Breast milk is the ideal food for infants, providing all nutrients and antibodies that they require . Feeding with human breast milk is considered to be the single most important preventive intervention for infant survival. In developing countries, exclusive breastfeeding for the first six months of life has been estimated to prevent 13% of deaths each year in children less than 5 years old . Breastfeeding is defined as exclusive when no other supplement, such as water, juice, non-human milk, or food, excepting drugs, vitamins and minerals, is administered to the infant .
The association between socio-economic factors like maternal age, maternal education level, household income, mean cost of the housing in the area where the family lives and infant feeding practice are complex and may be even interrelated; in addition, the relations identified in bivariate analysis may not hold in multiple analysis and new association may be uncovered. Moreover, it is really tricky to capture the material and financial aspects of SES. An inverse association is also reported: the duration of breastfeeding was referred to be the highest among the mothers of the lower income group followed by mothers from the upper income groups . Another study reports that mothers with a higher level of education started breastfeeding and more continued for the first 2 months after birth . The literature on the determinants of breastfeeding has [3–5] consistently identified maternal smoking as predictor of lower breastfeeding rates. Babies whose mothers reported smoking during pregnancy were less likely to be breastfed [6, 7]. Moreover, the development of caries in children may be associated with prenatal maternal smoking and postnatal environmental smoke exposure [8–11]. Maternal smoking during pregnancy appears to be a proxy for the mother’s unhealthy diet and poor oral hygiene practices [9–11].
Despite great efforts and achievements in oral health promotion, caries remains a major childhood health problem . In Italy, as in the majority of industrialized countries, recent data have revealed that caries is distributed unevenly, with the highest burden evident in underprivileged groups [13, 14]; this situation highlights the need for novel complementary strategies in caries prevention efforts.
The term early childhood caries (ECC) encompasses any form of caries occurring in infants, toddlers and preschool-aged children . The pattern of caries in toddlers aged 12–30 months is specific. Current evidence suggests that the practice of nocturnal bottle-feeding with beverages containing sugar is the most important etiological factor in caries development . Interactions among social, behavioral and microbiological factors, including several risk factors, also contribute to this process [13–18]. Epidemiological data focusing on ECC prevalence in toddlers are scarce . An association between ECC and breastfeeding has been proposed, especially when breast milk is consumed ad libitum, in several daytime and nocturnal intakes, over a prolonged period . Milk residues that accumulate in the mouth, promote caries development, especially during the night, when the salivary flow rate is reduced; however, the results of studies examining this association have been inconclusive [18, 19].
Milk and milk products contain nutrients, such as calcium, phosphate, casein, and lipids, with potential anti-caries properties . In Italy, the daily consumption of milk was associated with a lower prevalence of caries in schoolchildren with no fluoride supplementation and poor oral hygiene . However, studies of the association between dairy product intake and dental caries in young children have been rare, and the results have been inconsistent [21, 22].
The aim of this retrospective study was to investigate the potential association between feeding practices, maternal and environmental smoking exposure and SES as risk factors for caries development in toddlers aged 24–30 months.