Keeping Your Child’s Teeth Healthy at Night

A friend, who also happens to be a mother and a dentist asked me a while back, if she thought she needed to brush her 10-month-olds teeth after his last feed at night to stop him getting dental decay. It was a good question, but I didn’t know the answer.

1. Would you wake up a sleeping baby to brush their teeth after the last feed? (surely this is crazy, right?)
2. Do you brush after each still feed in the night? (again, level 10 madness)

We sat in our staff room, and realised, that despite being parents AND dentists, we were ill-equipped to answer these questions.

What guidance do Dentists use?

• Formula at night
  • Feed your child
  • When they are finished, remove the bottle from their mouth
  • Get back in bed and pray they stay asleep
• Breastfeeding at night
  • Honestly, I am a little bit embarrassed to say this. There is very little guidance on how to manage baby teeth and on-demand night breastfeeding past the age of 12 months in relation to dental decay. Recent systematic reviews highlight shortcomings in existing studies as confounding factors cannot be controlled (confounding factors in this case are toothbrushing, fluoride use, and intake of sugary drinks and foods, which will all impact the chances of getting decay) and therefore conclusions cannot be drawn (2).
  • This makes the advice to continue on demand breastfeeding to 2 years and beyond from The World Health Organisation, just a tad confusing for both parents and professionals.

So, what’s the problem with night feeds and teeth?

Bottle/baby or nursing caries is a form of tooth decay that is caused by children sleeping with bottles. It is more commonly caused when a child goes to bed with a bottle filled with milk or juice-anything except cooled, boiled water. The decay forms in a very particular pattern, all teeth except the lower front ones.

But feeding from a bottle isn’t the same as feeding from the boob.

Most of the time, night time feeding from a bottle will cause bottle caries.

Very rarely breastfeeding on demand will cause nursing caries.

Breastfeeding is different from bottle-feeding because…

1. The latch
   1. Nipples – babies don’t suck the nipple, they have a wide mouth which is filled with boob & nipple. The nipple landing at the junction between the soft & hard palate, resulting in no pooling of milk in the mouth, the milk bypassing the teeth and going straight down the throat.
   2. Bottles  – these sit much further forward in the mouth (which can lead to a tongue thrusting habit and a change development of the jaw, teeth and facial muscles) meaning that the milk, can pool in the mouth, near and on the teeth.

1. The milk
   1. Breast Milk it changes depending on what your baby needs and contains millions of live cells, including;
      1. White blood cells & stem cells.
      2. Lactoferrin, which has antibacterial properties
      3. Antibodies which neutralise bacteria
   2. Formula changes all the time, as companies try to mimic breast milk. It will nourish your baby, but it doesn’t contain all of the live cells, and clever feedback systems our body has evolved over millions of years.

1. Delivery Device
   1. Nipples – by month 8 of pregnancy, good bacteria (Bifidobacterium) are secreted from the milk ducts, they then die (they can’t survive outside the body as they are anaerobic) and leave behind potent acids and antibiotic chemicals that repel bacteria. This is thought to prevent naturally occuring bacteria on our skin colonising your babies mouth!
   2. Bottles – grow a biofilm, that is filled with bacteria, as do dummies/pacifiers, this can change the bacteria that colonise your babies mouth. These bacteria are linked to dental decay. These bacteria can be transferred from parents into the babies mouths. This is why you should never “clean” a dummy in your mouth before putting it in your babies mouth.

Regardless of how you choose to feed your children my advice is this

• Trust your instincts, you are their parent, do what feels right for you and your child.
  • If you are breastfeeding, continue on-demand feeding if this feels right for you and your baby, the world health organisation advice is to breastfeed until 2 years and beyond.
  • If your baby is formula fed, don’t leave them with a bottle overnight, let them finish their feed and remove the bottle.

• Keep their mouth clean
  • Use baby dental wipes that contain Xylitol to reduce the bacteria in your babies mouth that can cause decay BEFORE the teeth erupt.
  • When the first tooth erupts (usually around 6 months) brush it! Brush twice a day with a fluoride toothpaste.

• Limit free sugars
  • Food and drink that humans have messed with (doesn’t have mud on it still!) generally contain added sugar that 100% does cause decay. So control this variable wherever possible. Don’t add sugar to weaning foods, and try and stick to water and milk.

• Get the right support
  • Register with a dentist, and have a check-up when they get their first tooth, or when they turn 1, whichever is sooner.
  • Take the advice of your professionals, they will keep a close eye on your child’s dental development, and they will be able to spot any problems early, and advise if any changes need to be made.

References

1. Virtanen, Jorma I et al. “Oral health behaviors and bacterial transmission from mother to child: an explorative study.” BMC oral health vol. 15 75. 3 Jul. 2015, doi:10.1186/s12903-015-0051-5
2. Tham R and others. ‘Breastfeeding and the risk of dental caries: a systematic review and meta‐analysis’ Acta Paediatrica 2015: volume 104(S467), pages 62 to 84
3. https://www.gov.uk/government/publications/health-matters-child-dental-health/health-matters-child-dental-health
4. https://www.gov.uk/government/publications/breastfeeding-and-dental-health/breastfeeding-and-dental-health
5. https://www.bspd.co.uk/Resources/Position-Statements
6. https://www.unicef.org.uk/babyfriendly/phe-statement-breastfeeding-and-dental-health/
7. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/605266/Delivering_better_oral_health.pdf

Special thanks to several people in helping me write this blog. They have contributed to the content, and fact checking and I couldn’t have done it without them.

Dr Claire Stevens, Mum, Consultant in Paediatric Dentistry, and saver of children’s teeth. Dr Laura Lenihan, Mum, instagram boss and family GP, and Charlotte Young, Mum, author, breastfeeding counsellor and lactation consultant.