Non-Cochrane · aetiology · PM38732602
Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis.
Shrestha Sheetal Kiran, Arora Amit, Manohar Narendar, et al. · Nutrients · 2024 · PubMed · doi:10.3390/nu16091355
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
19
current version
GRADE rated
0
No studies
0
Included studies
61
linked below
No studies 0 · 0%Ungraded 19 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children under 6 years of age (preschool children), any gender, race, geographical location or socioeconomic status, without any systemic disease or disability | 15,236 preschool children analysed across 31 included studies (n=31); studies from high- and middle-income countries, published 1994-2023 |
| Intervention | Preschool children (<6 years) who are breastfed (exclusive or partial) | Breastfeeding (any/exclusive/partial) and by duration (<4, <6, <12, <18, <24 months) and nocturnal breastfeeding |
| Comparison | Preschool children (<6 years) who are not breastfed | No breastfeeding, or breastfeeding for the longer duration band (≥4, ≥6, ≥12, ≥18, ≥24 months), or no nocturnal breastfeeding |
| Outcomes | Prevalence of dental caries (ECC) on primary teeth, assessed by a qualified dental practitioner or trained/calibrated examiner, with first dental examination before age 6 | Dental caries / ECC / severe ECC measured as dmfs, dmft, dft, dfs or ICDAS; 26 studies meta-analysed and 5 reported narratively |
| Study designs | Cohort studies and case-control studies (including cohort/case-control nested in other designs); RCTs, quasi-experimental, cross-sectional, single case reports and reviews excluded | 22 cohort studies and 9 case-control studies (n=31) |
| Timing | Not specified (first dental examination before 6 years of age) | Not specified |
Search date: 13 May 2023 (databases searched from inception). Databases: MEDLINE (Ovid); Scopus; Web of Science (ISI); Embase (Ovid); CINAHL (EBSCO)
Questions and results
Breastfeeding (exclusive or partial, any duration) vs No breastfeeding
Population: Preschool children (<6 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental caries (early childhood caries) Case-control studies In case-control studies, any breastfeeding versus no breastfeeding was not significantly associated with early childhood caries (OR 1.04, 95% CI 0.78-1.38; ungraded). Source: Results 3.7.1; Figure 3 · same question in other reviews | OR 1.04 [0.78, 1.38] | 5 studies · 1022 participants | Ungraded |
Dental caries (early childhood caries) Cohort studies In cohort studies, any breastfeeding versus no breastfeeding was not significantly associated with early childhood caries (RR 0.98, 95% CI 0.77-1.26; high heterogeneity; ungraded). Source: Abstract; Results 3.7.1; Figure 2 · same question in other reviews | RR 0.98 [0.77, 1.26] | 10 studies · 8506 participants | Ungraded |
Dental caries (ECC) First dental examination before age 6 years · Cohort studies; sensitivity analysis excluding studies 37, 41, 45, 53, and 56 Population: Preschool children under 6 years of age After excluding five studies, breastfeeding was associated with lower ECC risk in cohort studies (RR 0.82, 95% CI 0.71 to 0.95; I²=0%). Source: Results §3.7.1, sensitivity analysis · same question in other reviews | RR 0.82 [0.71, 0.95] | 5 studies | Ungraded |
Nocturnal breastfeeding vs No nocturnal breastfeeding
Population: Preschool children under 6 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental caries (ECC) First dental examination before age 6 years · Cohort studies; sensitivity analysis excluding study 39 After excluding one study, nocturnal breastfeeding was associated with higher ECC risk (RR 3.05, 95% CI 2.40 to 3.87; I²=33%). Source: Results §3.7.2, sensitivity analysis · same question in other reviews | RR 3.05 [2.40, 3.87] | 2 studies | Ungraded |
Dental caries (early childhood caries) Cohort studies Population: Preschool children (<6 years) Breastfeeding for <4 vs ≥4 months was not significantly associated with early childhood caries (RR 0.95, 95% CI 0.80-1.13; ungraded). Source: Results 3.8.1; Figure 5 · same question in other reviews | RR 0.95 [0.80, 1.13] | 2 studies · 1017 participants | Ungraded |
Breastfeeding for <6 months vs Breastfeeding for ≥6 months
