Breastfeeding provides infants protection against tooth decay through several mechanisms. Saliva and breastmilk contain proteins like lactoferrin, secretory IgA, and components of beta-casein that inhibit the adhesion of cariogenic bacteria like Streptococcus mutans. Breastfeeding also promotes the growth of beneficial bacteria like Lactobacillus that produce acids suppressing the growth of pathogenic bacteria. Population studies show breastfed infants have lower rates of tooth decay and prolonged breastfeeding is not definitively linked to higher decay risks. Components in breastmilk like alpha-lactalbumin may also have anti-cancer properties providing additional health benefits to nursing infants.

1. Saliv och bröstmjölk – för hälsa eller sjukdom?
2010-04-19
Ämnen i både saliv och bröstmjölk kan förhindra att bakterier får fäste på tandytorna, visar Liza Danielsson Niemi i den
avhandling hon försvarar vid Umeå universitet den 22 april.
Bakterier samlas gärna på olika ytor i kroppen där de lever i ordnade samhällen, s.k. biofilmer. Vissa bakterier i
biofilmen har skyddsfunktioner för värden/människan medan andra kan ge infektionssjukdomar. Bakteriernas förmåga
att få fäste på ytor och celler hänger på hur väl de kan binda till mottagarmolekyler (receptorer) hos värden. I saliven
finns många molekyler som kan fungera som receptorer för bakterier, bl.a. proteinerna staterin och gp-340. Efter att de
själva har fäst på en tandyta binder de bakterier. Avhandlingen visar att staterin kan styra bindningen av Actinomyces-
arter så att bindningen av infektionsorsakande bakterier förhindras och bindningen av mer hälsosamma bakterier
gynnas. Det skulle kunna skydda mot infektioner.
Glykoproteinet gp-340 har många biologiska funktioner och kan bl.a. binda kariesassocierade streptokocker till
biofilmer på tänderna. I avhandlingen beskrivs ett antal storleksvarianter av gp-340 som bär skilda sockerstrukturer och
klumpar ihop (binder) bakterier på olika sätt. Varianternas roll i gp-340:s försvarsmekanismer kan förklara en del
skillnader i känslighet för t.ex. karies.
Även proteiner som tillförs via kosten kan påverka bindningen av bakterier. För många spädbarn är bröstmjölk den
huvudsakliga födan och den är lik saliven på många sätt. Avhandlingen visar att bröstmjölk, mer specifikt en del av
bröstmjölksproteinet β-kasein och laktoferrin, kan förhindra att vissa streptokocker binder sig till tandytan.
Bröstmjölken skulle därför kunna ha en skyddande effekt mot tidig kolonisation av sådana streptokocker, som i andra
studier visats vara en riskfaktor för karies.
Umeå Universitet, Medecins fakultet, Aktuellt
Host ligands and oral bacterial adhesion: studies on phosphorylated polypeptides
and gp-340 in saliva and milk
Infectious diseases e.g. gastric ulcer, caries and perodontitis, are caused by bacteria in a biofilm. Adhesion of
bacteria to host ligands e.g. proteins, polypeptides and glycoproteins, is a key event in biofilm formation and
colonization of surfaces such as mucosa and tooth tissues. Thus, host ligands could contribute to the susceptibility
to infectious diseases. The general aim of this doctoral thesis was to study the effect of phosphorylated
polypeptides and gp-340 in saliva and milk on oral bacterial adhesion and aggregation.
Statherin is a non-glycosylated, phosphorylated polypeptide in saliva. The polypeptide inhibits precipitation and
crystal growth of calcium phosphate and mediates adhesion of microorganisms. By using a hybrid peptide
construct, the domain for adhesion of Actinomyces isolated from human infections and from rodents was found to
reside in the C-terminal end, and the adhesion was inhibitable. With alanine substitution the peptide recognition
epitope in the C-terminal end was delineated to Q and TF, where QAATF was an optimal inhibitory peptide. In
contrast, human commensal Actinomyces bound to the middle region in a non-inhibitable fashion. Gp-340 is
another protein in saliva, and it is a large, multifunctional glycoprotein. Four novel size variants (I-IV) of salivary
gp-340 were distinguished within individuals, and their glycoforms were characterized. All four size variants were
identical in the N-terminal amino acid sequence and shared core carbohydrates. Low-glyco lung gp-340, high-
glyco saliva gp-340, and size variants I-III aggregated bacteria differently. Human milk, which shares many traits
with saliva, could inhibit adhesion of Streptococcus mutans to saliva-coated hydroxyapatite (s-HA), a model for
teeth, in an individually varying fashion. Human milk caseins, lactoferrin, secretory IgA, and IgG inhibited the
binding avidly. By using synthetic peptides the inhibitory epitope in b-casein was mapped to a C-terminal stretch
of 30 amino acids. Inhibition by human milk, secretory IgA and the b-casein-derived inhibitory peptide was
universal among a panel of mutans streptococci.
