Association of long-duration breastfeeding and dental caries estimated with marginal structural models

Abstract

Purpose Estimate the association between breastfeeding ≥24 months and severe early childhood caries (ECC). Methods Within a birth cohort (n=715) from low-income families in Porto Alegre, Brazil, the age 38-month prevalence of severe-ECC (≥4 affected tooth surfaces or ≥1 affected maxillary anterior teeth) was compared over breastfeeding duration categories using marginal structural models to account for time-dependent confounding by other feeding habits and child growth. Additional analyses assessed whether daily breastfeeding frequency modified the association of breastfeeding duration and severe-ECC. Multiple imputation and censoring weights were used to address incomplete covariate information and missing outcomes, respectively. Confidence intervals (CI) were estimated using bootstrap re-sampling. Results Breastfeeding ≥24 months was associated with the highest adjusted population-average severe-ECC prevalence (0.45, 95% CI: 0.36, 0.54) compared with breastfeeding <6 months (0.22, 95% CI: 0.15, 0.28), 6–11 months (0.38, 95% CI: 0.25, 0.53), or 12–23 months (0.39, 95% CI: 0.20, 0.56). High frequency breastfeeding enhanced the association between long-duration breastfeeding and caries (excess prevalence due to interaction: 0.13, 80% CI: −0.03, 0.30). Conclusions In this population, breastfeeding ≥24 months, particularly if frequent, was associated with severe-ECC. Dental health should be one consideration, among many, in evaluating health outcomes associated with breastfeeding ≥24 months.

Dentin caries risk indicators in 1-year-olds. A two year follow-up study

“…[38] Breast feeding at age one was not associated with dentin caries at 3 years of age, which is in agreement with studies from Brazil, [39] USA [40] and Iran. [37] Contrary to these studies, Chaffee et al [41] found a higher prevalence of ECC in Brazilian 3-year-olds from low income families when breastfeeding had been prolonged until the age of 2 years. The relationship between breastfeeding and ECC is complex and confounded by several behavioural factors, such as sugar intake and social variables, [42] which are more likely -than the breastfeeding per se -to be etiological factors when studying the relationship between breastfeeding and ECC.…”

Assessing causal effects of early life‐course factors on early childhood caries in 5‐year‐old Ugandan children using directed acyclic graphs (DAGs): A prospective cohort study

“…Only a few previous studies in dental public health have applied DAGs to guide the analyses of empirical data. [25][26][27][28] In this study, the regression models based on cussed by various authors, this may lead to invalid estimates. 15,66,67 In the alternative DAG 2, the path from dental attendance to cariogenic bacteria opened previously closed backdoor paths for flow of association, EBF marital status maternal education ?wealth index ?…”

“…17,24 However, few dental studies have so far employed DAGs in analyses of empirical data. [25][26][27][28] In previous work, we…”

Effect of Mode of Delivery on Early Oral Colonization and Childhood Dental Caries: A Systematic Review

“…Previous research showed the influence of perinatal factors, such as prolonged rupture of membranes [35], maternal antibiotic treatment [35], and maternal sexually transmitted disease experience [14], on the establishment of oral microflora. Also, oral health behaviors including the frequency of eating sweets and toothbrushing [28, 29, 36, 37], bottle feeding and breastfeeding [23, 28], including duration of breastfeeding [38], have been reported as determinants of oral levels of S. mutans . In addition, the parent’s socioeconomic status [28, 37] has been associated with differences in early oral colonization by S. mutans.…”