Journal Mobile Options
Table of Contents
Vol. 41, No. 6, 2007
Issue release date: November 2007
Caries Res 2007;41:484–488

The Effect of Prolonged and Exclusive Breast-Feeding on Dental Caries in Early School-Age Children

New Evidence from a Large Randomized Trial

Kramer M.S. · Vanilovich I. · Matush L. · Bogdanovich N. · Zhang X. · Shishko G. · Muller-Bolla M. · Platt R.W.
Departments of aPediatrics and bEpidemiology and Biostatistics, McGill University Faculty of Medicine, Montreal, Canada; cNational Research and Applied Medicine Mother and Child Centre, Minsk, Belarus; dFaculté de science dentaire, Université de Nice, Nice, France

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


To study the effects of prolonged and exclusive breast-feeding on dental caries, we followed up children participating in the Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial of a breast-feeding promotion intervention based on the WHO/UNICEF Baby-Friendly Hospital Initiative. A total of 17,046 healthy, mother-infant breast-feeding pairs were enrolled from 31 Belarussian maternity hospitals and affiliated polyclinics, of whom 13,889 (81.5%) were followed up at 6.5 years. At follow-up, polyclinic pediatricians transcribed the reports of a standard dental examination performed by public health dentists at age 6 years and recorded in the children’s polyclinic charts. Analysis was based on intention to treat, with a statistical model that accounts for clustering within hospitals/clinics to permit inferences at the individual level. The experimental intervention led to a large increase in exclusive breast-feeding at 3 months (43.3 vs. 6.4%, p < 0.001) and a significantly higher prevalence of any breast-feeding at all ages up to and including 12 months. No significant intervention effects were observed on dental caries. Our results, based on the largest randomized trial ever conducted in the area of human lactation, provide no evidence of beneficial or harmful effects of prolonged and exclusive breast-feeding on dental caries at early school age.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Bowen WH, Lawrence RA: Comparison of the cariogenicity of cola, honey, cow milk, human milk, and sucrose. Pediatrics 2005;116:921–926.
  2. Brams M, Maloney J: ‘Nursing bottle caries’ in breast-fed children. J Pediatr 1983;103:415–416.
  3. Campbell MK, Elbourne DR, Altman DG, for the CONSORT Group: CONSORT statement: extension to cluster randomised trials. BMJ 2004;328:702–708.
  4. Dini EL, Holt RD, Bedi R: Caries and its association with infant feeding and oral health-related behaviours in 3–4-year-old Brazilian children. Community Dent Oral Epidemiol 2000;28:241–248.
  5. Dye BA, Shenkin JD, Ogden CL, Marshall 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. J Am Dent Assoc 2004;135:55–66.
  6. Gardener DE, Norwood JR, Eisenson JE: At-will breast feeding and dental caries: four case reports. J Dent Res 1977;44:186–191.
  7. Hallett KB, O’Rourke PK: Social and behavioural determinants of early childhood caries. Aust Dent J 2003;48:27–33.
  8. Hallonsten A-L, Wendt L-K, Mejàre I, Birkhed D, Håkansson C, Lindvall A-M, et al: Dental caries and prolonged breast-feeding in 18-month-old Swedish children. Int J Paediatr Dent 1995;5:149–155.
  9. Hausen H, Kärkkäinen S, Seppä L: Caries data collected from public health records compared with data based on examinations by trained examiners. Caries Res 2001;35:360–365.
  10. Horta BL, Bahl R, Martines JC, Victora CG: Evidence on the long-term effects of breastfeeding: systematic reviews and meta-analyses. WHO Library Cataloguing-in-Publication Data. World Health Organization, 2007.
  11. Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J: Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. AHRQ Publication No 07-E007. Rockville, Agency for Healthcare Research and Quality, 2007.
  12. Kotlow LA: Breast feeding: a cause of dental caries in children. J Dent Child 1977;44:192–193.
  13. Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, Collet J-P, Vanilovich I, Ducruet T, Shishko G, Zubovich V, Mknuik D, Gluchanina E, Dombrovskiy V, Ustinovitch A, Kot T, Bogdanovich N, Ovchinikova L, Helsing E for the PROBIT Study Group: Promotion of breastfeeding intervention trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA 2001;285:413–420.
  14. Kramer MS, Kakuma R: Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev 2002;1:CD003517. DOI: 10.1002/ 14651858.CD003517.
  15. León-Cava N, Lutter C, Ross J, Luann M: Quantifying the Benefits of Breastfeeding: A Summary of the Evidence. Washington, Pan American Health Organization PAHO, 2002.
  16. Matee MIN, van’t Hof MA, Maselle SY, Mikx FHM, van Palenstein Helderman WH: Nursing caries, linear hypoplasia and weaning habits in Tanzanian infants. Community Dent Oral Epidemiol 1994;22:289–291.
  17. Rugg-Gunn AJ, Roberts GJ, Wright WG: Effect of human milk on plaque pH in situ and enamel dissolution in vitro compared with bovine milk, lactose, and sucrose. Caries Res 1985;19:327–334.
  18. Sayegh A, Dini EL, Holt RD, Bedi R: Oral health, sociodemographic factors, dietary and oral hygiene practices in Jordanian children. J Dent 2004;33:379–388.
  19. Thomson ME, Thomson CW, Chandler NP: In vitro and intra-oral investigations into the cariogenic potential of human milk. Caries Res 1996;30:434–438.
  20. 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;91:411–417.
  21. Weerheijm KL, Uyttendaele-Speybrouck BFM, Euwe HC, Groen HJ: Prolonged demand breast-feeding and nursing caries. Caries Res 1998;32:46–50.
  22. WHO/UNICEF: Protecting, Promoting and Supporting Breastfeeding: the Special Role of Maternity Services. Geneva, World Health Organization, 1989.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50