The main conclusions are: (i) statherin mediates differential binding of commensal versus infectious Actinomyces
strains with small conformation-dependent binding epitopes, (ii) salivary gp-340 has individual polymorphisms
that at least affect binding of bacteria, (iii) human milk inhibits S. mutans adhesion to s-HA in an individually
varying fashion, and the C-terminal end of human milk β-casein is one inhibitory component. Together these
results suggest that the studied host ligands can influence the composition of the oral biofilm. Statherin may
protect the host from colonization of bacteria associated with infections. Gp-340 size variants may affect functions
related to host innate immune defences such as interactions with a wide array of bacteria, and human milk may
have a protective effect in infants from colonization of mutans streptococci.
Danielsson Niemi, Liza (Umeå universitet, Medicinsk fakultet, Odontologi, Kariologi)
Host ligands and oral bacterial adhesion: studies on phosphorylated polypeptides and gp-340 in saliva and milk
Umeå universitet, Medicinsk fakultet, Odontologi, Kariologi
2010-03-30
URI: urn:nbn:se:umu:diva-32894
Permanent länk: http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-32894
ISBN: 978-91-7264-969-9

2. Amning ger barnet karies-skyddande munbakterier
2012-10-18
Att amma sitt nyfödda barn ger det mer än bara näring. Barn som ammas helt eller delvis har lactobaciller som skyddar
mot kariesbakterien Streptococcus mutans i sin munflora, medan barn som inte ammas helt saknar dessa bakterier. Det
visar en svensk studie av 207 tremånaders spädbarn vars saliv testats för olika bakterier.
I fosterlivet är barnen helt sterila både i mun och i tarm. Efter födelsen får de snabbt en uppsättning bakterier ifrån
mamma och omgivningen, bland annat via födan.
Var tredje barn som ammades helt och cirka var fjärde som ammades delvis hade de skyddande lactobacillerna i
munnen, men inte ett enda barn som flaskmatades. Forskarna efterlyser nu studier som undersöker vilken betydelse
detta har för barnens hälsa längre fram i livet, med ett primärt fokus på tidig kariesutveckling.
Text: Fredrik Hedlund, Tandläkartidningen
Källa:
Holgerson PL, Vestman NR, Claesson R, Ohman C, Domellöf M, Tanner AC, Hernell O, Johansson I. Oral Microbial Profile Discriminates Breastfed
from Formula-Fed Infants. J Pediatr Gastroenterol Nutr 2012, doi:10.1097/MPG.0b013e31826f2bc6.
Oral Microbial Profile Discriminates Breast-fed From Formula-fed Infants.
Abstract
OBJECTIVES: Little is known about the effect of diet on the oral microbiota of infants, although diet is known to
affect the gut microbiota. The aims of the present study were to compare the oral microbiota in breast-fed and
formula-fed infants, and investigate growth inhibition of streptococci by infant-isolated lactobacilli.
METHODS: A total of 207 mothers consented to participation of their 3-month-old infants. A total of 146 (70.5%)
infants were exclusively and 38 (18.4%) partially breast-fed, and 23 (11.1%) were exclusively formula-fed. Saliva
from all of their infants was cultured for Lactobacillus species, with isolate identifications from 21 infants.
Lactobacillus isolates were tested for their ability to suppress Streptococcus mutans and S sanguinis. Oral swabs
from 73 infants were analysed by the Human Oral Microbe Identification Microarray (HOMIM) and by
quantitative polymerase chain reaction for Lactobacillus gasseri.
RESULTS: Lactobacilli were cultured from 27.8% of exclusively and partially breast-fed infants, but not from
formula-fed infants. The prevalence of 14 HOMIM-detected taxa, and total salivary lactobacilli counts differed by
feeding method. Multivariate modelling of HOMIM-detected bacteria and possible confounders clustered samples
from breast-fed infants separately from formula-fed infants. The microbiota of breast-fed infants differed based on
vaginal or C-section delivery. Isolates of L plantarum, L gasseri, and L vaginalis inhibited growth of the cariogenic
S mutans and the commensal S sanguinis: L plantarum >L gasseri >L vaginalis.
CONCLUSIONS: The microbiota of the mouth differs between 3-month-old breast-fed and formula-fed infants.
Possible mechanisms for microbial differences observed include species suppression by lactobacilli indigenous to
breast milk.
Holgerson PL, Vestman NR, Claesson R, Ohman C, Domellöf M, Tanner AC, Hernell O, Johansson I.
