World Health Organization (WHO) guidelines currently recommend exclusive breastfeeding for the first six months with complimentary breastfeeding up to two years of age. The WHO recommendation for exclusive breastfeeding has been in place since 2001. A Cochrane review published in 20121 concluded that, ‘exclusive breastfeeding for six months (versus three to four months, with continued mixed breastfeeding thereafter) reduces gastrointestinal infection and helps the mother lose weight and prevent pregnancy but has no long-term impact on allergic disease, growth, obesity, cognitive ability or behaviour.’ This current review is the most recent of a number of previous reviews that have investigated the relationship between dental caries and breastfeeding.2,3,4,5,6

The reviewers have undertaken a broad search in three major databases including a total of 63 studies. The majority of these were cross-sectional studies and the authors provide good detail regarding the quality problems of the included studies. Even in the better quality studies the issue of recall bias was highlighted as a potential problem as most studies gathered data on feeding practices using self-report.

The authors present a narrative synthesis of the bulk of the included studies and also present a number of meta-analyses that include studies of mixed design. These analyses suggest that breastfeeding up to 12 months of age is not associated with an increased risk of dental caries and in may offer some protection compared with formula. These findings are similar to those of Avila et al.6 who restricted their meta-analysis to the two highest quality cross-sectional studies finding that breast fed children were less affected by dental caries than bottle fed children (OR= 0.43, (95%CI: 0.23-.08, I2: 30.14%).

While the findings of these recent meta-analyses suggest a benefit regarding caries for breastfeeding up to the age of 12 months the quality of the available studies should be taken into consideration. The finding that continuation of breastfeeding beyond 12 months may pose a increased risk of caries is interesting but as the authors point out this may be linked to other associated practices. As noted by the authors in their conclusions, higher quality studies are needed that properly control for confounders to better inform infant feeding practices. Readers might also like to note that a Cochrane review of breastfeeding for oral health is currently ongoing.7