Borrie Felicity
Consultant Orthodontist, Dr Gray's Hospital, Elgin, Scotland.
Evid Based Dent. 2018 Mar 23;19(1):5. doi: 10.1038/sj.ebd.6401282.
Data sourcesPubmed, Embase, Scopus databases and New York Academy of Medicine Grey Literature Report. There were no restrictions on language and publication dates.Study selectionTwo reviewers selected both prospective and retrospective studies of children who had either been exclusively breastfed or were mixed breastfed; who were in either the primary or mixed dentition, and malocclusion was assessed. The following malocclusion traits were included; Class 2 molar, open-bite, non-spaced dentition and posterior crossbite.Data extraction and synthesisData were extracted including type of dentition, type of malocclusion, breastfeeding data collection method, results, breast feeding malocclusion odds ratio (OR) and quality of the article. The ORs of associations between different lengths of breastfeeding and the various malocclusion traits were calculated.ResultsThirty-one studies were included in a qualitative synthesis, nine in the quantitative analysis. All studies were observational, a majority examining malocclusion in the mixed dentition. Two studies looked at associations between no breastfeeding and posterior crossbite, finding children not breastfed presented 1.7 times more posterior crossbite than those breastfed for between one and six months (OR = 1.70 CI 2.01-2.39). ORs were calculated for exclusive breastfeeding and posterior crossbite with different duration of breastfeeding, and duration of breastfeeding and posterior crossbite. With regard to open bite and breastfeeding the OR=1.76 (CI 0.55-5.61) comparing those who were breastfed for less than or more than six months. Children breastfed for up to six months presented 1.25 times more Class 2 molar relationships than those breastfed for over six months. Children breastfed for up to six months presented 1.73 times more non-spaced dentitions than those breastfed for over six months (OR =1.73, CI 1.35-2.22).ConclusionsBreastfeeding is a protective factor against posterior crossbites and Class 2 malocclusion in primary and mixed dentitions, with the protective effect increasing with the months of breastfeeding. There is no clear evidence for breastfeeding proving any benefit against other malocclusion risks; open bite and non-spaced dentitions.
数据来源
PubMed、Embase、Scopus数据库以及纽约医学院灰色文献报告。对语言和出版日期没有限制。
研究选择
两名评审员选取了关于纯母乳喂养或混合母乳喂养儿童的前瞻性和回顾性研究；这些儿童处于乳牙列或混合牙列，且对其错颌畸形进行了评估。纳入了以下错颌畸形特征：安氏II类磨牙关系、开颌、牙列无间隙和后牙反颌。
数据提取与综合
提取的数据包括牙列类型、错颌畸形类型、母乳喂养数据收集方法、结果、母乳喂养与错颌畸形的比值比（OR）以及文章质量。计算了不同母乳喂养时长与各种错颌畸形特征之间关联的OR值。
结果
定性综合纳入了31项研究，定量分析纳入了9项研究。所有研究均为观察性研究，大多数研究考察混合牙列中的错颌畸形。两项研究观察了非母乳喂养与后牙反颌之间的关联，发现未母乳喂养的儿童出现后牙反颌的几率比母乳喂养1至6个月的儿童高1.7倍（OR = 1.70，CI 2.01 - 2.39）。计算了纯母乳喂养与不同母乳喂养时长的后牙反颌之间以及母乳喂养时长与后牙反颌之间的OR值。关于开颌与母乳喂养，比较母乳喂养少于或多于6个月的儿童，OR = 1.76（CI 0.55 - 5.61）。母乳喂养6个月及以内的儿童出现安氏II类磨牙关系的几率比母乳喂养超过6个月的儿童高1.25倍。母乳喂养6个月及以内的儿童出现牙列无间隙的几率比母乳喂养超过6个月的儿童高1.73倍（OR = 1.73，CI 1.35 - 2.22）。
结论
母乳喂养是乳牙列和混合牙列中后牙反颌和安氏II类错颌畸形的保护因素，保护作用随母乳喂养月数增加而增强。没有明确证据表明母乳喂养对其他错颌畸形风险（开颌和牙列无间隙）有任何益处。
