1 Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia.
2 School of Dentistry and Oral Health, Griffith University, Gold Coast Campus, Queensland, Australia.
J Dent Res. 2019 Jul;98(7):755-762. doi: 10.1177/0022034519843487. Epub 2019 Apr 11.
Breastfeeding is important for health and development. Yet, the interaction between breastfeeding duration and usage of fluoridated water on caries experience has not been investigated. This study examined exposure to fluoridation as an effect modifier of the association between breastfeeding duration and caries. The 2012 to 2014 national population-based study of Australian children involved parental questionnaires and oral epidemiological assessment. Children were grouped by parent-reported breastfeeding duration into minimal (none or <1 mo), breastfed for 1 to <6 mo, breastfed for 6 to 24 mo, and sustained (>24 mo). Residential history and main water source used for the first 2 y of life were collected to group children into exposed (WF) and nonexposed (NF) to fluoridation. Socioeconomic status, infant formula feeding, and sugar-sweetened beverage (SSB) consumption data were collected. The prevalence and severity of caries in children aged 5 to 6 y were primary outcomes. Multivariable regression models with robust error estimation were generated to compute prevalence ratios (PRs) and mean ratios (MRs) for 3 breastfeeding groups against the reference (breastfed for 6-24 mo). Of the 5- to 6-y-old children, 2,721 were in the WF and 1,737 were in the NF groups. The groups had comparable distributions of socioeconomic factors, infant formula feeding, and SSB consumption. There were U-shape distributions of caries experience among breastfeeding groups, being more pronounced among NF children. Among NF children, the minimal and sustained breastfeeding groups had significantly higher PR (1.4 [1.1-1.9] and 1.8 [1.4-2.4]) and MR (2.1 [1.4-3.3] and 2.4 [1.4-4.1]) than the reference group. However, among the WF children, this association between breastfeeding duration and caries attenuated after adjustment for other factors. The study contributes evidence of a nonlinear (U-shape) association between breastfeeding duration and dental caries. Early life exposure to fluoridated drinking water attenuated the potential cariogenic effect of both lack of and sustained breastfeeding.
母乳喂养对健康和发育很重要。然而，母乳喂养时间与饮用氟化水之间的相互作用对龋齿的影响尚未得到研究。本研究检查了氟化物暴露作为母乳喂养时间与龋齿之间关联的效应修饰剂。这项 2012 年至 2014 年澳大利亚全国性的儿童人群研究涉及父母问卷调查和口腔流行病学评估。根据父母报告的母乳喂养时间，将儿童分为最少（无或<1 个月）、母乳喂养 1 至<6 个月、母乳喂养 6 至 24 个月和持续（>24 个月）。收集了儿童前 2 年的居住史和主要用水来源，以将儿童分为暴露于（WF）和未暴露于（NF）氟化水的组。收集了社会经济地位、婴儿配方奶粉喂养和含糖饮料（SSB）消费数据。儿童 5 至 6 岁时的龋齿患病率和严重程度为主要结果。采用具有稳健误差估计的多变量回归模型，计算了与参考组（母乳喂养 6-24 个月）相比的 3 个母乳喂养组的患病率比（PR）和均数比（MR）。在 5-6 岁的儿童中，有 2721 名儿童在 WF 组，1737 名儿童在 NF 组。这两组的社会经济因素、婴儿配方奶粉喂养和 SSB 消费分布相当。母乳喂养组的龋齿患病率呈 U 形分布，在 NF 儿童中更为明显。在 NF 儿童中，持续母乳喂养组和最小母乳喂养组的 PR（1.4[1.1-1.9]和 1.8[1.4-2.4]）和 MR（2.1[1.4-3.3]和 2.4[1.4-4.1]）显著高于参考组。然而，在 WF 儿童中，这种母乳喂养时间与龋齿之间的关联在调整其他因素后减弱了。本研究提供了母乳喂养时间与龋齿之间存在非线性（U 形）关联的证据。生命早期接触氟化饮用水减弱了缺乏和持续母乳喂养的潜在致龋作用。
