Breast and Bottle Feeding as Risk Factors for Dental Caries: A Systematic Review and Meta-Analysis

PLoS One. 2015 Nov 18;10(11):e0142922. doi: 10.1371/journal.pone.0142922. eCollection 2015.


Understanding the role that breastfeeding and bottle feeding play in the development of dental caries during childhood is essential in helping dentists and parents and care providers prevent the disease, and also for the development of effective public health policies. However, the issue is not yet fully understood. The aim of this systematic review and meta-analysis was to search for scientific evidence in response to the question: Do bottle fed children have more dental caries in primary dentition than breastfed children? Seven electronic databases and grey literature were used in the search. The protocol number of the study is PROSPERO CRD 42014006534. Two independent reviewers selected the studies, extracted data and evaluated risk of bias by quality assessment. A random effect model was used for meta-analysis, and the summary effect measure were calculated by odds ratio (OR) and 95% CI. Seven studies were included: five cross-sectional, one case-control and one cohort study. A meta-analysis of cross-sectional studies showed that breastfed children were less affected by dental caries than bottle fed children (OR: 0.43; 95%CI: 0.23-0.80). Four studies showed that bottle fed children had more dental caries (p<0.05), while three studies found no such association (p>0.05). The scientific evidence therefore indicated that breastfeeding can protect against dental caries in early childhood. The benefits of breastfeeding until age two is recommended by WHO/UNICEF guidelines. Further prospective observational cohort studies are needed to strengthen the evidence.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Bottle Feeding / adverse effects*
  • Breast Feeding*
  • Child, Preschool
  • DMF Index
  • Dental Caries / diagnosis*
  • Dental Caries / etiology
  • Dental Caries / pathology
  • Female
  • Humans
  • Infant
  • Male
  • Odds Ratio
  • Risk Factors
  • Tooth, Deciduous / pathology

Grants and funding

The institutes which provided us funding were: CAPES (Coordenação de Aperfeiçoamento de Pessoal de Ensino Superior), Fapemig (Fundação de Amparo à Pesquisa do estado de Minas Gerais), CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico) and PRPq/UFMG (Pró-Reitoria de Pesquisa da UFMG). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.