Does breastfeeding increase the risk of early childhood caries (ECC)? A systematic review

To review the current evidence on the association of breastfeeding during the first years of life with the development of Early Childhood Caries (ECC).

A systematic review of literature was conducted in June 2019 and again in March 2024 at the following Databases: Pub Med, Scopus, Cochrane Library, Science Direct, Google Scholar, for studies reporting on children aged up to 71 months investigating breastfeeding duration/cessation and presence of caries at the examination. Prospective Cohort studies were included in the review. The systematic review was conducted according to PRISMA statement guidelines.

Of the 4894 papers identified, the data extraction protocol led to 8 studies for further review. Assessment of Risk of Bias was made using the ROBINS-E tool. Six studies were characterized as high risk of bias, one characterized with some concerns and one with low risk of bias. Breastfeeding for 6-12 months has a protective effect against ECC. There is no association between breastfeeding and ECC for the ages 12-24 months; however, depending on the frequency or when combined with increased sugar consumption, it can have an impact on dental caries prevalence. Beyond 24 months, breastfeeding was associated with increased ECC prevalence.

Based on the studies included in this review and within their limitations, breastfeeding up to 2 years of age does not increase ECC risk, but after 2 years of age breastfeeding is associated with increased risk of ECC.

The protocol for this systematic review was registered on PROSPERO (CRD42020179773).