Coping with Dental Caries
Brighton MI USA
From: NEW BEGINNINGS, Vol. 14 No. 1, January-February 1997, pp. 10-11
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time.
(For comments by Renee Cox's dentist, Dr. Kevin Hale, see "A Pediatric Dentist's Perspective".)
"Are you willing to stop breastfeeding William?" I had heard those words before, and I couldn't believe I was hearing them again. As the words reverberated in my head all I could think of was, "How many times will my breastfeeding relationship with William (and what I felt to be the very soul of our relationship) be challenged?"
It was first challenged when he was born prematurely, developed low blood sugar, and was quickly sent to the special care nursery. I didn't get to breastfeed him until eight hours after he was born. It was challenged again when he developed jaundice, and I was told by his pediatrician to wean him temporarily, which I did for several feedings until I got in contact with an LLL Leader. She was able to calm my fears in my vulnerable emotional state, and I resumed breastfeeding. Now, once again, another challenge.
This challenge occurred in the most unlikely of placesthe pediatric dentist's office! My daughter, Katherine, who is four now, had numerous cavities and even has one crown, so I was sure to bring William in for his first checkup as soon as his first few teeth appeared at about one year. At that point I heard the bad news: four cavities in the top front four teeth.
After identifying the cavities, Dr. Hale and I began talking. What could be the cause of dental caries at such an early age? William's having so many cavities was somewhat surprising. It wasn't as if I was feeding him candy, marshmallows, and ice cream for breakfast, lunch, and dinner! In fact, William had very few sweets and very little juice (mostly water, instead). He did nurse on demand and William slept in our bed and nursed through the night. Well, there, it was said. Dr. Hale had not been aware of this aspect of our "attachment parenting" lifestyle with Katherine, but by the time I took William in to see him, Dr. Hale and I had developed a close enough relationship that I was able to be honest with him about our family's lifestyle.
As I was later to learn, frequency of night nursing may contribute to dental caries, particularly if the baby is attached to the breast all night. It would be similar to snacking many times during the night, not brushing your teeth, and thereby providing an ideal environment for bad bacteria to flourish in your mouth. No, breast milk doesn't leak from the breast as it does from a bottle, but it may coat the teeth because the flow of saliva which helps to clean the teeth is lower at night. The pH of the mouth lowers and, in those who are susceptible, high acid producing bacteria flourish. Next thing you know there are cavities. The percentage of nursing mothers and babies affected by this is very small, but our family ended up being one of the chosen few.
When Dr. Hale asked, "Are you willing to stop breastfeeding William?" my answer was no. Breastfeeding provides the best nutrition, the best immunological defense, and it's part of our lifestyle. It's also one of the major ways I feel close to my baby. Dr. Hale's remark turned out to be just a question after all. Not a command, not an ultimatum, but one way in which Dr. Hale tried to determine my feelings on the issue. Once he heard my "no" we both tried to come up with a compromisehow to maintain the breastfeeding relationship and preserve the health of William's teeth.
Because he felt the frequency of nursing was a factor, Dr. Hale asked whether I could group breastfeeding sessions together. I'm sure Dr. Hale didn't realize the practical impossibility of this since he had never breastfed! With a clear understanding that William was going to continue to nurse on demand day and night, Dr. Hale suggested a routine in which we would try to keep his teeth immaculately clean, wipe them with a cloth after every breastfeeding, brush his teeth three to four times a day, and apply a small amount of topical fluoride (being sure to wipe off the excess fluoride). Upon hearing this I immediately felt relief. This was a solution that would allow us to continue breastfeeding as much as we needed to and have healthy teeth for William as well. Fear followed right behind. The proposed "program" sounded like far too much work. With two children and a busy schedule, would we be able to fit this in as well? William screamed through the once-a-day brushings I was already doing. But I was determined not to have William experience any more trauma from having more cavities filled. Since I was also very upset during those fillings, I did not want to go through it again either.
So we started on this experimental programwake up, brush his teeth, apply topical fluoride, nurse throughout the day, keep a dry cloth handy, wipe his teeth after every nursing (which he didn't like), go to sleep, nurse at night. I must confess that I did not wake up at night to wipe his teeth with the dry cloth. Other mothers who may have more stamina than I, go to it! But one of the reasons William is in bed with us is so he can nurse and I don't even have to wake up.
We continued this routine for three months, had a checkup and no cavities. Then another three-month checkup and no cavities. Six months with no cavities! Both Dr. Hale and I were so happy it was as if we had won the lottery! Everyone in the office was happy for us, and even William managed a smile.
I am convinced that honest communication in which values were mutually respected made it possible to arrive at a solution. We were successful beyond my wildest dreams, and I can only hope our story helps other families in similar situations. While the solution or technique to resolve dental caries may not be the same in every situation, communication that respects everyone's values is an essential ingredient in the resolution process.
And yes, William still protests through every brushing, but at 21 months old he still nurses on demand, is cavity-free, and oh, he has the sweetest smile.