Article Data

  • Views 663
  • Dowloads 312


Open Access

Breastfeeding and its Association with Early Childhood Caries – An Umbrella Review

  • Noopur T Panchanadikar1
  • Abirami S1
  • M S Muthu2,3,*,
  • Selvakumar H1
  • Priya Jayakumar1
  • Amit Agarwal4

1Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

2Centre for Early Childhood Caries and Research Department of Pediatric and Preventive Dentistry, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

3Adjunct Research Associate, Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, United Arab Emirates

4Department of Telemedicine PGIMER, Chandigarh, Tamil Nadu, India

DOI: 10.17796/1053-4625-46.2.1 Vol.46,Issue 2,March 2022 pp.75-85

Published: 01 March 2022

*Corresponding Author(s): M S Muthu E-mail:


Objective: To systematically assess systematic reviews and meta-analyses investigating the association of breastfeeding with ECC.

Study Design: A systematic search was carried out from MEDLINE® (PubMed), EMBASE, the Cochrane Central Database, OVID, Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports and Epistemonikos Databases up to November 2019. Data extraction was carried out by two investigators. ROBIS tool was used for quality assessment of included systematic reviews.

Results: Four systematic reviews were found assessing the correlation of breastfeeding with ECC. Findings were grouped into four categories, according to the duration, frequency, pattern, and comparison of feeding habits. Two systematic reviews assessing duration of breastfeeding above the age of 12 months had odds ratios of 1.86 and 1.99, showing positive correlation with ECC while nocturnal breastfeeding showed highest odds ratio of 7.14. Of the four included reviews, three had low risk of bias and one had unclear risk of bias.

Conclusions: Breastfeeding beyond the age of 12 months, accompanied by nocturnal feeding, had a positive association with ECC. Further research is warranted for assessment of diurnal and nocturnal sleep-time breastfeeding habits, together with the role of enamel defects (hypoplasia), and the risk of ECC.


Breastfeeding; Early childhood caries; Risk factor

Cite and Share

Noopur T Panchanadikar,Abirami S,M S Muthu,Selvakumar H,Priya Jayakumar,Amit Agarwal. Breastfeeding and its Association with Early Childhood Caries – An Umbrella Review. Journal of Clinical Pediatric Dentistry. 2022. 46(2);75-85.


1. Pitts N, Baez R, Diaz-Guallory C, et al. Early Childhood Caries: IAPD Bangkok Declaration. Int J Paediatr Dent , 2019;29:384–386.

2. Cui L, Li X, Tian Y, et al. Breastfeeding and early childhood caries: a meta-analysis of observational studies. Asia Pac J Clin Nutr , 2017;26:867–880.

3. Tan SF, Tong HJ, Lin XY, Mok B, Hong CH. The cariogenicity of commercial infant formulas: a systematic review. Eur Arch Paediatr Dent , 2016; 17:145–156.

4. World Health Organization. The optimal duration of exclusive breastfeeding. Geneva, Switzerland: World Health Organization, 2001.

5. Pitts AT. Dental caries in babies. Lancet , 1927; 209:502–503.

6. Nakayama Y, Mori M. Association between nocturnal breastfeeding and snacking habits and the risk of Early Childhood Caries in 18- to 23-month-old Japanese children. J Epidemiol , 2015; 25:142–147.

7. Neves PAM, Ribeiro CCC, Tenuta LMA, et al. Breastfeeding, Dental Biofilm Acidogenicity, and Early Childhood Caries. Caries Res, 2016; 50:319–324.

8. Avila WM, Pordeus IA, Paiva SM, Martins CC. Breast and bottle feeding as risk factors for dental caries: a systematic review and meta-analysis. PLoS ONE 10:1-14, 2015.

9. Tham R, Bowatte G, Dharmage S, et al. Breastfeeding and the risk of dental caries: a systematic review and meta-analysis. Acta Paediatr , 2015; 104:62–84.

10. Pieper D, Antoine S-L, Mathes T, Neugebauer EAM, Eikermann M. Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol , 2014; 67:368–375.

11. Whiting P, Savović J, Higgins JPT, et al. ROBIS: A new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol , 2016; 69:225–234.

12. Valaitis R, Hesch R, Passarelli C, Sheehan D, Sinton J. A systematic review of the relationship between breastfeeding and Early Childhood Caries. Can J Public Health Rev, 2000; 91:411–417.

13. Castilho SD, Filho A de AB. The history of infant nutrition. J Pediatr (Rio J) , 2010; 86:179–188.

14. Peres RCR, Coppi LC, Volpato MC, Groppo FC, Cury JA, Rosalen PL. Cariogenic potential of cows, human and infant formula milks and effect of fluoride supplementation. Br J Nutr , 2009; 101:376–382.

15. Bowen WH. Comparison of the cariogenicity of cola, honey, cow milk, human milk, and sucrose. Pediatrics, 2005; 116:921–926.

16. Lagerlöf F. Caries-Protective Factors in Saliva. Adv Dent Res 8(2):229–38.

17. Dawes C. Salivary flow patterns and the health of hard and soft oral tissues. J Am Dent Assoc , 1994; 2008;139:18S-24S.

18. Vázquez-Nava F, Vázquez REM, Saldivar GAH, Beltrán GFJ, Almeida AVM, Vázquez RCF. Allergic Rhinitis, Feeding and Oral Habits, Toothbrushing and Socioeconomic Status. Caries Res, 2008; 42:141–147.

19. Yonezu T, Yotsuya K, Yakushiji M. Characteristics of Breast-fed Children with Nursing Caries. Bull Tokyo Dent Coll, 2006; 47:161–165.

20. Perera PJ, Fernando MP, Warnakulasooriya TD, Ranathunga N. Effect of Feeding Practices on Dental Caries among Preschool Children: A Hospital Based Analytical Cross Sectional Study. Asia Pac J Clin Nutr , 2014; 23:272–277.

21. Matee M, Hof M, Maselle S, Mikx F, Helderman W van P. Nursing caries, linear hypoplasia, and nursing and weaning habits in Tanzanian infants. Community Dent Oral Epidemiol , 1994; 22:289–293.

22. van Palenstein Helderman WH, Soe W, van ’t Hof MA. Risk Factors of Early Childhood Caries in a Southeast Asian Population. J Dent Res, 2006; 85:85–88.

23. Harris R, Nicoll AD, Adair PM, Pine CM. Risk factors for dental caries in young children: a systematic review of the literature. Community Dent, 2004;Health 21:71–85.

24. Seow WK, Clifford H, Battistutta D, Morawska A, Holcombe T. Case-control study of Early Childhood Caries in Australia. Caries Res , 2009; 43:25–35.

25. Kirthiga M, Muthu M, Ankita S, Richard K. Risk factors for Early Childhood Caries: a systematic review and meta-analysis of case control and cohort studies. Pediatr Dent , 2019;41:95–106.

26. Niviethitha S, Muthu MS, Kavitha S. In Vitro Assessment of Enamel Permeability in Primary Teeth with and without Early Childhood Caries Using Laser Scanning Confocal Microscope. J Clin Pediatr Dent , 2016; 40:215-20.

27. Narrenthran JS, Muthu MS, Renugalakshmi A. In vivo Scanning Electron Microscope Assessment of Enamel Permeability in Primary Teeth with and without Early Childhood Caries. Caries Res , 2015; 49:209–15.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

PubMed (MEDLINE) PubMed comprises more than 35 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full text content from PubMed Central and publisher web sites.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time