Population: Preschool children (<6 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental caries (early childhood caries) Cohort studies In cohort studies, breastfeeding for <6 vs ≥6 months was not significantly associated with early childhood caries (RR 0.97, 95% CI 0.88-1.06; ungraded). Source: Results 3.8.2; Figure 6 · same question in other reviews | RR 0.97 [0.88, 1.06] | 6 studies · 4850 participants | Ungraded |
Dental caries (early childhood caries) Case-control studies In case-control studies, breastfeeding for <6 months was associated with significantly fewer caries than ≥6 months (OR 0.53, 95% CI 0.41-0.67; ungraded). Source: Abstract; Results 3.8.2; Figure 7 · same question in other reviews | OR 0.53 [0.41, 0.67] | 2 studies · 1201 participants | Ungraded |
Breastfeeding for <12 months vs Breastfeeding for ≥12 months
Population: Preschool children (<6 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental caries (early childhood caries) Cohort studies Breastfeeding for <12 vs ≥12 months was associated with significantly fewer caries (RR 0.65, 95% CI 0.50-0.86), indicating breastfeeding beyond 12 months increases ECC risk (substantial heterogeneity; ungraded). Source: Abstract; Results 3.8.3; Figure 8 · same question in other reviews | RR 0.65 [0.50, 0.86] | 8 studies · 4365 participants | Ungraded |
Breastfeeding for <18 months vs Breastfeeding for ≥18 months
Population: Preschool children (<6 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental caries (early childhood caries) Cohort studies Breastfeeding for <18 vs ≥18 months was associated with significantly fewer caries (RR 0.41, 95% CI 0.18-0.92; substantial heterogeneity; ungraded). Source: Abstract; Results 3.8.4; Figure 9 · same question in other reviews | RR 0.41 [0.18, 0.92] | 5 studies · 2332 participants | Ungraded |
Dental caries (ECC) First dental examination before age 6 years · Cohort studies; sensitivity analysis excluding studies 35, 42, and 48 Population: Preschool children under 6 years of age After excluding three studies, breastfeeding for less than 12 months was associated with lower dental caries risk (RR 0.70, 95% CI 0.62 to 0.80; I²=0%). Source: Results §3.8.3, sensitivity analysis · same question in other reviews | RR 0.70 [0.62, 0.80] | 5 studies | Ungraded |
Breastfeeding for <24 months vs Breastfeeding for ≥24 months
Population: Preschool children (<6 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental caries (early childhood caries) Cohort studies Breastfeeding for <24 vs ≥24 months was not significantly associated with early childhood caries in the main analysis (RR 0.59, 95% CI 0.33-1.05; substantial heterogeneity; ungraded). Source: Results 3.8.5; Figure 10 · same question in other reviews | RR 0.59 [0.33, 1.05] | 4 studies · 2271 participants | Ungraded |
Dental caries (ECC) First dental examination before age 6 years · Cohort studies; sensitivity analysis excluding studies 48 and 52 Population: Preschool children under 6 years of age After excluding two studies, breastfeeding for less than 18 months was associated with fewer dental caries (RR 0.26, 95% CI 0.16 to 0.42; I²=0%). Source: Results §3.8.4, sensitivity analysis · same question in other reviews | RR 0.26 [0.16, 0.42] | 3 studies | Ungraded |
Nocturnal breastfeeding vs No nocturnal breastfeeding
Population: Preschool children (<6 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental caries (early childhood caries) Cohort studies Nocturnal breastfeeding was associated with a significantly increased risk of early childhood caries (RR 2.35, 95% CI 1.42-3.89; substantial heterogeneity; ungraded). Source: Abstract; Results 3.7.2; Figure 4 · same question in other reviews | RR 2.35 [1.42, 3.89] | 3 studies · 1590 participants | Ungraded |
Dental caries (ECC) First dental examination before age 6 years · Cohort studies; sensitivity analysis excluding Peres et al. (2017) Population: Preschool children under 6 years of age After excluding Peres et al. (2017), breastfeeding for less than 24 months was associated with fewer caries (RR 0.49, 95% CI 0.39 to 0.62; I²=6%). Source: Results §3.8.5, sensitivity analysis · same question in other reviews | RR 0.49 [0.39, 0.62] | 3 studies | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental caries (early childhood caries) Narrative single study (Lima 2016): no nocturnal BF vs nocturnal BF at 16 months | OR 0.51 [0.39, 0.65] | 1 study | Ungraded |
Dental caries (early childhood caries) Narrative single study (Matee 1994): nocturnal breast-feeding | OR 17.8 [6.3, 50.3] | 1 study | Ungraded |
