WHO and the United Nations Children’s Fund (UNICEF) recommend that breastfeeding be initiated within the first hour after birth, continued exclusively for the first 6 months of life and continued, with safe and adequate complementary foods, up to 2 years or beyond.

The risk of dying in the first 28 days of life is 33% higher for new-borns who initiated breastfeeding 2–23 hours after birth, and more than twice as high for those who initiated 1 day or longer after birth, compared to new-borns who were put to the breast within the first hour after birth.

The first tooth usually erupts in an infant’s mouth between 6 and 12 months of age. As each tooth erupts the risk of developing dental caries increases, hence age and number of teeth increases risk. Cariogenic bacteria are transmitted to the child via close contact with the mother’s saliva but their levels and cariogenicity vary between individuals depending on maternal bacterial levels, maternal caries prevalence, oral hygiene practices and exposure to dietary sugars.



The sugar present in breast milk is lactose. Breast milk LACTOSE is not thought to have the same effect on teeth as pure sugar because of all the protective antibacterial properties, enzymes and high pH levels in breast milk. For example:

Streptococcus mutans (a bacteria causing tooth decay) is killed by lactoferrin—a glycoprotein in breast milk that carries iron and has a bactericidal action.

NO link between breastfeeding or its duration with early childhood caries on primary teeth decay. The mechanics of breastfeeding make it unlikely for human milk to stay in the baby’s mouth for long. Breastmilk is not thought to pool/ remain in the baby’s mouth in the same way as bottled milk because the milk doesn’t flow unless the baby is actively sucking. Also, milk from the breast enters the baby’s mouth behind the teeth. If the baby is actively sucking then he is also swallowing, so pooling breast milk in the baby’s mouth appears not to be an issue around the teeth. The artificial nipple is very short, so the liquid in the bottle is likely to pass over teeth before being swallowed.

During breastfeeding, the nipple is drawn deep within the baby’s mouth, and milk is literally squirted into the back of his mouth. The suckling process includes a swallow and the nursing child must swallow before he can go on to the next step In contrast, baby bottles can drip milk, juice, or formula into the baby’s mouth even if he is not actively sucking. If the baby does not swallow, the liquid can pool in the front of the mouth


 Baby bottles on the other hand can drip milk, juice, or formula into the baby’s mouth even if he is not actively sucking. If the baby does not swallow, the liquid can pool in the front of the mouth. The effects of formula on enamel shows that most artificial baby milks reduced the pH (acidity) significantly, supported significant bacterial growth and dissolved enamel. Some caused decay in a matter of weeks.


Compared to bottle feeding, breastfeeding promotes normal mouth, palate and airway shape, and optimal teeth alignment. These factors can help to reduce sudden infant death syndrome (SIDS), sleep disturbances, the need for orthodontic treatment and can promote other future health benefits. Some studies found that breastfeeding can reduce the risk of teeth being misaligned (malocclusions).

These breastfeeding behaviours are inter-related.

  1. Breastfeeding duration
  2. Frequency of breastfeeding
  3. Night/Nocturnal breastfeeding during sleep

Frequent breastfeeding, prolonged breastfeeding and night breastfeeding would cause tooth decay ONLY IF diets or good oral hygiene practice is not observed

3. Night/Nocturnal breastfeeding is often used to comfort an infant or child who may then fall asleep with the nipple in their mouth. In this position, the tongue fills the mouth and holds the breast milk against the surfaces of the teeth, thereby prolonging the exposure of the substrate to the cariogenic bacteria that are attached to the teeth surfaces and hence increasing the risk of dental caries.

Excerpt from Guidance Breastfeeding and Dental Health, Public

Health England, 2019. Public Health England says:

 ‘dental teams should continue to support and encourage mothers to breastfeed not being breastfed is associated with an increased risk of infectious morbidity (for example gastroenteritis, respiratory infections, middle-ear infections) breastfeeding up to 12 months of age is associated with a decreased risk of tooth decay. Breastfeeding is the physiological norm against which other behaviours are compared; therefore dental teams should promote breastfeeding and include in their advice the risks of not breastfeeding to general and oral health’

Excerpt from Breastfeeding An Overview of Oral and General Health

Benefits, Salone, Vann and Dee, J Am Dent Assoc, 2013. The American Dental Association says ‘we call upon all dental team members to be advocates, promoters and supporters of breastfeeding. We also encourage dental professionals to inform care-givers of the importance of cleansing infants’ teeth as soon as they erupt by using a washcloth or soft toothbrush to reduce bacterial colonization and to help reduce children’s risk of developing ECC [early childhood caries].’


It is normal and natural to breastfeed and to still be breastfeeding by the time a baby has little teeth. The idea that breastfeeding is the cause for tooth decay makes no sense biologically, and is not borne out by research. Breastfeeding is too important to abandon without good evidence. There are many possible causes of tooth decay and it is important to keep teeth clean and try to minimise all the risk factors whether breastfeeding or not.

For ideas to help protect your children’s teeth see the article

Perhaps, you missed our digging deep session on oral health on the wall of ”ask the dentists” Facebook group, click here https://web.facebook.com/groups/askthedentists/

Babies oral health


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