Tooth Decay Distribution May be Affected by Night-Time Infant Posture when being Breast-Fed, On-Demand and the Presence of a Clinically Significant Upper Lip Tie

Background: One of the purported advantages of revising upper lip ties surgically is that it reduces the risk of tooth decay; it was decided to carry out a study to assess tooth decay in relation to upper lip ties in on-demand, night-time breast fed infants.

Method: A retrospective study on the records of patients presenting at my specialist paediatric practice was conducted. The inclusion criteria were that the patients were being breast fed, on-demand, at night and had been diagnosed with tooth decay affecting their upper deciduous incisors. 48 records fulfilling the inclusion criteria were used. Clinical feeding data were evaluated; which breast the mother preferred when feeding at night and was the baby consuming any solid or liquid nutrients in addition to breast milk. Digital images of the upper incisors were available to supplement the clinical written records for the assessment of the severity and distribution of tooth decay and to evaluate the severity of the upper lip ties. The Kotlow classification: Class I (least) to Class IV (most) was used.

Results: The age range of the patients was 16 months to 59 months. There was a range of severity of tooth decay and the lesion distribution was noted to always be asymmetric. The presence of a Class III or Class IV upper lip tie was noted in all cases. The mothers all had a preference to use the same breast when feeding in bed, at night and all the babies were having additional dietary carbohydrate input as well as the breast-milk during the day.

Conclusion: The asymmetric distribution of tooth decay in on-demand, night-time breast-fed infants was observed with the presence of a clinically significant upper lip tie and the effects of gravity altering the distribution of carbohydrate-containing saliva due to the nocturnal feeding posture of the infant.