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

<div><p>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.</p></div

Forest plot of meta-analysis for four cross-sectional studies.

<p>Evaluates bottle or breast feeding practices and dental caries (outcome: presence of dental caries vs. absence of dental caries). Pooled effect measures [odds ratio (OR) and 95% confidence interval (CI)] indicated no statistically significant difference between breast and bottle fed children. I² = 33.14%. Fixed effect model used.</p

Characteristics of studies included in systematic review.

<p>OR_adj = Odds ratio adjusted</p><p>ECC = Early childhood caries</p><p>† Dmft = decayed tooth, decayed tooth indicated for extraction, filled tooth</p><p>‡Exclusive breast milk = 100% breast milk.</p><p>‖Moderate-High mixed feeding = 58–99% breast milk.</p><p>ᵜLow mixed feeding = 1–57% breast milk.</p><p>¤Exclusive use of formula = 0% breast milk.</p><p>Characteristics of studies included in systematic review.</p

Screening of articles.

<p>Four-phase PRISMA flow-diagram for study collection, showing number of studies identified, screened, eligible, included in review and meta-analysis [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0142922#pone.0142922.ref026" target="_blank">26</a>].</p

Newcastle-Ottawa quality assessment summary.

<p>¹For cross-sectional and case-control studies. ²For case-control study only. ³For cohort study only. ⁴For all study designs. †This item was allocated a maximum of 2 points. †† This item was allocated a maximum of 2 point for cross-sectional and 3 points for cohort and case-control studies. NR = not rated.</p

Tooth Erosion and Eating Disorders: A Systematic Review and Meta-Analysis

<div><p>Background</p><p>Eating disorders are associated with the highest rates of morbidity and mortality of any mental disorders among adolescents. The failure to recognize their early signs can compromise a patient's recovery and long-term prognosis. Tooth erosion has been reported as an oral manifestation that might help in the early detection of eating disorders.</p><p>Objectives</p><p>The aim of this systematic review and meta-analysis was to search for scientific evidence regarding the following clinical question: Do eating disorders increase the risk of tooth erosion?</p><p>Methods</p><p>An electronic search addressing eating disorders and tooth erosion was conducted in eight databases. Two independent reviewers selected studies, abstracted information and assessed its quality. Data were abstracted for meta-analysis comparing tooth erosion in control patients (without eating disorders) vs. patients with eating disorders; and patients with eating disorder risk behavior vs. patients without such risk behavior. Combined odds ratios (ORs) and a 95% confidence interval (CI) were obtained.</p><p>Results</p><p>Twenty-three papers were included in the qualitative synthesis and assessed by a modified version of the Newcastle-Ottawa Scale. Fourteen papers were included in the meta-analysis. Patients with eating disorders had more risk of tooth erosion (OR = 12.4, 95%CI = 4.1–37.5). Patients with eating disorders who self-induced vomiting had more risk of tooth erosion than those patients who did not self-induce vomiting (OR = 19.6, 95%CI = 5.6–68.8). Patients with risk behavior of eating disorder had more risk of tooth erosion than patients without such risk behavior (Summary OR = 11.6, 95%CI = 3.2–41.7).</p><p>Conclusion</p><p>The scientific evidence suggests a causal relationship between tooth erosion and eating disorders and purging practices. Nevertheless, there is a lack of scientific evidence to fulfill the basic criteria of causation between the risk behavior for eating disorders and tooth erosion.</p></div

Quality assessment criteria used for cross-sectional studies through a modified version of Newcastle-Ottawa Scale for observational studies.

<p>Quality assessment criteria used for cross-sectional studies through a modified version of Newcastle-Ottawa Scale for observational studies.</p

Meta-analysis of two cross-sectional studies associating tooth erosion with eating disorder risk behavior (EDs) vs. control groups (patients without eating disorder risk behavior), with statistical significance; I² = 11.3%, random effect model used.

<p>Meta-analysis of two cross-sectional studies associating tooth erosion with eating disorder risk behavior (EDs) vs. control groups (patients without eating disorder risk behavior), with statistical significance; I² = 11.3%, random effect model used.</p

Meta-analysis of nine case-control studies showing twelve different outcomes associating tooth erosion with types of eating disorders (EDs) with or without self-induced vomiting (SIV) vs. controls.

<p>Eating disorders were analyzed in subgroups according to each type of ED. Heterogeneity: I² = 0.0% (Anorexia subgroup), I² = 44.0% (Bulimia subgroup), I² = 0.0% (Bulimia with SIV subgroup), I² = 0.0% (Bulimia without SIV subgroup), I² = 0.0% (EDs subgroup), random effect model used.</p

Screening of articles.

<p>Four-phase PRISMA flow-diagram for study collection <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0111123#pone.0111123-Moher1" target="_blank">[38]</a>, showing the number of studies identified, screened, eligible, and included in the review and meta-analysis.</p