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...