Per- and Polyfluoroalkyl Substances (PFAS) in Serum of 2 to 5 year-Old Children: Temporal Trends, Determinants, and Correlations with Maternal PFAS Concentrations.

Young children may experience higher per- and polyfluoroalkyl substances (PFAS) exposure than adults due to breastfeeding, higher dust ingestion rates, and frequent hand-to-mouth activities. We explored temporal trends and determinants of child serum PFAS concentrations and their correlations with paired maternal PFAS concentrations. From 2009 to 2017, we collected one blood sample from each of 541 children aged 2-5 years participating in the Childhood Autism Risks from Genetics and Environment (CHARGE) study and quantified 14 PFAS in serum. For nine frequently detected PFAS (>65% of samples), we performed multiple regression adjusting for potential determinants to estimate mean percent concentration changes. For a subset of 327 children, we also quantified nine PFAS in their mother's serum collected at the same visit and computed Spearman correlation coefficients (rsp) between maternal and child PFAS concentrations. During 2009-2017, child serum concentrations of all nine PFAS decreased by 6-25% annually. Several PFAS concentrations were higher among non-Hispanic white children and those with highly educated parents. Most maternal and child PFAS concentrations were moderately correlated (rsp = 0.13-0.39), with a strong correlation for N-methyl perfluorooctane sulfonamido acetic acid (rsp = 0.68). Breastfeeding duration appeared to contribute to higher child and lower maternal PFAS concentrations, resulting in relatively weak correlations between maternal and child PFAS concentrations for samples collected in early childhood. Considering that more than half of our study children had neurodevelopmental concerns, the generalizability of our findings might be limited.

Prevalence of dental carries and its association with breastfeeding duration among young children in Addis Ababa, Ethiopia.

BACKGROUND: Breastfeeding is a crucial feeding practices that significantly contributes to the healthy development of children. However, the effect of breastfeeding duration on caries risk is unclear, as different studies have found different results. This study aims to assess the prevalence of dental caries and its association with breastfeeding duration among young children aged 12-36 months in selected health facilities of Addis Ababa, Ethiopia. METHODS: A cross-sectional study among 380 children aged 12-36 months from 11 health centers in Addis Ababa was conducted. Questionnaires and dental examinations were used to collect data. Dental caries was measured by the deft (decayed-extracted-filled teeth) index. Binary logistic regression was used to assess the association between dental caries and duration of breastfeeding, after adjusting for the confounders. RESULTS: The prevalence of dental caries was 53.4% (95% CI: 48.3, 58.5%), with 13.7% having high caries and 39.7% having low caries. Breastfeeding duration was not significantly associated with dental carries, after adjusting for confounders. However, sugar intake, older age, mothers' unemployment, and not being in marital union are risk factors for dental caries development. CONCLUSIONS: Promotion of healthy diet, especially limiting intake of sugar and sweets, and integration of oral health into primary health care programs are recommended. Further research using longitudinal design or meta-analysis is recommended to establish more concise evidence on the association between breastfeeding duration and dental caries.

Too hot to thrive: a qualitative inquiry of community perspectives on the effect of high ambient temperature on postpartum women and neonates in Kilifi, Kenya.

OBJECTIVE: To understand community perspectives on the effects of high ambient temperature on the health and wellbeing of neonates, and impacts on post-partum women and infant care in Kilifi. DESIGN: Qualitative study using key informant interviews, in-depth interviews and focus group discussions with pregnant and postpartum women (n = 22), mothers-in-law (n = 19), male spouses (n = 20), community health volunteers (CHVs) (n = 22) and stakeholders from health and government ministries (n = 16). SETTINGS: We conducted our research in Kilifi County in Kenya's Coast Province. The area is largely rural and during summer, air temperatures can reach 37˚C and rarely go below 23˚C. DATA ANALYSIS: Data were analyzed in NVivo 12, using both inductive and deductive approaches. RESULTS: High ambient temperature is perceived by community members to have direct and indirect health pathways in pregnancy and postpartum periods, including on the neonates. The direct impacts include injuries on the neonate's skin and in the mouth, leading to discomfort and affecting breastfeeding and sleeping. Participants described babies as "having no peace". Heat effects were perceived to be amplified by indoor air pollution and heat from indoor cooking fires. Community members believed that exclusive breastfeeding was not practical in conditions of extreme heat because it lowered breast milk production, which was, in turn, linked to a low scarcity of food and time spend by mothers away from their neonates performing household chores. Kangaroo Mother Care (KMC) was also negatively affected. Participants reported that postpartum women took longer to heal in the heat, were exhausted most of the time and tended not to attend postnatal care. CONCLUSIONS: High ambient temperatures affect postpartum women and their neonates through direct and indirect pathways. Discomfort makes it difficult for the mother to care for the baby. Multi-sectoral policies and programs are required to mitigate the negative impacts of high ambient temperatures on maternal and neonatal health in rural Kilifi and similar settings.

