Postpartum Interventions
At postpartum visits with the mother, focus on the following:
- Promote breast feeding
- Children who are breastfed are less likely to develop caries than those who are bottle fed, especially if there is ad lib use of bottles and sippy cups. Breast milk is a complex, highly specialized and dynamic source of nutrition for the infant, and contains antimicrobials and beneficial bacteria that help the infant establish a healthy oral microbiome that is more resistant to caries.
- Breastfeeding has multiple other proven health benefits.
- The American Academy of Pediatrics recommends that breastfeeding should be exclusive for the first 6 months of life. Breast feeding can be continued to age 2 or beyond, if desired by both mother and child, consistent with recommendations from the World Health Organization.
- Evidence suggests breastfeeding for longer than 12 months and frequent nocturnal breastfeeding can increase the risk of early childhood caries; however, breastfeeding offers many health benefits and should be continued for as long as desired by caregivers. Wiping the gums and teeth gently with moist gauze after each feeding can reduce the infant's caries risk.
- Promote use of xylitol products or chlorhexidine rinse (Peridex) for mom during late pregnancy and postpartum period.
- Xylitol can help decrease transmission of caries causing bacteria from mom to child.
- If chlorhexidine is used, use only for brief periods of time (i.e. weeks) to reduce the risk of tooth staining.
- Vitamin D supplements are recommended for all infants during the first year of life to support healthy teeth and bones.
- Ensure children are not put to bed with a bottle.
- Teeth are at highest risk overnight when saliva levels are low.
- Gently clean infants' gums and teeth after breastfeeding, then brush twice daily with a smear of fluoride toothpaste once teeth erupt (AAP and AAPD recommendation).
- Recommend children see a dentist at 6-12 months of age.
- The American Academy of Pediatrics (AAP) recommends that 100% fruit juice should not be introduced before 12 months of age, and should be limited to no more than 4 ounces a day for children aged 1 to 3 years.
- The American Heart Association recommends that sugar in foods and drink should be avoided in children in children under 2 years.
- Encourage smoking cessation. Maternal smoking during pregnancy is associated with increased risk of early childhood caries, although more studies are needed to account for confounding variables. Possible mechanisms for increased caries risk include toxic effects of tobacco on developing dental structures in utero and during infancy and increased vertical transmission of S mutans due to the higher levels of the bacteria found in individuals who smoke.
References
Guideline on Infant Oral Health Care. AAPD. Revised 2014.
Salone LR, Vann WF, Dee DL. Breastfeeding : An overview of the oral and general health benefits. JADA 2013; 144(2):143-151.
Arishi RA, Lai CT, Geddes DT and Stinson LF (2023) Impact of breastfeeding and other early-life factors on the development of the oral microbiome. Front. Microbiol. 14:1236601. doi: 10.3389/fmicb.2023.1236601
Shrestha, S.K.; Arora, A.; Manohar, N.; Ekanayake, K.; Foster, J. Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. Nutrients 2024,16,1355. https://doi.org/ 10.3390/nu16091355
Samani, D., Ziaei, S., Musaie, F., & Mokhtari, H. (2024, July 12). Maternal smoking during pregnancy and early childhood dental caries in children: a systematic review and meta-analysis. National Institute of Health.
Silk, H. Douglass, A., Douglass, J., Silk, L. (2008, April 15). Oral Health During Pregnancy. Am Fam Physician. 2008;77(8):1139-1144.
Younger Meek, J., & Noble, L. (2022, June 27). Policy statement: Breastfeeding and the use of human milk | pediatrics | American Academy of Pediatrics. https://publications.aap.org/pediatrics/article/150/1/e2022057988/188347/Policy-Statement-Breastfeeding-and-the-Use-of?autologincheck=redirected(opens in new tab)
National Institute of Dental and Craniofacial Research. Oral Health in America: Advances and Challenges. National Institutes of Health, Dec. 2021, https://www.nidcr.nih.gov/research/oralhealthinamerica. Accessed 29 July 2026(opens in new tab)