Exclusive Breastfeeding and Risk of Dental Malocclusion

Abstract

OBJECTIVES: The distinct effect of exclusive and predominant breastfeeding on primary dentition malocclusions is still unclear. We hypothesized that exclusive breastfeeding presents a higher protective effect against malocclusions than predominant breastfeeding and that the use of a pacifier modifies the association between breastfeeding and primary dentition malocclusions.METHODS: An oral health study nested in a birth cohort study was conducted at age 5 years (N = 1303). The type of breastfeeding was recorded at birth and at 3, 12, and 24 months of age. Open bite (OB), crossbite, overjet (OJ), and moderate/severe malocclusion (MSM) were assessed. Poisson regression analyses were conducted by controlling for sociodemographic and anthropometric characteristics, sucking habits along the life course, dental caries, and dental treatment.RESULTS: Predominant breastfeeding was associated with a lower prevalence of OB, OJ, and MSM, but pacifier use modified these associations. The same findings were noted between exclusive breastfeeding and OJ and between exclusive breastfeeding and crossbite. A lower prevalence of OB was found among children exposed to exclusive breastfeeding from 3 to 5.9 months (33%) and up to 6 months (44%) of age. Those who were exclusively breastfed from 3 to 5.9 months and up to 6 months of age exhibited 41% and 72% lower prevalence of MSM, respectively, than those who were never breastfed.CONCLUSIONS: A common risk approach, promoting exclusive breastfeeding up to 6 months of age to prevent childhood diseases and disorders, should be an effective population strategy to prevent malocclusion. WHAT'S KNOWN ON THIS SUBJECT:Breastfeeding provides a protective effect against some malocclusions, and there is a strong inverse correlation between the duration of breastfeeding and the duration of pacifier use. WHAT THIS STUDY ADDS:The protective effects of predominant and exclusive breastfeeding against malocclusion are distinct: exclusive breastfeeding reduces the risk of malocclusions regardless of pacifier use, whereas the effect of predominant breastfeeding depends on the duration of the pacifier use. Dr K. Peres coordinated the oral health data collection, conceptualized the study, and drafted the initial manuscript; Dr Cascaes conducted all statistical analyses and reviewed and revised the manuscript; Dr M. Peres trained field workers and supervised data collection and critically reviewed the manuscript; Dr Demarco, together with Dr K. Peres, coordinated the oral health data collection, trained field workers and supervised data collection, and critically reviewed the manuscript; Dr Santos coordinated all stages of the birth cohort study and critically reviewed the manuscript; Dr Matijasevich critically reviewed the manuscript; and Dr Barros, together with Dr Santos, coordinated all stages of the birth cohort study and critically reviewed the manuscript. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work. It is well known that b...

Association between duration of breastfeeding and malocclusions in primary and mixed dentition: a systematic review and meta-analysis

“…in mixed dentition 8 , and the other eleven in primary dentition 4, 9–11, 18–24 . The relationship between breastfeeding and overbite/anterior openbite was examined by fourteen studies, all in primary dentition 3, 6, 10, 12, 18–21, 24–29 . The relationship between breastfeeding and overjet/anterior crossbite in primary dentition was examined by six studies 3, 10, 18–20, 29 .…”

“…13, 14, 32, 33 investigated the same association in primary dentition. The relationship between breastfeeding and the development of occlusion/malocclusion was analyzed in nine studies, all in primary dentition 5–7, 10–12, 18, 34, 35 .…”

Evaluation of a preventive educational program for malocclusions: 7-year study

“…Corrêa-Faria et al 6 identified bottle feeding and deleterious oral habits as determinants for malocclusion in preschool children. Peres et al 7 , found that 34% of the children studied showed greater horizontal overjet, 37% showed anterior open bite, and 10% showed posterior crossbite in the deciduous dentition. These studies reinforce the importance of encouraging early abandonment of sucking habits as a preventive measure for the development of malocclusions.…”

“…However, Peres et al 7 found no association between maternal level of education and malocclusion. The association between the parents' level of education and the abandonment of the sucking habit was not significant in this study, considering that 39.9% of the children with the habit, who participated in the PPM, abandoned the habit in the first three months, regardless of their guardian's education level (Table 5).…”

“…Parental involvement in preventive educational programs is essential, since parents are co-responsible for the promotion and maintenance of the oral health conditions of their children, and have the role of pursuing a better quality of life 7,13 . The knowledge acquired by parents and their children, invariably, has repercussions on the oral health practices of other family members 14 .…”