Breastfeeding, consumption of ultraprocessed foods, and dental caries at 4 years of age: A birth cohort study.

BACKGROUND: Cohort studies have demonstrated an association between prolonged and/or frequent breastfeeding and early childhood caries (ECC). AIM: To investigate the association between prolonged breastfeeding and ECC at 48 months, while considering the interaction between prolonged breastfeeding and ultraprocessed foods (UPF). DESIGN: Data from a birth cohort study conducted in southern Brazil were used (n = 3645). Poisson regression was used to evaluate the influence of breastfeeding and UPF consumption on the prevalence and experience of caries. To measure the interaction on the additive scale between breastfeeding and UPF consumption on the prevalence and experience of ECC, the relative excess risk due to interaction (RERI) was calculated. RESULTS: Prolonged breastfeeding was associated with higher prevalence (PR = 1.82; CI:1.59-2.08) and experience (RR = 2.47; CI:1.97-3.10) of ECC. Greater prevalence (PR = 1.16; CI: 1.04-1.30) and experience of ECC (RR = 1.22; CI: 1.00-1.48) were found in children who had high consumption of UPFs. Negative RERIs were observed for the prevalence and experience of ECC (-0.25 and -0.001). CONCLUSION: High UPF consumption and prolonged breastfeeding were associated with ECC. No interaction, however, was observed, showing that the two exposures have independent effects. To prevent ECC, policies and programs are needed to support breastfeeding until the age of 2 years and to limit the consumption of UPF.

Maternal hygiene and knowledge on complementary feeding during infancy and early childhood in Lahore, Pakistan.

Objectives: To assess practice and knowledge levels regarding complementary feeding among mothers of infants. METHODS: The analytical cross-sectional study was conducted in CMH Lahore Medical College & Institute of Dentistry, Cantonment, Lahore, Pakistan, from December 2021 to April 2022, and comprised mothers of children aged 6-24 months. Data was collected using a self-administered questionnaire exploring hygiene practices and knowledge related to complementary feeding. Data was analysed using SPSS 23. RESULTS: Of the 117 mothers with mean age 38.5±27.3 years, 115(98.3%) were married and 97(82.9%) resided in urban settings. Among the infants, 70(59.8%) were aged 12-24 months, 55(47%) were first-born, 72(61.5%) were exclusively breastfed for the first 6 months and 45(38.5%) continued breastfeeding along with complementary feeding after 6 months. Hygiene practices correlated to both marital status and the type of family (pa;lt;0.05). A significant association was found between mother's occupation to breastfeeding and hygiene practices (pa;lt;0.05). There was no significant association of breastfeeding practices with maternal age and maternal education (p>0.05). CONCLUSIONS: Maternal information related to complementary feeding was found to be good, and breastfeeding practices were significantly associated with the mother's occupation. Maternal hygiene practices were also good, and were significantly associated with the mother's occupation and type of family.

Effects of non-nutritive sucking habits on malocclusions: a systematic review.

The development of the craniomandibular system is guided by genetic interactions and environmental factors, including specific habits such as breastfeeding, bottle feeding, thumb sucking and the use of pacifiers. These habits can have a considerable impact on the growth of the developing jaws and can lead to malocclusion in children. This review aims to investigate potential associations between non-nutritive sucking habits (NNSHs) and malocclusions compared to the presence of nutritive sucking habits (NSHs). To carry out this systematic review, we followed the PRISMA protocol and performed a bibliographic search of the existing literature until April 2023 in the following electronic databases: Medline, PubMed, The Cochrane Library and Embase. Out of a total of 153 records, we included 21 studies. We found that the chances of diagnosing a malocclusion were higher for children with bottle nutrition when compared to breast-fed children. Breastfeeding provides protection against malocclusions. In the same manner, persistent NNSH habits appeared to be associated with increased chances of having malocclusions. The longer the child was breastfed, the shorter the duration of the pacifier habit and the lower the risk of developing moderate/severe malocclusions. The duration of the habits has a positive influence on the appearance of occlusion defects.

