Breastfeeding and its Association with Early Childhood Caries - An Umbrella Review

Objective: To systematically assess systematic reviews and meta-analyses investigating the association of breastfeeding with ECC. Study Design: A systematic search was carried out from MEDLINE® (PubMed), EMBASE, the Cochrane Central Database, OVID, Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports and Epistemonikos Databases up to November 2019. Data extraction was carried out by two investigators. ROBIS tool was used for quality assessment of included systematic reviews. Results: Four systematic reviews were found assessing the correlation of breastfeeding with ECC. Findings were grouped into four categories, according to the duration, frequency, pattern, and comparison of feeding habits. Two systematic reviews assessing duration of breastfeeding above the age of 12 months had odds ratios of 1.86 and 1.99, showing positive correlation with ECC while nocturnal breastfeeding showed highest odds ratio of 7.14. Of the four included reviews, three had low risk of bias and one had unclear risk of bias. Conclusions: Breastfeeding beyond the age of 12 months, accompanied by nocturnal feeding, had a positive association with ECC. Further research is warranted for assessment of diurnal and nocturnal sleep-time breastfeeding habits, together with the role of enamel defects (hypoplasia), and the risk of ECC.