Association Between Breastfeeding Type and Duration and the Molar and Facial Characteristics of Preschoolers Aged 2 To 6 Years: A Cross-Sectional Study

Objective: To calculate the association between the type and duration of breastfeeding and the deciduous molar relationship and facial characteristics of preschoolers aged 2 to 6 years. Study design: This crosssectional study included 160 pre-schoolers aged 2 to 6 years old, enrolled in the 2019 academic year from 3 public schools in Data collection involved two phases. The first phase consisted in determining the facial type, anteroposterior and vertical profile, facial dimensions, and the molar relationship between primary second molars. The second phase included interviews with the parents or legal guardians. Children with exclusive breastfeeding and with mixed/artificial feeding (breastfeeding and bottle-feeding, or exclusive artificial bottle-feeding) were included. Chi-square test, t-test, multiple linear regression, and binary logistic regression tests were applied (p<0.05). Results: The facial length, width, and the lower third were greater in the exclusive breastfeeding group than in the mixed/artificial feeding group (3.74mm, p=0.002; 2.06mm, p=0.047; and 2.94mm, p=0.015; respectively). In addition, children with breastfeeding for more than six months showed greater facial length, facial width and lower third (3.20mm, p=0.038; 3.68mm, p=0.006; and 3.57mm, p=0.026; respectively). The duration of exclusive breastfeeding influenced facial width, noting an increase of 3.32mm (p=0.011) if a pre-schooler had exclusive breastfeeding for more than six months. Conclusion: There were no significant associations between type and duration of breastfeeding and the molar terminal plane, facial type, or profile. However, facial dimensions were greater in the exclusive breastfeeding group, and when breastfeeding was longer than six months.

Breastfeeding; Preschool; Face; Primary dentition

1. Lyons KE, Ryan CA, Dempsey EM, Ross RP, Stanton C. Breast Milk, a Source of Beneficial Microbes and Associated Benefits for Infant Health. Nutrients. 2020;12(4):E1039. doi:10.3390/nu12041039

2. Pereira Lopes TS, Branco Lima CC, Cerqueira Silva RN, Almeida de Deus Moura LF, Moura de Lima MD, Pinheiro Lima MCM. Association Between Duration of Breastfeeding and Malocclusion in Primary Dentition in Brazil. J Dent Child (Chic). 2019;86(1):17‐23.

3. World Health Organization, UNICEF. Global Strategy for Infant and Young Child Feeding. Geneva, Switzerland: World Health Organization; 2003. Available at: http://apps.who.int/iris/bitstream/10665/42590/1/9241562218. pdf?ua¼1&ua¼1. Accessed Apr 16, 2020.

4. Peres KG, Cascaes AM, Peres MA, et al. Exclusive Breastfeeding and Risk of Dental Malocclusion. Pediatrics. 2015;136(1):e60‐e67. doi:10.1542/peds.2014-3276

5. Cleminson J, Oddie S, Renfrew MJ, McGuire W. Being baby friendly: evidence-based breastfeeding support. Arch Dis Child Fetal Neonatal Ed. 2015;100(2):F173‐F178. doi:10.1136/archdischild-2013-304873

6. Zielińska MA, Sobczak A, Hamułka J. Breastfeeding knowledge and exclusive breastfeeding of infants in first six months of life. Rocz Panstw Zakl Hig. 2017;68(1):51‐9.

7. Romero CC, Scavone-Junior H, Garib DG, Cotrim-Ferreira FA, Ferreira RI. Breastfeeding and non-nutritive sucking patterns related to the prevalence of anterior open bite in primary dentition. J Appl Oral Sci. 2011;19(2):161‐168. doi:10.1590/s1678-77572011000200013

8. Montaldo L, Montaldo P, Cuccaro P, Caramico N, Minervini G. Effects of feeding on non-nutritive sucking habits and implications on occlusion in mixed dentition. Int J Paediatr Dent. 2011;21(1):68‐73. doi:10.1111/j.1365-263X.2010.01092.x

9. Vasconcelos FM, Massoni AC, Heimer MV, Ferreira AM, Katz CR, Rosenblatt A. Non-nutritive sucking habits, anterior open bite and associated factors in Brazilian children aged 30-59 months. Braz Dent J. 2011;22(2):140‐5. doi:10.1590/s0103-64402011000200009

10. Marquezin MCS, Araujo DS, Amato JN, et al. A cluster analysis of the relationship between sucking habits, consistency of food ingested, and taste sensitivity in children. J Texture Stud. 2019;50(3):248‐56. doi:10.1111/jtxs.12396

11. Costa CTD, Shqair AQ, Azevedo MS, Goettems ML, Bonow MLM, Romano AR. Pacifier use modifies the association between breastfeeding and malocclusion: a cross-sectional study. Braz Oral Res. 2018;32:e101. doi:10.1590/1807-3107bor-2018.vol32.0101

12. Boronat-Catalá M, Bellot-Arcís C, Montiel-Company JM, Almerich-Silla JM, Catalá-Pizarro M. Does breastfeeding have a long-term positive effect on dental occlusion?. J Clin Exp Dent. 2019;11(10):e947‐e951. doi:10.4317/jced.56312

13. Chen X, Xia B, Ge L. Effects of breast-feeding duration, bottle-feeding duration and non-nutritive sucking habits on the occlusal characteristics of primary dentition. BMC Pediatr. 2015;15:46. doi:10.1186/s12887-015-0364-1

14. Labzelter and Saller A. Reproduced from Singh IP and Bhasin MK Anthropometry. New Delhi: Bharti Bhavan, Kem Publishers. 1968.