Teeth reveal juvenile diet, health and neurotoxicant exposure retrospectively: What biological rhythms and chemical records tell us.

Integrated developmental and elemental information in teeth provide a unique framework for documenting breastfeeding histories, physiological disruptions, and neurotoxicant exposure in humans and our primate relatives, including ancient hominins. Here we detail our method for detecting the consumption of mothers' milk and exploring health history through the use of laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) mapping of sectioned nonhuman primate teeth. Calcium-normalized barium and lead concentrations in tooth enamel and dentine may reflect milk and formula consumption with minimal modification during subsequent tooth mineralization, particularly in dentine. However, skeletal resorption during severe illness, and bioavailable metals in nonmilk foods, can complicate interpretations of nursing behavior. We show that explorations of the patterning of multiple elements may aid in the distinction of these important etiologies. Targeted studies of skeletal chemistry, gastrointestinal maturation, and the dietary bioavailability of metals are needed to optimize these unique records of human health and behavior.

A videoconferencing verification method for enrollment of breastfeeding dyads to an online prospective mixed methods study during the COVID-19 pandemic.

AIMS: To apply videoconferencing as a new verification method prior to enrollment for an online survey-based study. DESIGN: A prospective-observational, mixed methods, three group, repeated measures study involved recruiting a population-based sample of breastfeeding mothers and infants (N = 81). Twenty-seven mothers were recruited for each group: mothers returning to work outside of the home, mothers returning to work from home and mothers staying home with their infants full-time. METHODS: Data were collected at four time points, infant age 4, 12, 20 and 24 weeks, via online survey. Participating mothers received a $10 gift card for completing each survey. Social media, word of mouth and brochures promoted United States-based recruitment nationwide. A publicly available direct link to the survey was initially provided to interested mothers. After the suspicion of online fraud, videoconferencing was instituted for self-referrals and phone calls for professional referrals. RESULTS: The survey was invaded by response fraud 3 weeks after the initial survey deployment. Out of 109 respondents who visited the survey site during that timeframe, only eight mothers (10%) were eligible (22 June 2022 to 14 July 2022). After recruitment modification, 313 individuals emailed the study team with 65 self-referred mothers (80%) enrolled in the study via videoconferencing while eight mothers (10%) had a professional referral and enrolled via phone call (23 August 2022 to 30 March 2023). CONCLUSION: Providing a direct survey link, even with CAPTCHA-protection, evoked fraudulent responses. Videoconferencing is an emerging verification method that can be readily applied to the enrollment of breastfeeding dyads for an online study. IMPACT: The emergence of fraudulent respondents and internet bots threatens data quality. This study addressed the strategy of videoconferencing as a new verification method for recruitment and enrollment of breastfeeding dyads. This knowledge can be applied by researchers to secure sample validity and data integrity.

What is a superior labial frenulum? An anatomical and histological study.

Anatomy of the superior labial frenulum (SLF), at first glance, seems to be well established. However, existing studies on the SLF lack description of the incisivus labii superioris (ILS), which cannot be ignored when discussing the SLF. We believe that thorough understanding of the SLF necessitates the anatomical knowledge of the ILS. This study aimed to elucidate the anatomical relationship between the orbicularis oris (OO), ILS, and SLF. A total of 20 formalin fixed human cadaveric specimens were used for gross anatomical and/or histological observation. For histological observation, all specimens were stained with Masson-trichrome. The SLF was a mucosal fold between the gingival mucosa and alveolar mucosa with connective tissue deep to it. The connective tissue attached to the alveolar bone in the junction between the right and left ILS. Skeletal muscle fibers other than orbicularis oris was found in one specimen, which were considered the ILS. During a frenulectomy, removal of the connective tissue bundle is required to prevent recurrence of the high SLF insertion.

Prolonged breastfeeding and dental caries in preschool children.

