by Anne Eglash MD, IBCLC, FABM
Does breastfeeding help prevent malocclusion of the primary teeth? Malocclusion can be defined simply as lack of perfect alignment between the upper and lower teeth, which can be associated with impacted teeth, overcrowding of teeth, and/or a problematic bite. Malocclusions often result in the need for orthodontic treatment. There are many factors that play a role in the alignment of teeth. Some of these factors are genetic and not modifiable, but some are, such as breastfeeding, use of a pacifier, and finger sucking.
A group of researchers reviewed over 800 articles on the topic of breastfeeding and malocclusion of the primary teeth, and found only 7 high quality articles to include in its analysis.
What do you think the authors concluded about the relationship between breastfeeding and dental malocclusion of the primary teeth (choose 1 or more):
- Expectant families can be counseled that infants who breastfeed as recommended (exclusive until 6 months, then until at least 1-2 years) do not share the same degree of risk of developing malocclusions as those who breastfeed sub-optimally (early weaning).
- Lack of breastfeeding increases the risk of an anterior over-bite (front teeth overlap the bottom teeth).
- Infants who are exclusively breastfed for 6 months have a lower risk of a posterior cross bite (the top back teeth bite down inside the bottom back teeth) compared to infants who do not breastfeed exclusively.
- Infants who breastfeed past 12 months have a lower risk that the upper and lower canine teeth and first molars won’t line up.
See the Answer
Answers: All are correct.
Link to the Abstract
Malocclusions in young children: Does breast-feeding really reduce the risk? A systematic review and meta-analysis.
Doğramacı EJ, Rossi-Fedele G, Dreyer CW.
BACKGROUND:
Researchers have purported that breast-feeding can decrease the risk of malocclusions. The authors studied the relationship of breast-feeding on malocclusions in young children by means of conducting a systematic review of association (etiology).
TYPES OF STUDIES REVIEWED:
The authors used a 3-step search strategy, including electronic searches. They considered studies whose investigators included healthy children with primary dentition with a history of breast-feeding and in which the study investigators had assessed specific malocclusion outcomes to be eligible for inclusion in this review. The authors considered prospective and retrospective (longitudinal) studies, case-control studies, and analytical cross-sectional studies. Two of the authors, using standardized instruments, independently assessed the methodological quality and extracted data from the included studies. For situations for which there were a sufficient number of studies, the authors conducted meta-analyses using the random-effects model, supplemented with the fixed-effects model in situations for which statistical heterogeneity was 50% or less, assessed using the I2 statistic.
RESULTS:
The authors identified 7 studies that were included in the review. They found that children who had breast-fed suboptimally had an increased risk of developing malocclusions and that a strong and significant association existed between a shorter duration of breast-feeding(less than 12 months) and the development of an anterior open bite (n = 1,875; risk ratio, 3.58; 95% confidence interval, 2.55 to 5.03; P < .00001) and a class II canine relationship (n = 1,203; risk ratio, 1.65; 95% confidence interval, 1.38 to 1.97; P < .00001).
CONCLUSIONS:
Young children with a history of suboptimal breast-feeding have a higher prevalence and risk ratio for malocclusions. These children have an increased risk of developing a class II canine relationship, posterior crossbite, and anterior open bite.
PRACTICAL IMPLICATIONS:
Dental health care professionals should continue to encourage and promote breast-feeding; however, patients should be aware that children still can develop malocclusions, despite having received optimal breast-feeding, owing to the multifactorial etiology of malocclusions.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
There is certainly no guarantee that a child who breastfeeds for 2 years is going to avoid orthodontia. When I mentioned to a family medicine resident that breastfed babies are less likely to have braces, she shared her hearty skepticism by telling me that she nursed for more than 2 years, and had a mouth full of metal as a teen.
There are many genetic factors and some other environmental factors that contribute to malocclusion. In the case of oral anatomy, breastfeeding does not modify genetic factors very well. The authors also mention that nonnutritive sucking behaviors, such as thumb sucking and pacifiers, increase the risk of malocclusions. In fact, using a pacifier causes a 10-fold increased risk of malocclusion as compared to infants who never breastfeed.
My take-away from this literature analysis is that I can share with families that breastfeeding can decrease the risk of malocclusion. Pacifiers and digit sucking can increase the risk of malocclusion, so that if a family needs to use a pacifier, advise using it sparingly. And as for those natural thumb suckers? Best to start a savings plan for future orthodontist visits!
Sally Hammerman
Good information