Dummies, Thrush & Decay - What Every Parent Needs To Know

Pacifiers, Dummies, Binkies whatever you want to call them (and there are 160 options here!) chat to any parent and you will find they're rather like Marmite - either loved or loathed.

Some (myself included before number one) just think all babies have them!  They like to suck and that does the job right?

As discussed in this post - a pacifier is ultimately an attempt at replicating the breast, and indeed babies use them as a replacement nipple, not the other way around (ie to say baby is using mum like a dummy actually makes no sense).

Like most discussions surrounding something truly normalised in our culture, it often turns anecdotal ie I had one and I'm fine, my children had them and their teeth are perfectly straight after they were breastfed for two years, it's personal preference - and so on and so forth.

But something I'm yet to hear mentioned is the rather more compelling evidence linking pacifiers to Candida (thrush) and ultimately tooth decay.  Yup caries, holes, decay, bad teeth! (I wonder if there are 160 alternatives to describe that?)

You're expecting evidence right?

A study that considered infants under 18 months of age detected Candida in 58%.  Pacifiers were positively associated with both frequency and severity of yeast infections, whilst no relationship was detected between the prevalence of yeast and breast-feeding or bottle-feeding habits.

"The results suggest that use of a pacifier is an important local factor in the colonization and proliferation of yeast in the oral cavity." (1)

Another assessed the surface of 25 pacifiers in a daycare setting and found 80% had a biofilm.  The two main genera isolated were Staphylococcus and Candida.

"Our results confirm that pacifiers can be seen as potential reservoirs of infections" (2)

A third swabbed the mouth and dummies of 100 children under 18 months and found Forty four per cent of dummies were colonised by Candida.

"Children who sucked dummies had clinical thrush and positive mouth swabs for candida more frequently than those who did not." (3)

A 2006 study found:

Infants who routinely sucked a pacifier had a significantly higher rate of oral candidal carriage, suggesting a reservoir of infection. (4)

Candida & Its Relationship To Pacifiers & Caries

The Brazilian Journal of Oral Sciences in 2007 reviewed the literature surrounding Candida in the mouth of infants and its association with early childhood caries (ECC).  They concluded that colonisation of Candida could be related to pacifier usage, feeding habits and caries lesions. (5)

A study that analysed 166 children aged 1-4 years found candida in 24% of samples:

"The results of the study suggest that the use of a pacifier increases the occurrence of both salivary lactobacilli and candida. It could therefore be a factor influencing caries susceptibility and activity in children." (6)

Another study examining children over 2 years old for a period of 2 years, found that although both pacifier sucking and using a bottle at night increased the occurrence of both candida and oral lactobacilli - bottle use was less significant than dummy use

"The results of the logistic regression analysis showed prolonged pacifier-sucking (≥24 months) to be a significant risk factor for caries development in children, with a rather high relative risk (RR) of 3.5 (95% confidence interval (CI), 1.5–8.2; P = 0.003). (7)

A 2012 study took 30 children with caries (group 1) and 30 children without and found Candida levels were "remarkably higher" in group 1.  They concluded:

"This study supports the active role of Candida species in dental caries." (8)

In 2009 a study noted candida are frequently detected in the mouths of children with extensive caries compared to those without:

"Samples of saliva from 14 children with caries lesions and from 13 caries-free subjects were evaluated for the presence of mutans streptococci, lactobacilli and Candida spp. by culture. Eleven of 14 carious subjects hosted Candida spp. in their saliva as against only 2 out of 13 subjects without caries lesions." (9)

Another in 2006 considered plaque and dentine from from 56 children aged 1–5 years - which were divided them into three groups early childhood caries (ECC); caries and caries-free.  They concluded:

"There is a significant association between the presence of C. albicans and early childhood caries." (10) 

Whilst pacifier manufacturers have created orthodontic dummies to try and combat the effect of abnormal pressures caused by pacifiers on teeth and gums, it seems to me problems such as thrush and caries are just as significant, yet don't appear to have been well publicised.  

Surely parents have a right to all the facts when deciding whether to introduce one?  

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References
1.  ASDC J Dent Child. 2001 Jan-Feb;68(1):33-6, 10
2.  Nursing & Health Sciences Volume 8, Issue 4, pages 216–223, December 2006

3.  Arch Dis Child 1985;60:381-382 doi:10.1136/adc.60.4.381
4.  Oral candidal flora in healthy infants, Journal of Oral Pathology & Medicine, Volume 24, Issue 8, pages 361–364
5.  Brazilian Journal of Oral Sciences, Vol. 6, No. 20, January - March 2007, pp. 1249 - 1253

6.  Acta Odontologica Scandinavica, 1997, Vol. 55, No. 1 , Pages 9-13

7.  Acta Odontologica Scandinavica, Department of Preventive Dentistry and Cariology, Institute of Dentistry, and Department of Pediatrics, University of Oulu, Oulu, Finland 1998, Vol. 56, No. 4 , Pages 233-237
8. Comparative Evaluation of Oral Candida Albicans in Children with and without dental caries.  Int J Clin Pediatr Dent 2012;5(2):108-112

9. Support for the role of Candida spp. in extensive caries lesions of children.  NEW MICROBIOLOGICA, 32, 101-107, 2009
10. Archives of Oral Biology Volume 51, Issue 11, November 2006, Pages 1024–1028

Breastfeeding - Certainties V Risks

When discussing the implications of not receiving human milk, it never ceases to amaze me how many rush to answer with details of how they didn't breastfeed - yet them/their child doesn't have XYZ (whatever is being discussed); thus they can conclude the study/discussion in question is "rubbish".

Generally no other supporting evidence follows, the conclusion is reached purely based up on their personal experience.

This is quite typical of human nature I think.  We base our "norms" on what we see around us, we are less likely to believe negative implications of something unless we see/experience it first hand.  Furthermore it's very difficult for a mother to begin to contemplate negative implications that may relate to her own child - believing it's rubbish is an inherently more comfortable position.

But it doesn't take a genius to establish this logic is fatally flawed.  If you don't know anyone who smokes and has died of lung cancer, is it accurate to conclude smoking doesn't cause harm?  Many of us were raised without booster seats in the car for older toddlers/children - I didn't come to harm in a crash therefore does that mean nobody else has?  That we can abandon safety in the fact of anecdotal evidence?

The reality is that when discussing infant feeding, we are talking risks not certainties.

Risk

Noun: The possibility of suffering harm or loss; danger.

Cer·tain·ty
Noun: Firm conviction that something is the case.

Saying not breastfeeding is linked with increased risk of obesity or SIDS or diabetes does not, I repeat does not, thrice I will say does not mean every non breastfed infant will turn out fat, suffer SIDS or end up diabetic.  Nor does it mean no breastfed baby will become overweight, not become a victim of SIDS or develop diabetes.

What it does mean is if you take two groups - one breastfed and one not, those not breastfed would be more likely or have a higher chance of developing XYZ.  Sometimes this risk is slight, other times more significant - but it remains a risk not a given.

If we can maintain this perspective, perhaps it may lead to more progressive dialogue whereby instead of debate over whether one has/hasn't had experience something that tallies with what evidence is telling us - we could instead move on to discuss how to reduce whatever risk is in question.