hum Dev 2008; 84(7):471-7.

Ribeiro NM, Ribeiro MA. Breastfeeding and early childhood caries: a critical review. J Pediatr (Rio J). 2004; 80(5 Suppl):S199-210.

Roberts GJ, Cleaton-Jones PE, Fatti LP, Richardson BD, Sinwel RE, Hargreaves JA, et al. Patterns of breast and bottle feeding and their association with dental caries in 1- to 4-year-old South African children. 2. A case control study of children with nursing caries. Community Dent Health 1994; 11(1):38-41.

Weerheijm KL, Uyttendaele-Speybrouck BF, Euwe HC, Groen HJ. Prolonged demand breast-feeding and nursing caries. Caries Res 1998; 32(1):46-50.

Vignarajah S, Williams GA. Prevalence of dental caries and enamel defects in the primary dentition of Antiguan pre-school children aged 3-4 years including an assessment of their habits. Community Dent Health 1992; 9(4):349-60.

Rosenblatt A, Zarzar P. Breast-feeding and early childhood caries: an assessment among Brazilian infants. Int J Paediatr Dent 2004; 14(6):439-45.

Hong L, Levy SM, Warren JJ, Broffitt B. Infant breast-feeding and childhood caries: a nine-year study. Pediatr Dent 2014; 36(4):342-7.

Kramer MS, Vanilovich I, Matush L, Bogdanovich N, Zhang X, Shishko G, 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(6):484-8.

Dye BA, Shenkin JD, Ogden CL, Marchall TA, Levy SM, Kanellis MJ. The relationship between healthful eating practices and dental caries in children aged 2-5 years in the United States, 1988-1994. Journal of American Dental Association 2004; 135:55-66.

Iida H, Auinger P, Billings RJ, Weitzman M. Association between infant breastfeeding and early childhood caries in the United States. Pediatrics 2007; 120(4):e944-52.

Nunes AMM, Alves CMC, Araujo FB, Ortiz TML, Ribeiro MRC, Silva AAM, et al. Association between prolonged breast-feeding and early childhood caries: a hierarchical approach. Community Dent Oral Epidemiol 2012; 40:542-9.

Moynihan P, Tanner LM, Holmes RD, Hillier-Brown F, Mashayekhi A, Kelly SAM, et al. Systematic Review of Evidence Pertaining to Factors That Modify Risk of Early Childhood Caries. JDR Clin Trans Res 2019; 4(3):202-16.

Fontana M. The Clinical, Environmental, and Behavioral Factors That Foster Early Childhood Caries: Evidence for Caries Risk Assessment. Pediatr Dent 2015; 37(3):217-25.

Iwinski S, Gotsch G. Feeding On Cue. New Beginnings 2003; 20(4):126.

Vanore JV, Christensen JC, Kravitz SR, Schuberth JM, Thomas JL, Weil LS, et al. Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 2: Hallux rigidus. J Foot Ankle Surg 2003; 42(3):124-36.

Derkson GD, Ponti P. Nursing bottle syndrome; prevalence and etiology in a non-fluoridated city. J Can Dent Assoc 1982; 48(6):389-93.

Williams SA, Hargreaves JA. An inquiry into the effects of health related behaviour on dental health among young Asian children resident in a fluoridated city in Canada. Community Dent Health 1990; 7:413-20.

Harmon Jones C. Duration, Intensity, and Exclusivity of Breastfeeding: Recent Research Confirms the Importance of these Variables. Breastfeeding Abstracts 2006; 25(3):17-20.

Hallonsten AL, Wendt LK, Mejare I, Birkhed D, Hakansson C, Lindvall AM, et al. Dental caries and prolonged breast-feeding in 18-month-old Swedish children. Int J Paediatr Dent 1995; 5(3):149-55.

Garcia R, Borrelli B, Dhar V, Douglass J, Gomez FR, Hieftje K, et al. Progress in Early Childhood Caries and Opportunities in Research, Policy, and Clinical Management. Pediatr Dent 2015; 37(3):294-9.

Peres KG, Chaffee BW, Feldens CA, Flores-Mir C, Moynihan P, Rugg-Gunn A. Breastfeeding and Oral Health: Evidence and Methodological Challenges. J Dent Res 2018; 97(3):251-8.

Early Childhood Caries: IAPD Bangkok Declaration. Int J Paediatr Dent 2019; 29(3):384-6.

Branger B, Camelot F, Droz D, Houbiers B, Marchalot A, Bruel H, et al. Breastfeeding and early childhood caries. Review of the literature, recommendations, and prevention. Arch Pediatr 2019; 26(8):497-503.

How to Cite
Marković, E., Marković, D., Vuković, R., Perić, T., Kilibarda, B., & Vukovic , A. (2019). BREASTFEEDING – THE PERSPECTIVE OF PAEDIATRIC DENTIST. Health Care, 48(4), 35-42.
Review paper