Ben's Beautiful Smile
Bayside, NY, USA
From New Beginnings, Vol. 31 No. 1, 2010, p. 20
My son Benjamin was a happy, breastfed toddler. When he was 15 months old, I noticed a light brown line across his front tooth that could not be scraped away. This brown line is the telltale sign of tooth decay in young children, and I was paralyzed with worry. For three months, as I fretted, researched, and called dentists, I saw that line spread like wildfire from one tooth to another until all four front teeth were affected. It was devastating.
All the research I did, and each dentist I spoke to, suggested that breastmilk (specifically breastmilk consumed while falling asleep and sleeping) was the cause of this decay, and that prompt night weaning was the only way to halt the decay. My gut instinct was that this could not be so. Humans were meant to nurse at night, into toddlerhood, and had been doing so for eons -- why would something so natural and wholesome be damaging?
And, whatever the cause, how on earth could I night wean my little boy? I can see it even more clearly now: he was still such a baby, and was not ready to stop nursing at night.
We would have survived, of course -- many mothers night wean young toddlers gently and successfully -- but it was simply not how I envisioned our nursing relationship progressing. It seemed to me that nursing to sleep was one of the Seven Wonders of the World, and it made me happy to give that to Ben. I remember one afternoon, walking and nursing Ben in the baby carrier, looking down at his warm, sleepy face, his soft fluttersucks, his body drifting off into milky sleep. My heart ached. How could I let this end so abruptly, when neither of us was ready?
The research was sharply divided. Dentists across the board said breastmilk on the teeth at night caused decay, and recommended that "habit" nursing stop as soon as a baby's first tooth appeared. How many babies would wean prematurely if sleep-time comfort nursing were taken away from them? Breastfeeding advocates mostly said that breastmilk had little, if anything, to do with decay. This was supported by my own experience: all the breastfeeding toddlers I knew nursed at night and had no decay.
And yet, my instincts told me that even if breastmilk didn't cause Ben's decay, it must have played some role, as he consumed so much of it, both day and night. I read an article by Anne Altshuler in La Leche League Leaders' periodical, Leaven Apr/May 2006; 27, "Early Childhood Caries: New Knowledge Has Implications for Breastfeeding Families." Essentially, this article explains that breastmilk alone does not cause much more decay than water, but that breastmilk mixed with solid foods can be damaging to the teeth in certain vulnerable children. This made a lot of sense to me. I knew we had been lax about cleaning Ben's teeth before bed, and that he had slept many nights with a mouth full of food particles mixing with breastmilk.
So I planned to keep Ben's teeth as clean as I could both day and night, and to work on halting the damage. My heart was still wracked with guilt, worry, and an enormous amount of uncertainty, but I decided to go with my instincts and not change our nursing pattern unless this plan did not work.
The first dentist we took Ben to did not want to participate in my plan. "I know it will be hard," she said, with a sympathetic pout, "but I'm very strict about nighttime nursing." When I asked her if there was anything she could do to halt the decay, she said no, and that if I didn't night wean I would be giving my child cavities.
At the suggestion of a mom in my La Leche League Group, we took Ben to a different dentist. Dr. Tina was not covered by our insurance, but she was gentle and soothing. She recommended dietary changes, increasing tooth brushing frequency, cleaning the mouth out after nursing to sleep, and a very conservative amount of fluoride to protect the teeth.
We were very diligent with our plan. Ben protested, but soon became used to our routine of brushing his teeth three times a day. We were very strict about sugar in his diet. Xylitol had been recommended as a tool to decrease the cavity-causing bacteria in the mouth, and we developed a routine of putting an digestible xylitol gel into his mouth several times a day. We reluctantly did the fluoride too, but were happy that the dentist recommended cutting out all fluoridated water, and using half a pea-sized amount of fluoride. We also gave him a swig of water in a medicine dropper after he'd fallen asleep to clean out his mouth.
And things began to improve! Each time we returned to the dentist, she said that the decay was stabilizing. After a few months, we started doing fluoride every other day instead of every day. We let Ben try ice cream and juice (both of which he fell in love with), and became somewhat more relaxed about occasionally missing a brushing. Eventually, I stopped giving him those nighttime swigs of water.
Now, one year later, Dr. Tina has declared the decay completely arrested. We have been advised to decrease the fluoride to once every three days, and the goal is to stop it altogether if things still look good in two months. I feel proud and lucky -- this amount of tooth care doesn't always work to halt decay. I worked hard to take care of Ben's teeth, and my work paid off. But I am also proud that I was able to let my instincts guide me on this one. I was getting opinions left and right about what I should and shouldn't do, but I knew what I had to do. I wasn't sure if it was the perfect choice, but I followed my heart and it all worked out in the end.
Ben has been brave throughout it all, sitting in the dentist chair month after month, being patient as we stick that finger toothbrush in his mouth over and over again. And yes, he still enjoys his nighttime and naptime milk. What a good boy. What a beautiful smile.