*Department of Odontology, Cariology, Umeå University †Department of Odontology, Microbiology, Umeå University ‡Department of Clinical
Sciences, Pediatrics, Umeå University, Umeå, Sweden §Department of Molecular Genetics, Forsyth Institute, Harvard School of Dental Medicine,
Boston, MA.
J Pediatr Gastroenterol Nutr. 2013 Feb;56(2):127-36. doi: 10.1097/MPG.0b013e31826f2bc6.
PMID: 22955450
Vårdpersonals skyldighet att stödja amning
Sverige har skrivit under Innocenti-deklarationen som talar om att vårdpersonal ska stödja amning enligt WHO's
definition, vilken innebär delamning i 2 år eller längre. Denna deklaration omfattar även tandvårdspersonal.
Med principerna för mänskliga rättigheter, speciellt de som kommer i uttryck i Barnkonventionen, är vår vision en
miljö som möjliggör att mammor, familjer och andra vårdnadshavare ska kunna göra informerade val om optimalt
uppfödningssätt, som är definierat som enbart amning i sex månader och därefter skall barnen fortsätta att ammas
med tillägg av lämplig kost upp till två års ålder eller längre. För att uppnå denna vision krävs kunnigt, praktiskt
stöd som också är nödvändigt för att uppnå högsta standard av hälsa och utveckling för späda och små barn, vilket
är den universellt erkända rättigheten för varje barn.
Operationella mål: Försäkra att hälsosektorn och andra relevanta sektorer skyddar, främjar och stödjer enbart
amning i sex månader och därefter fortsatt amning upp till två års ålder eller längre, samtidigt som kvinnor får
tillgång till det stöd de behöver inom familjen, samhället och arbetsplatsen för att uppnå dessa mål.
Innocenti 2005
Översättning: Elisabeth Kylberg i samarbete med AMNIS
http://www.amningshjalpen.se/images/stories/innocenti2005.pdf

3. Infant Dental Decay - Is it related to Breastfeeding?
Brian Palmer, D.D.S.
Lactose
• found only in mammal milk
• in lower intestine - turns to Lactic acid
• L. acid promotes Lactobacillus bifidus
• L. bifidus helps prevent intestinal putrefaction
– one of the benefits of breastfeeding
• Milk is the best source of calcium and lactose
Guthrie, H. Introductory Nutrition, 1983, C.V.Mosby, p26
Mammals
• There are 4640 species of mammals
• Humans are but one species
• All species breastfeed their young
• Most, but not all, have lactose in their milk.
– Dr. Olaf Oftedal - National Zoological Park
• Humans are the only mammal with any
significant decay in deciduous teeth.
“Most animals do not have
decay in their deciduous teeth”
- Dr. Peter Emily - Father of Veterinarian Dentistry
Strep mutans is highly susceptible to
the bactericidal action of Lactoferrin.
LF chelates iron, making this essential nutrient
inaccessible to an invading microorganism.
(LF is present in breastmilk)
Arnold, R. et al. A Bactericidal Effect for Human Lactoferrin.
Science, July 15, 1977; 197(4300):263-5
“Study demonstrates that prolonged
demand breast-feeding does not lead
to higher caries prevalence.”
Weerheijm KL, Prolonged demand breast-feeding and
nursing caries, Caries Res, 1998;32(1):46-50.
Human breastmilk kills cancer cells.
Catharina Svanborg of Lund, Sweden has discovered that
human breastmilk has killed all cancer cells tested.
The cancer killer is one of the most abundant proteins in breast
milk - alpha-lactalbumin, which helps to produce lactose.
Stomach acid may be the key to its activation.
Research received a $200,000 grant from the American Cancer
Society - the only non-American lab with ACS support
P. Radelsky, Human Breast Milk Kills Cancer Cells,
Discover magazine, June, 1999, 68-75.
“Population-based studies do not
support a definitive link between
prolonged breast-feeding and caries.”
H. Slavkin, Streptococcus Mutan, Early
Childhood Caries and New Opportunities,
JADA, Vol. 130, Dec. 1999, 1787-92.
Harold C. Slavkin, D.D.S. - Director, National
Institute of Dental and Craniofacial Research,
National Institute of Health, Bethesda, Md.
Due to the contradictory nature of previous
research findings and weak methodology
used - authors concluded that the evidence
linking breastfeeding and infant caries
remains equivocal (vague, ambiguous,
doubtful, questionable).
• Recommendation: There is no “right time”
to wean a breast-fed infant.
Joyce Sinton et al., A systematic overview of the relationship
between infant feeding caries and breast-feeding.
Ont Dent, 1998; 75(9)(Nov):23-27
Presentation Created by:
Brian Palmer, D.D.S.
Broadway Medical Building
Complete presentation at:
http://www.brianpalmerdds.com/pdf/caries.pdf