Association Between Infant-Feeding Practices and Early Childhood Caries: A Clinical and Epidemiological Study

Abstract

Highlights: What are the main findings? This study shows that children who were breastfed had significantly lower dmft scores compared with those who were mixed- or formula-fed, indicating a protective effect of breastfeeding against early childhood caries (ECC). A longer duration of breastfeeding and daily use of fluoride toothpaste were identified as independent protective factors against caries in the logistic regression analysis. What are the implications of the main findings? Promoting breastfeeding and providing appropriate oral hygiene education during infancy may help reduce the risk of ECC and improve long-term oral health outcomes. Incorporating guidance on infant feeding and daily fluoride toothpaste use into pediatric care and community health programs could strengthen early prevention efforts. Background: Early childhood caries (ECC) remains one of the most prevalent chronic conditions among preschool children worldwide. Feeding practices during infancy play a significant role in shaping oral microbial colonization and caries risk. This study aimed to evaluate the association between breastfeeding, artificial feeding, and the occurrence of ECC among children aged 3–5 years. Methods: A cross-sectional clinical and epidemiological study was conducted involving 103 children aged 3–5 years. Parents completed a structured questionnaire. Participants were divided into three groups based on infant feeding history: exclusively breastfed, exclusively artificially fed, and mixed-fed. Clinical oral examinations assessed dmft indices. Statistical analysis included Kruskal–Wallis and Mann–Whitney U tests for dmft scores, Chi-square tests for categorical variables, Spearman correlations, and binary logistic regression to identify predictors of dental caries. Results: Among participants, 43.6% were exclusively breastfed, 41.7% mixed-fed, and 14.5% exclusively artificially fed. The mean dmft index was highest in formula-fed children (4.2 ± 3.78), followed by mixed-fed (2.97 ± 3.19) and breastfed children (1.75 ± 2.99). Kruskal–Wallis analysis showed significant differences in dmft among groups (p = 0.005), with breastfed children having lower dmft than both formula-fed (p = 0.009) and mixed-fed (p = 0.006) children. Caries presence was significantly associated with feeding type (χ2 = 14.00, p = 0.001) and fluoride toothpaste use (χ2 = 7.56, p = 0.023). A weak negative correlation was observed between dmft and breastfeeding duration (ρ = −0.266, p = 0.007). Logistic regression identified longer breastfeeding duration (OR = 0.889, 95% CI: 0.81–0.97, p = 0.010) and use of fluoride toothpaste (OR = 0.323, 95% CI: 0.13–0.81, p = 0.012) as protective factors against dental caries. Parental questionnaire responses suggested prolonged bottle feeding and nocturnal feeding habits as contributing factors. Conclusions: Longer breastfeeding duration and regular use of fluoride toothpaste were associated with lower risk of dental caries in children. Formula feeding was associated with higher dmft scores. Infant feeding practices significantly influence the risk of early childhood caries. Encouraging breastfeeding and educating parents on appropriate weaning and oral hygiene measures may reduce ECC incidence and support better long-term oral health outcomes.