PURPOSE: To explore breastfeeding from 6 to 18 months of age and to study the association between breastfeeding and caries prevalence at 5 years of age. METHODS: The study included 1088 children from one Norwegian county and was based on the Norwegian Mother, Father and Child Cohort Study (MoBa). The children had clinical dental examination at 5 years of age, and parents answered a questionnaire, which included information on breastfeeding, oral health behaviour and child characteristic. Multivariate logistic regressions were performed. The study was ethically approved. RESULTS: Of the studied children, 77% were breastfed at 6 months of age and 16% were still breastfed at 18 months of age. Few children (6%) were breastfed during night at 18 months of age, while 11% received sugary drink during night. No association was found between breastfeeding up to 18 months of age and caries prevalence at 5 years of age (p > .05). Children who at 18 months of age had their teeth brushed less than twice daily (OR 2.4, CI 1.5-3.9), consumed sugary drink once a week or more often (OR 1.7, CI 1.1-2.7) and had non-Western parents (OR 3.4, CI 1.5-8.1) were more likely to have caries experience at 5 years of age than other children. CONCLUSION: Breastfeeding up to 18 months of age was not associated with caries development during preschool age.

Association between breastfeeding and periodontitis in Korean women using Korea National Health and Nutrition Examination Survey (KNHANES): a cross-sectional study.

OBJECTIVES: The effect of breastfeeding on periodontal disease in women remains unclear. This cross-sectional study used data from the Korean National Health and Nutrition Examination Survey to explore the association between breastfeeding and periodontitis in Korean women using data from the Korean National Health and Nutrition Examination Survey (KNHANES VII). MATERIALS AND METHODS: Cross-sectional data was analyzed from the KNHANES 2016-2018. The study population included 5,587 parous women aged ≥ 30 years. The outcome variable was the presence or absence of periodontitis. The explanatory variable, period of breastfeeding, was defined as "none", "1-11 months", and "more than 12 months". Confounder variables (socio-educational, personal healthcare practice, and systemic medical characteristics) were adjusted for in the logistic regression analysis. RESULTS: Approximately 60% of the participants breastfed for ≥ 12 months. In all statistical models, the prevalence of periodontitis was approximately 60% greater in women that did not breastfeed compared to women that had breastfed for 12 months or longer. When adjusted for age, statistical significance was only present in the 50-59 years age group (adjusted odds ratio [aOR], 1.678; 95% confidence interval [CIs], 1.046-2.691). CONCLUSION: Our study shows that women that breastfed for a relatively long duration had a lower risk of periodontitis. Therefore, breastfeeding may be beneficial for women's periodontal health. These results are expected to be helpful in oral health education for pregnant women.

The number of erupted teeth as a risk factor for dental caries in eighteen-month-old children: a cross­sectional study.

BACKGROUND: Dental caries is one of the most common chronic diseases worldwide, affecting lifelong as well as children. Therefore, it is important to clarify factors related to early childhood caries (ECC) in a younger population in terms of caries prevention. However, the prevalence of ECC is low in developed countries in the twenty-first century and a large-scale survey is needed to clarify the risk factors. Furthermore, earlier tooth eruption is not taken into consideration in most studies of ECC, even though it may be a factor of ECC. The present study investigated the prevalence and risk factors of dental caries in children aged 18 months in a core city of Japan. METHODS: Findings from a total of 7351 children aged 18 months were analyzed. Anthropometric measurements of height and weight, as well as an oral examination and a microbiological caries-risk test, were performed. Additionally, a structured interview sheet was provided to the parents or guardians. Findings of dental caries at 18 months of age were evaluated using a logistic regression model. RESULTS: Of the enrolled children, 1.2% had experienced dental caries. Multivariable logistic regression analysis results indicated a significant association with dental caries at 18 months of age for the following factors: second child (OR = 1.78; 95% CI:1.08-2.93, P < 0.05), third and later child (OR = 2.08; 95% CI:1.12-3.89, P < 0.05), 12 or fewer erupted teeth (OR = 0.47; 95% CI:0.24-0.96, P < 0.05), 17 or more erupted teeth (OR = 4.37; 95% CI:1.63-11.7, P < 0.01), Cariostat score (+ + +) (OR = 3.99; 95% CI:1.29-12.31, P < 0.05), daily eating before bed (OR = 2.62; 95% CI: 1.55-4.45, P < 0.001), three or more snacks per day (OR = 2.03; 95% CI:1.15-3.58, P < 0.05), and breastfeeding (OR = 3.30; 95% CI:2.00-5.44, P < 0.001). CONCLUSIONS: These results suggest that the number of erupted teeth, as well as birth order, eating habits, and breastfeeding, are significant factors in dental caries occurrence at 18 months of age.

The impact of infant feeding and oral hygiene habits on early childhood caries: A cross-sectional study.

