Fact or Fiction? Understanding the Relationship Between Breastfeeding and Oral Health

Alexiyah Coughlin, BSN, RN, IBCLC

Humans have been breastfeeding since the beginning of time and it has been a primary source of nutrition for neonates, infants, toddlers, and even early school-age children for many decades.  In fact, it wasn’t until 1865 when the first known commercial cow’s milk formula came on the market. It wasn’t until the 40’s-50’s when formula became recognized as a safe substitute for infant nutrition.  Finally, in the 60’s, there was a sharp decline in the rate of breastfeeding, inversely related to increased popularity of formula.  At that time, formula was cheap and perceived as optimal. Finally, we started to see movement back in favor toward breastfeeding with hefty amounts of studies that supported the benefits of breastfeeding.  Today, families are able to make educated decisions on how to feed their babies.  With that comes so many sources of information that may impact your decision:  information from your doctor, your baby’s doctor, your lactation consultant, your grandmother, your mother-in-law, the list goes on. It’s not surprising that you may be wondering what information you can rely on!  In light of 2024 Oral Health Day, let’s take a look at the top 5 fact vs. fiction around breastfeeding and oral health.

1. Breastfeeding causes tooth decay? FICTION!  This one has led to a multitude of practices that have included recommendations to clean baby’s gums after nursing sessions and even avoid nighttime nursing.  The myth is that pooling of breastmilk, which contains sugar, feeds the specific bacteria that cause dental caries.  We know that dental decay is a consequence of bacterial interaction with an environment, markedly certain sugars.  Recent studies have shown that breastmilk actually contains lactoferrin, known to kill streptococcus mutans (credited as the main bacteria responsible for dental decay).  We also know that breastfeeding children are more likely to be exposed to this specific bacteria by other means via their caregivers, such as through sharing utensils, or through other children by sharing items like bottles or pacifiers.  Interestingly, there is also research that credits infant immunity by exposure to antibodies in milk from mothers with a history of strep mutans.  In general, genetic predisposition is much more likely to contribute to early dental decay, while new research has supported that oral bacteria is likely offset by the antibodies in breastmilk.
2. Breastfeeding causes crooked teeth? FICTION!  The claim is that breastfeeding beyond the eruption of teeth has a negative impact on oral anatomy.  It serves as the basis for recommendations to cease breastfeeding once baby starts teething.  Fortunately, we know better that as a soft tissue, the breast morphs to match the baby’s mouth and breastfeeding actually encourages wide palate and natural movements of the tongue, jaw, and surrounding structures.  In turn, these positive impacts actually strengthen the mouth and foster a healthier, wider palate to allow ample space for baby teeth to erupt.
3. Pacifier and bottle use can change baby’s mouth? FACT!  In contrary to the myth above, false nipples can absolutely alter oral shape and function.  There is a lot of controversy surrounding the use of these tools.  Overall, moderation is key.  There are studies that show significant decreases in SIDS with nighttime pacifier use, often causing promotion of use.  And, of course, bottles tend to be a necessary tool, even for breastfeeding babies.  Ideally, use is in moderation.  Prolonged use has been shown to contribute to high palate, dysfunctional breastfeeding, overbite, and malpresentation of tooth eruption.  Ideally, babies may be transitioned around 6 months to non-spouted cups as an alternative to bottles, and away from pacifier use by 6-9 months of age.  
4. It’s unsafe for pregnant or breastfeeding parents to see the dentist? FICTION!  Dentists and obstetrical providers will thank us for this one:  it’s IMPORTANT to see your dentist while you’re pregnant or lactating, and most treatment is completely safe for either group.  Untreated dental emergencies can lead to dangerous consequences.  There are only a few exceptions.  Radiographic imaging, such as x-Rays or panoramic imaging are usually discouraged during pregnancy.  While most antibiotics are safe during breastfeeding, there are certain antibiotics that are unsafe for a pregnant person.  Work together with your dentist and pregnancy provider to confirm safety of specific treatments.
5. Tongue ties are normal? FACT…AND FICTION!  Possibly one of the most controversial topics related to oral health and breastfeeding:  tethered oral tissues.  Often a battle between pediatric providers and lactation professionals, oral ties are a recent hot topic.  The truth is, both sides have it (sort of) right.  Frenula (plural for frenulum) are the structures that anchor various oral structures to the mouth.  There are actually 7 frenula in the mouth:  one that connects the tongue to the floor of the mouth (most commonly in discussion), two that connect the lips to the gums, and four that connect the cheeks to the gums.  It is true that frenula are a normal part of human anatomy but their mere presence is not what is concerning for breastfeeding dyads.  However, when these structures are tight or restricted, they may impact oral function and the ability of the baby to nurse, crediting the terms “tongue tie” or “lip tie”.  Sometimes babies may learn to compensate for these restrictions, especially in parents with ample or oversupply.  These babies may appear to nurse well on the surface, but even compensation is dysfunctional, often leading to consequences like gradual decrease in supply, inefficient transfer, poor weight gain, “colicky babies” (tummy troubles, fussiness), discomfort, nipple damage, recurrent mastitis, and the list goes on.  Working with an IBCLC specifically trained in recognizing oral function is imperative.  Successful release of these tissues comes with multi-directional support, including lactation, body work, and a specially trained release provider.  

Human milk is a natural source of nutrition with a multitude of benefits for both parents and babies.  Busting these and other myths surrounding breastfeeding and oral function is an important piece of reassurance that breastfeeding is and symbiotic with oral health!  

Rumble Tuff is proud to support parents where they’re at!  To schedule a virtual pumping appointment with one of our skilled IBCLCs, click here.  To watch our series on transforming culture to support chestfeeding and pumping parents, Breast Pump: The Musical, head here.  You’ve got this, and we’ve got you.