Dental caries (early childhood caries) Narrative single study (Ganesh 2022): BF during sleep | AOR 6.5 | 1 study | Ungraded |
Dental caries (early childhood caries) Narrative single study (Ganesh 2022): BF in early morning sleep hours | AOR 3.7 | 1 study | Ungraded |
Dental caries (early childhood caries) Narrative single study (Ganesh 2022): BF at beginning of sleep | AOR 6.7 | 1 study | Ungraded |
Included primary studies 61
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Majorana 2014 Feeding and smoking habits as cumulative risk factors for early childhood caries in toddlers, after adjustment for several behavioral… PMID:24528500 | 4 other reviews | not stated | not extracted yet | not extracted yet |
| Bernabé 2017 Birth Weight, Breastfeeding, Maternal Smoking and Caries Trajectories DOI:10.1177/0022034516678181 | 2 other reviews | not stated | not extracted yet | not extracted yet |
| Roberts 1994 matched by author and year (probable) | 2 other reviews | not stated | not extracted yet | not extracted yet |
| Abanto 2023 Prolonged breastfeeding, sugar consumption and dental caries at 2 years of age: A birth cohort study DOI:10.1111/cdoe.12813 | 1 other review | not stated | not extracted yet | not extracted yet |
| Barroso 2021 Influence of breastfeeding duration on the incidence of dental caries in preschoolers: a cohort study DOI:10.1590/1806-93042021000100012 | 1 other review | not stated | not extracted yet | not extracted yet |
| Chaffee 2014 Association of long-duration breastfeeding and dental caries estimated with marginal structural models. PMID:24636616 | 1 other review | not stated | not extracted yet | not extracted yet |
| Cvanova 2022 Candida species and selected behavioral factors co-associated with severe early childhood caries: Case-control study. PMID:35959372 | 1 other review | not stated | not extracted yet | not extracted yet |
| Devenish 2020 Early childhood feeding practices and dental caries among Australian preschoolers DOI:10.1093/ajcn/nqaa012 | 1 other review | not stated | not extracted yet | not extracted yet |
| Feldens 2010 Early Feeding Practices and Severe Early Childhood Caries in Four-Year-Old Children from Southern Brazil: A Birth Cohort Study DOI:10.1159/000319898 | 1 other review | not stated | not extracted yet | not extracted yet |
| Feldens 2018 Feeding frequency in infancy and dental caries in childhood: a prospective cohort study. PMID:28868798 | 1 other review | not stated | not extracted yet | not extracted yet |
| Hong 2014 matched by author and year (probable) | 1 other review | not stated | not extracted yet | not extracted yet |
| Hong 2014 Infant breast-feeding and childhood caries: a nine-year study. PMID:25198001 | 1 other review | not stated | not extracted yet | not extracted yet |
| Lima 2016 matched by author and year (probable) | 1 other review | not stated | not extracted yet | not extracted yet |
| Manohar 2021 Impact of Dietary Trajectories on Obesity and Dental Caries in Preschool Children: Findings from the Healthy Smiles Healthy Kids Study. PMID:34209914 | 1 other review | not stated | not extracted yet | not extracted yet |
| Nakayama 2022 Risk Factors for Early Childhood Caries in Three-Year-Old Japanese Children: A Prospective Cohort Study. PMID:36309780 | 1 other review | not stated | not extracted yet | not extracted yet |
| Nunes 2012 Association between prolonged breast‐feeding and early childhood caries: a hierarchical approach DOI:10.1111/j.1600-0528.2012.00703.x | 1 other review | not stated | not extracted yet | not extracted yet |
| Peltzer 2015 Severe early childhood caries and social determinants in three-year-old children from Northern Thailand: a birth cohort study. PMID:26370287 | 1 other review | not stated | not extracted yet | not extracted yet |
| Peres 2017 Impact of Prolonged Breastfeeding on Dental Caries: A Population-Based Birth Cohort Study DOI:10.1542/peds.2016-2943 | 1 other review | not stated | not extracted yet | not extracted yet |
| Tashiro 2021 Caries and Its Association with Infant Feeding and Oral Health-related Behavior in 18-month and 3-year-old Japanese Children DOI:10.2209/tdcpublication.2020-0033 | 1 other review | not stated | not extracted yet | not extracted yet |
| Yokoi 2021 Association between the incidence of early childhood caries and attending childcare among toddlers in a rural area of Japan: a prospective… DOI:10.1080/00016357.2020.1795249 | 1 other review | not stated | not extracted yet | not extracted yet |