Background and Aim: The aim of this study is to evaluate the relationship between the Early Childhood Caries (ECC)/severe-ECC (S-ECC) and prolonged breast-feeding (BF), bottle-feeding, and oral hygiene habits in 0-year-old to 5-year-old Turkish children. Patients and Methods: Dental examinations were performed on 255 patients to determine the prevalence of the ECC and the S-ECC as per the definition of the American Academy of Pediatric Dentistry. To predict the progress rate of caries, noncavitated and cavitated lesion scores were assessed by using the International caries detection and assessment system II criteria. Information on infant feeding practices, oral hygiene habits, maternal characteristics, and demographic features were gathered by means of a questionnaire. The results were statistically evaluated. Results: There were no associations between BF duration, night-time BF, bottle-feeding, and the ECC. And there were also no associations between BF duration, night-time BF, bottle-feeding, and the S-ECC. Cavitated lesions were more common in children breastfed at night for 18-23 months compared to 12-17 months (P = 0.031). Sweetened bottle was an impact factor on caries experience (P = 0.042). A significant correlation was found for dmft, S-ECC, and the cavitated lesions regarding sugar consumption (P = .001, P = .002, and P = .001, respectively). Early introduction to tooth-brushing and regular dental visits were significantly effective in reducing the ECC (P < .001 and P < .001, respectively). Conclusion: BF and bottle-feeding practices were not associated with the ECC/S-ECC. Sweetened bottles and sugary foods are strong risk factors for the ECC/S-ECC.

Combination Effect of Diurnal Exposure to Sucrose and Nocturnal Exposure to Lactose on Enamel Demineralization.

We have hypothesized that the association between human milk and caries in breastfeeding children could be explained by the combination of a diurnal cariogenic diet with the nocturnal lactose fermentation, conditions simulated in this experimental study. Cariogenic biofilm was formed on bovine enamel slabs, which were exposed 8x/day for 3 min to a 10% sucrose solution, simulating a highly cariogenic diurnal diet, or 50 mM NaCl solution (control). Simulating the nocturnal retention of milk in mouth, biofilms were transferred to culture medium containing 0.7% lactose for 2 h, or only to culture medium (control). Four groups were designed (n = 12): Ctrl, no exposure to diurnal sucrose or nocturnal lactose; Lac, only nocturnal exposure to lactose (2 h); Suc, only diurnal exposure to sucrose (8x/day); and Suc→Lac, diurnal exposure to sucrose (8x/day) followed by nocturnal exposure to lactose (2 h). The medium was changed 3x/day, at the beginning of the day and after diurnal and nocturnal exposures. Calcium in the medium was determined as a chemical indicator of partial demineralizations occurred during the diurnal and the nocturnal treatments; the medium pH was also determined. After 96 h of growth, biofilms were harvested to evaluate CFU, biomass, and extracellular polysaccharides, soluble and insoluble. The percentage of enamel surface hardness loss (%SHL) was evaluated as cumulative demineralization. Data were analyzed by one-way ANOVA and Tukey's test (α = 5%). Highest %SHL (p < 0.05) was found for the Suc→Lac (40.6%) group when compared to Suc (32.1%), Lac (6.6%), and Ctrl (2.4%) groups. Calcium released during the diurnal and nocturnal treatments was, respectively, Suc→Lac = Suc > Lac = Ctrl and Suc→Lac > Lac > Suc = Ctrl (p < 0.05). Regarding the Ctrl group, calcium released from nocturnal lactose fermentation by the Suc→Lac group was 4-fold greater than that provoked by the Lac group. The findings were supported by the pH of the media. The data suggest that the biofilm formed under diurnal exposure to sucrose enhances the cariogenicity of nocturnal exposure to lactose.

Association of Sleep-Time Feeding Practices with Early Childhood Caries: A Case-Control Study.

