Breast-feeding may be associated with a reduction in specific malocclusions in primary dentition

Breast-feeding may be associated with a reduction in specific malocclusions in primary dentition

JADA+ CONTENT This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evid...

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This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.


Romina Brignardello-Petersen, DDS, MSc, PhD


Dogramacı EJ, Rossi-Fedele G, Dreyer CW. Malocclusions in young children: does breast-feeding really reduce the risk? A systematic review and meta-analysis. JADA. 2017;148(8):566-574.e6. http:// Key words. Pediatrics; breastfeeding; malocclusion; primary dentition; risk factors; systematic review. Clinical relevance. Clinicians usually list a reduction in the risk of developing malocclusions among the many benefits of breastfeeding. Clinicians should know what the quality of the evidence behind that claim is before making specific recommendations to their patients. Study summary. The authors conducted a systematic review (SR) to study the association between breastfeeding and malocclusions in the primary dentition. They searched 4 electronic databases through November 2016 for comparative observational studies assessing this association. They found 7 cross-sectional studies that included a total of 4,869 participants whose ages ranged from 2 to 6 years. Children who had not been breastfed had 1.44 times the risk of having an anterior crossbite than those who had been breastfed.* There were no differences in posterior crossbite between the groups.y There were also no differences in anterior or posterior crossbite between children who had been breastfed nonexclusively and those who had been breastfed exclusively.z Children who had had a shorter duration of breastfeeding had 1.66 times the risk of having a class II canine relationship and 2.4 times the risk of having an anterior open bite than children who had had a longer duration of breastfeeding.§ There were no differences in the risk of posterior crossbite between children who had longer and shorter durations of breastfeeding. Strength and limitations. The authors of this SR searched for and selected the studies to include in their

SR appropriately. However, they included only studies that they judged to be of high methodological quality, which led them to exclude 23 eligible studies that may have provided more data and relevant data for their SR.{ The authors included only cross-sectional studies, but they used the risk ratio as the measure of association to pool the results. This is not correct because crosssectional studies can only assess the presence of a malocclusion (not the risk of developing it), and therefore the interpretation of the estimates they provided cannot correctly be made from type of studies they presented. The results of the meta-analyses were inconsistent across comparisons and outcomes, which decreases our confidence in the overall association between breastfeeding and malocclusions. In addition, for most of the outcomes and comparisons in which an association was observed, the pooled estimate was not precise, which decreases our confidence even further. The authors did not report the demographic characteristics of the children included in the studies, which makes it difficult for us to judge the applicability of this evidence. Thus, this SR does not provide sufficient evidence of a strong association between breastfeeding and malocclusion. When using this evidence to provide advice to patients, however, clinicians should remember that this is only 1 outcome of multifactorial etiology, and this evidence does not suggest any harm from breastfeeding on this outcome. n Copyright ª 2017 American Dental Association. All rights reserved.

Address correspondence to Dr. Brignardello-Petersen at e-mail [email protected] Disclosure. Dr. Brignardello-Petersen did not report any disclosures. * Risk ratio (RR), 1.44; 95% confidence interval (CI), 1.15 to 1.81; n ¼ 3 studies, 2,228 children. y RR, 1.09; 95% CI, 0.62 to 1.92. z RR (95% CI), 1.03 (0.83 to 1.27) for anterior crossbite; 1.84 (0.94 to 3.58) for posterior crossbite. § RR (95% CI), 1.66 (1.39 to 1.98) for class II canine relationship; 2.40 (1.04 to 5.54) for anterior open bite. The authors defined “shorter duration of breastfeeding” as less than 12 months. { Although high-quality studies are more useful, systematic review authors should include all relevant evidence and compare the results between high- and low-quality studies. If such results do not differ, then we can be even more confident about the presence or absence of an association and obtain more precise estimates of the magnitude of such association.


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2017 e1