Explore Ways for Children to Maintain a Caries-Free State While Receiving the Benefits of Breast Milk for as Long as Possible: A Longitudinal Analysis

Background: The relationship between prolonged breastfeeding and ECC remains inconclusive and equivocal. However, dentists must manage children’s oral health while respecting the mother's chosen feeding habits and provide information on maintaining a caries-free state while receiving the benefits of breast milk for as long as possible. This longitudinal study aimed to investigate the occurrence of dental caries in children who were breastfed for at least 18 months, and to explore ways for children to remain caries-free while receiving the benefits of prolonged breastfeeding. Methods: Of 6746 children aged 42 months who underwent physical and oral examinations at public healthcare centers in Toyonaka City, Japan, 1210 who had continued breastfeeding for at least the first 18 months were enrolled in the study. Oral examinations and anthropometric height and weight measurements were performed at 18 and 42 months of age. Additionally, a structured self-administered interview sheet was provided directly to the guardians when the child was 18 months old. Caries risk factors were evaluated using a logistic regression model, with caries occurrence at 42 months of age as the dependent variable. Results: Among the enrolled children, 24.3% had experienced dental caries. Logistic regression analysis results revealed that the child factors of birth order (P< 0.001), snacking (P< 0.05), and colorimetric caries-risk test results (P< 0.001) were significantly associated with dental caries occurrence at 42 months. The child factor of wake-up time (P< 0.05) and the guardian factors of parental exhaustion (P< 0.05) and postnatal oral health class participation (P< 0.01) were significant preventive factors. Conclusions: These results suggest that establishing early waking habits in early childhood and providing psychological support and postnatal oral health instruction for mothers help their children to remain caries-free while receiving the benefits of prolonged breastfeeding.