Early childhood caries (ECC) remains a public health challenge globally, more so in developing countries. The association between sleep-time feeding practices and ECC remains obscure. The study evaluated this association using Feeding At Sleep Time (FeAST) scale. A case-control study was planned among 627 toddlers, were cases included children with ECC while controls were children without ECC. Three patterns of feeding associated with sleep were recorded: beginning of sleep, during the course of sleep, and early morning hours sleep. Dental caries was scored using International Caries Detection and Assessment System (ICDAS II). The study participants included 302 (48%) cases and 325 (52%) controls. Adjusted odds ratios (AORs) for breastfeeding at the beginning of sleep, during the course of sleep, and early morning hours sleep were 6.7, 6.5, and 3.7, respectively (p = 0.001), on comparing cases versus controls. Similarly, AORs for bottle-feeding at the beginning of sleep, course of sleep, and early morning hours sleep were 5.1, 8.3, and 3.7, respectively (p = 0.001). Addition of sweeteners yielded an AOR = 2.84, while the intake of solids during sleep yielded an AOR of 6.02(p = 0.001). Other feeding modes like sippers, tumblers, etc., had a statistically significant association (p = 0.001). Sleep-time feeding practices increase the risk for ECC in 12- to 36-month-old children.

Can Maternal Prenatal Self-Reported and Physiological Distress Predict Postnatal Caregiving Practices?

Maternal prenatal distress is associated with child outcomes, including health, neurocognitive, and socio-emotional development. Knowledge on underlying mechanisms is limited, yet relevant for prevention and intervention. This study investigated whether maternal prenatal distress predicts specific caregiving practices that are known for their effects on child outcomes. Caregiving practices studied were maternal caregiving quality and the initiation and course of breastfeeding and room-sharing. We hypothesized that more maternal prenatal distress would be associated with altered caregiving practices. Participants were 174 healthy mother-child dyads. During the 37th week of pregnancy maternal self-reported distress was assessed using questionnaires, and physiological stress by collecting saliva cortisol. Maternal caregiving quality was observed in postnatal week 5 during infant bathing. Weekly diaries on breastfeeding and daily diaries on room-sharing were completed during the first 6 postnatal months. In a regression analysis, no associations between maternal prenatal distress and caregiving quality were found. Multilevel analyses indicated that maternal prenatal evening cortisol was positively related to the initiation of breastfeeding and room-sharing. Replications are warranted, but these results suggest that breastfeeding and room-sharing initiation may be part of a mechanism underlying links between maternal prenatal physiological stress and child outcomes. As other prenatal cortisol markers and self-reported distress were not found to be related to the caregiving practices, it is likely that alternative mechanisms (co-)exist in explaining links between maternal prenatal distress and child outcomes. Future replication research including child outcomes and (other) potential mechanisms will inform prevention and intervention programs fostering healthy pregnancies and child development.

Association Between Breastfeeding Type and Duration and the Molar and Facial Characteristics of Preschoolers Aged 2 To 6 Years: A Cross-Sectional Study.

OBJECTIVE: To calculate the association between the type and duration of breastfeeding and the deciduous molar relationship and facial characteristics of preschoolers aged 2 to 6 years. STUDY DESIGN: This crosssectional study included 160 pre-schoolers aged 2 to 6 years old, enrolled in the 2019 academic year from 3 public schools in Data collection involved two phases. The first phase consisted in determining the facial type, anteroposterior and vertical profile, facial dimensions, and the molar relationship between primary second molars. The second phase included interviews with the parents or legal guardians. Children with exclusive breastfeeding and with mixed/artificial feeding (breastfeeding and bottle-feeding, or exclusive artificial bottle-feeding) were included. Chi-square test, t-test, multiple linear regression, and binary logistic regression tests were applied (p<0.05). RESULTS: The facial length, width, and the lower third were greater in the exclusive breastfeeding group than in the mixed/artificial feeding group (3.74mm, p=0.002; 2.06mm, p=0.047; and 2.94mm, p=0.015; respectively). In addition, children with breastfeeding for more than six months showed greater facial length, facial width and lower third (3.20mm, p=0.038; 3.68mm, p=0.006; and 3.57mm, p=0.026; respectively). The duration of exclusive breastfeeding influenced facial width, noting an increase of 3.32mm (p=0.011) if a pre-schooler had exclusive breastfeeding for more than six months. CONCLUSION: There were no significant associations between type and duration of breastfeeding and the molar terminal plane, facial type, or profile. However, facial dimensions were greater in the exclusive breastfeeding group, and when breastfeeding was longer than six months.

Breastfeeding and its Association with Early Childhood Caries - An Umbrella Review.