15. Bedita T, Naranbabu Th, Jibonkumar S, Kumar B. Facial morphology and facial index: a study on secular trend of Meitei male population of Bishnupur district, Manipur, India. Int J Anat Res 2016; 4(4):3279-83.

16. Choi JY, Kim T, Kim HM, Lee SH, Cho IS, Baek SH. Effect of frontal facial type and sex on preferred chin projection. Korean J Orthod. 2017;47(2):108‐17. doi:10.4041/kjod.2017.47.2.108

17. Baume LJ. Physiological tooth migration and its significance for the development of occlusion. Part I. The biogenetic course of the deciduous dentition. J Dent Res. 1950; 29:123.

18. Srinivasan D, Loganathan D, Kumar SS, Louis CJ, Eagappan S, Natarajan D. An Evaluation of Occlusal Relationship and Primate Space in Deciduous Dentition in Kancheepuram District, Tamil Nadu, India. J Pharm Bioallied Sci. 2017;9(Suppl 1):S45‐S49. doi:10.4103/jpbs.JPBS_89_17

19. Doğramacı EJ, Rossi-Fedele G, Dreyer CW. Malocclusions in young children: Does breast-feeding really reduce the risk? A systematic review and meta-analysis. J Am Dent Assoc. 2017;148(8):566‐574.e6. doi:10.1016/j. adaj.2017.05.018.

20. Galán-Gónzalez AF, Aznar-Martín T, Cabrera-Domínguez ME, Domínguez-Reyes A. Do breastfeeding and bottle feeding influence occlusal param-eters?. Breastfeed Med. 2014;9(1):24‐8. doi:10.1089/bfm.2013.0027

21. Corrêa-Faria P, Ramos-Jorge ML, Martins-Júnior PA, Vieira-Andrade RG, Marques LS. Malocclusion in preschool children: prevalence and determinant factors. Eur Arch Paediatr Dent. 2014;15(2):89‐96. doi:10.1007/s40368-013-0069-9

22. Leite-Cavalcanti A, Medeiros-Bezerra PK, Moura C. Aleitamento Natural, Aleitamento Artificial, Hábitos de Sucção e Maloclusões em Pré-escolares Brasileiros [Breast-feeding, bottle-feeding, sucking habits and malocclusion in Brazilian preschool children]. Rev Salud Publica (Bogota). 2007;9(2):194‐204. doi:10.1590/s0124-00642007000200004

23. Warren JJ, Bishara SE. Duration of nutritive and nonnutritive sucking behaviors and their effects on the dental arches in the primary dentition. Am J Orthod Dentofacial Orthop. 2002;121(4):347‐56. doi:10.1067/mod.2002.121445

24. Lopes-Freire GM, Cárdenas AB, Suarez de Deza JE, Ustrell-Torrent JM, Oliveira LB, Boj Quesada JR Jr. Exploring the association between feeding habits, non-nutritive sucking habits, and malocclusions in the deciduous dentition. Prog Orthod. 2015;16:43. doi:10.1186/s40510-015-0113-x

25. Agarwal SS, Sharma M, Nehra K, Jayan B, Poonia A, Bhattal H. Validation of Association between Breastfeeding Duration, Facial Profile, Occlusion, and Spacing: A Cross-sectional Study. Int J Clin Pediatr Dent. 2016;9(2):162‐6. doi:10.5005/jp-journals-10005-1356

26. Brustowicz KA, Padwa BL. Malocclusion in children caused by temporomandibular joint effusion. Int J Oral Maxillofac Surg. 2013;42(8):1034‐1036. doi:10.1016/j.ijom.2013.03.017

27. Consolação Soares ME, Ramos-Jorge ML, de Alencar BM, Marques LS, Pereira LJ, Ramos-Jorge J. Factors associated with masticatory performance among preschool children. Clin Oral Investig. 2017;21(1):159‐66. doi:10.1007/s00784-016-1768-5

28. Hinostroza-Izaguirre MC, Jara-Porroa JJ, Montalvo-Castillo SC, Romero-Gonzáles MA, Ticse-Tovar J. Impact of non-breastfeeding on the infant. Rev Cient Odontol 2017; 5 (2): 733-43. doi: 10.21142/2513-2754-0502-2017-733-743

29. López Del Valle LM, Singh GD, Feliciano N, Machuca Mdel C. Associations between a history of breast feeding, malocclusion and parafunctional habits in Puerto Rican children. P R Health Sci J. 2006;25(1):31‐4.

30. Hagos D, Tadesse AW. Prevalence and factors associated with exclusive breastfeeding among rural mothers of infants less than six months of age in Southern Nations, Nationalities, Peoples (SNNP) and Tigray regions, Ethiopia: a cross-sectional study. Int Breastfeed J. 2020;15(1):25. doi:10.1186/s13006-020-00267-y

31. Sanches MT. Manejo clínico das disfunções orais na amamentação [Clinical management of oral disorders in breastfeeding]. J Pediatr (Rio J). 2004;80(5 Suppl):S155‐S162. doi:10.2223/1249

32. Sánchez-Molins M, Grau Carbó J, Lischeid Gaig C, Ustrell Torrent JM. Comparative study of the craniofacial growth depending on the type of lactation received. Eur J Paediatr Dent. 2010;11(2):87‐92.

33. Ling HTB, Sum FHKMH, Zhang L, et al. The association between nutritive, non-nutritive sucking habits and primary dental occlusion. BMC Oral Health. 2018;18(1):145. Published 2018 Aug 22. doi:10.1186/s12903-018-0610-7

34. López Del Valle LM, Singh GD, Feliciano N, Machuca Mdel C. Associations between a history of breast feeding, malocclusion and parafunctional habits in Puerto Rican children. P R Health Sci J. 2006;25(1):31‐4.