| Abanto 2023 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Barroso 2021 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Bernabe 2017 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Chaffee 2014 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Cvanova 2022 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Dabawala 2017 Parenting style and oral health practices in early childhood caries: a case–control study DOI:10.1111/ipd.12235 | this review only | not stated | not extracted yet | not extracted yet |
| Dabawala 2017 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Devenish 2020 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Feldens 2010 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Feldens 2018 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Ganesh 2022 Association of Sleep-Time Feeding Practices with Early Childhood Caries: A Case-Control Study DOI:10.1159/000527035 | this review only | not stated | not extracted yet | not extracted yet |
| Ganesh 2022 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Haag 2019 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Haag 2019 Is There an Association between Breastfeeding and Dental Caries among Three-Year-Old Australian Aboriginal Children? PMID:31752094 | this review only | not stated | not extracted yet | not extracted yet |
| Hartwig 2017 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Hartwig 2019 Morphology of the occlusal surface for premolar and molar teeth as an indicator of age in the horse. PMID:20192017 | this review only | not stated | not extracted yet | not extracted yet |
| Lima 2016 Risk factors associated with early childhood caries – a case control study DOI:10.15448/198-6523.2016.2.21496 | this review only | not stated | not extracted yet | not extracted yet |
| Majorana 2014 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Manohar 2021 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Matee 1994 Nursing caries, linear hypoplasia, and nursing and weaning habits in Tanzanian infants DOI:10.1111/j.1600-0528.1994.tb02053.x | this review only | not stated | not extracted yet | not extracted yet |
| Matee 1994 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Nakayama 2022 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Nirunsittirat 2016 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Nirunsittirat 2016 Adverse birth outcomes and childhood caries: a cohort study. PMID:26750102 | this review only | not stated | not extracted yet | not extracted yet |
| Nunes 2012 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Palenstein Helderman 2006 DOI:10.1177/1544059106085001 | this review only | not stated | not extracted yet | not extracted yet |
| Peltzer 2015 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Peres 2017 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Qin 2008 Risk factors for severe early childhood caries in children younger than 4 years old in Beijing, China. PMID:18481576 | this review only | not stated | not extracted yet | not extracted yet |
| Roberts 1994 PMID:193983 | this review only | not stated | not extracted yet | not extracted yet |
| Seow 2009 Case-Control Study of Early Childhood Caries in Australia DOI:10.1159/000189704 | this review only | not stated | not extracted yet | not extracted yet |
| Seow 2009 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Tanaka 2013 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Tanaka 2013 Infant feeding practices and risk of dental caries in Japan: the Osaka Maternal And Child Health Study. PMID:23756313 | this review only | not stated | not extracted yet | not extracted yet |
| Tashiro 2021 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| van Palenstein Helderman 2006 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Werneck 2008 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Werneck 2008 Early childhood caries and access to dental care among children of Portuguese-speaking immigrants in the city of Toronto. PMID:19000463 | this review only | not stated | not extracted yet | not extracted yet |
| Yokoi 2020 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Yonezu 2006 Longitudinal Study of Prolonged Breast- or Bottle-feeding on Dental Caries in Japanese Children DOI:10.2209/tdcpublication.47.157 | this review only | not stated | not extracted yet | not extracted yet |
| Yonezu 2006 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).