OBJECTIVE: To systematically assess systematic reviews and meta-analyses investigating the association of breastfeeding with ECC. STUDY DESIGN: A systematic search was carried out from MEDLINE® (PubMed), EMBASE, the Cochrane Central Database, OVID, Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports and Epistemonikos Databases up to November 2019. Data extraction was carried out by two investigators. ROBIS tool was used for quality assessment of included systematic reviews. RESULTS: Four systematic reviews were found assessing the correlation of breastfeeding with ECC. Findings were grouped into four categories, according to the duration, frequency, pattern, and comparison of feeding habits. Two systematic reviews assessing duration of breastfeeding above the age of 12 months had odds ratios of 1.86 and 1.99, showing positive correlation with ECC while nocturnal breastfeeding showed highest odds ratio of 7.14. Of the four included reviews, three had low risk of bias and one had unclear risk of bias. CONCLUSIONS: Breastfeeding beyond the age of 12 months, accompanied by nocturnal feeding, had a positive association with ECC. Further research is warranted for assessment of diurnal and nocturnal sleep-time breastfeeding habits, together with the role of enamel defects (hypoplasia), and the risk of ECC.

Breastfeeding and Childhood Dental Caries: Results from a Socially Diverse Birth Cohort Study.

Previous studies showed that prolonged breastfeeding increases the risk of caries. However, the observed associations were mainly based on non-European populations, and important confounding and mediating factors like socioeconomic position (SEP) and diet were often neglected. The aim of this study was to investigate the role of breastfeeding and bottle-feeding practices on dental caries during childhood while accounting for SEP, ethnic background, and sugar intake. This study was part of the Generation R Study, a prospective multiethnic cohort study conducted in Rotterdam, The Netherlands. In total, 4,146 children were included in the analyses. Information about feeding practices was derived from delivery reports and questionnaires during infancy. Caries was measured via intraoral photographs at the age of 6 years and defined as decayed, missing, and filled teeth (dmft). Negative binomial hurdle regression analyses were used to study the associations between several infant feeding practices and childhood caries. The prevalence of dental caries at the age of 6 years was 27.9% (n = 1,158). Prolonged breastfeeding (for >12 months) was associated with dental caries (OR 1.35, 95% CI 1.04-1.74) and the number of teeth affected by dental caries (RR 1.27, 95% CI 1.03-1.56). Furthermore, nocturnal bottle-feeding was associated with dental caries (OR 1.52, 95% CI 1.20-1.93). All associations were independent of family SEP, ethnic background, and sugar intake. Results from this Dutch cohort study confirmed the previously observed associations between prolonged breastfeeding and nocturnal bottle-feeding and the increased risk of childhood dental caries, even after proper adjustments for indicators of SEP, ethnic background, and sugar intake. Future studies are encouraged to elaborate further on possible explanations for the observed relationships. Healthcare professionals should be aware and advise caregivers about the potential risk of prolonged breastfeeding on caries development by applying the current recommendations on breastfeeding, oral hygiene, and feeding frequency.

Do breastfed children have a lower chance of developing mouth breathing? A systematic review and meta-analysis.

OBJECTIVE: Determine the association between breastfeeding and the development of mouth breathing in children. MATERIALS AND METHODS: Seven databases were searched for studies investigating the association between the type of feeding and the development of the breathing pattern in children. Descriptive analysis and meta-analysis were performed, with the calculation of the prevalence and likelihood (odds ratios (95% CI)) of mouth breathing according to the duration of breastfeeding. RESULTS: The overall prevalence of mouth breathing was 44% (95% CI: 38-49) (N total = 1182). Breastfeeding was a protection factor against the development of mouth breathing (OR = 0.62; 95% CI: 0.41-0.93). The likelihood of developing mouth breathing was 41% and 34% lower among children that were breastfed for more than 12 and more than 24 months, respectively. No association was found between exclusive breastfeeding for up to 6 months and the occurrence of mouth breathing (OR = 0.60; 95% CI: 0.31-1.18). CONCLUSIONS: Due to the scarcity of cohort studies that met the inclusion criteria and the low certainty of the evidence, no strong evidence-based conclusion can be drawn. However, breastfeeding should be encouraged due to its possible protective effect, evidenced by the substantial reduction in the prevalence of mouth breathing pattern when performed for up to 2 years. Exclusive breastfeeding was not associated with the development of the breathing pattern. CLINICAL RELEVANCE: The results reveal that breastfeeding can protect children from the development of mouth breathing. Thus, healthcare providers should offer support so that mothers feel prepared and encouraged to perform breastfeeding. TRIAL REGISTRATION: PROSPERO registry: CRD42017062172.