Table 2 Characteristics of articles studying the relationship between breastfeeding and malocclusion in primary dentition.
Author (year) Type of study | N (dropouts) % gender (n) Mean age Sample selection Setting | Results | Odds Ratio | Quality Newcastle Ottawa Scale |
|---|---|---|---|---|
Agarwal et al.23 (2016) Cross-sectional | 415 (-) 54.9% M (228) 45.1% F (187) 4–6 years Consecutive India | Exclusive breastfeeding for up to 6 months has twofold increased probability of developing nonspaced dentition | Exposure: breastfeeding for up to 6 months, Event: nonspaced dentition, OR 1.92 (1.28–2.88) | 4 |
Germa et al.24 (2016) Prospective | 422 (612) 50% M (212) 50% F (212) 3 years Consecutive France | Breastfeeding duration not associated with posterior crossbite. Anterior openbite more frequent in children breastfed for up to 6 months | — | 5 |
Feldens et al.32 (2016) Cross-Sectional | 1026 (5.4%) 52% M (534) 48% F (492) 2–5 years Consecutive Brazil | Greater distocclusion in children with shorter duration of breastfeeding | Exposure: breastfeeding for up to 6 months, Event: malocclusion, OR 1.63 (CI 1.32–2.03) | 4 |
Lopes-Freire et al.7 (2015) Cross-Sectional | 275 (-) 52.4% M (144) 47.6% F (131) 3–6 years Consecutive Spain | No significant association between breast or bottle feeding and malocclusion (p > 0.05). No association between duration of breast or bottle feeding and malocclusion. | Exposure: exclusive breastfeeding, Event: malocclusion, OR 1.37 (CI 0.34–5.51) p = 0.739 | 5 |
Peres et al.10 (2015) Prospective cohort | 1123 (3108) 52.4% M (588) 47.6% F (535) 5 years Consecutive Brazil | Predominant breastfeeding (WHO) is related to less openbite, overjet and moderate-severe malocclusion (p = 0.019). Pacifier modifies associations. So does breastfeeding for overjet or posterior crossbite. Less openbite in children with 3 to 6 months’ breastfeeding (44%) | — | 6 |
Chen et al.9 (2015) Cross-sectional | 734 (113) 54.2% M (398) 45.8% F (336) 4.48 ± 0.84 years Consecutive China | Breastfeeding for up to 6 months related to more posterior crossbite (OR: 3.13) (p = 0.031) and absence of spaces in upper arch (OR 1.63). More NNSH in children with fewer months’ breastfeeding (p = 0.038) | Exposure: No breastfeeding/breastfed for up to 6 months, Event: posterior crossbite, OR 3.13 (CI 1.11–8.82) p = 0.031. Exposure: No breastfeeding/ breastfed for up to 6 months, Event: absence of spaces in upper arch OR 1.63 (CI 1.23–2.98) p = 0.038. | 4 |
Sum et al.29 (2015) Cross-sectional | 851 (24) 55.1% M (469) 44.4% F (378) 3.42 ± 1.10 years Cluster sampling China | Exclusive breastfeeding for over 6 months related to less Class II incisor relationship / overjet (p = 0.013) and greater intercanine and intermolar width (p = 0.006). No association with overbite or openbite. | Exposure: Exclusive breastfeeding for over 6 months, Event: Class II incisor relationship, OR 0.650 (0.438–0.966) p = 0.013. Exposure: Exclusive breastfeeding for up to 6 months, Event: Class II incisor relationship, OR 0.452 (0.277–0.739), p = 0.013. Exposure: Exclusive breastfeeding for over 6 months, Event: increased overjet, OR 0.511 (0.290–0.902) p = 0.021. | 4 |
Agarwal et al.23 (2014) Retrospective cross-sectional | 415 (x) 54.9% M (228) 45.1% F (187) 4–6 years Randomized India | Greater maxillary intermolar and intercanine distances when breastfed for over 6 months (p = 0.006). More posterior crossbite in children with up to 6 months’ breastfeeding (p = 0.001). Also more NNSH with up to 6 months’ breastfeeding. | Exposure: breastfeeding for up to 6 months, Event: digit sucking, OR 2.093 (1–4.37) p = 0.046. Exposure: breastfeeding for up to 6 months, Event: NNSH, OR 1.852 (0.073–9.03) p = 0.024. Exposure: breastfeeding for up to 6 months, Event: posterior crossbite, OR 7.304 (2.68–19.89) p = 0.001. | 4 |
Moimaz et al.28 (2014) Longitudinal cohort | 80 (40) -% M(-) -% F(-) 30 months Consecutive Brazil | Breastfeeding is related to overjet (p = 0.0001) and openbite (p = 0.002) | — | 6 |
Galan-Gonzalez et al.11 (2014) Cross-sectional | 298 (-) 45.3% M (135) 54.7% F (163) 3–6 years Representation of districts Spain | Better occlusion with breastfeeding than bottle feeding, more Class I canine, more diastemas and primate space, less crowding, less posterior crossbite, but not statistically significant (p > 0.005) | — | 4 |
Correa-Faria et al.12 (2014) Cross-sectional | 381 (-) 49.3% M (188) 50.7% F (193) 3–5 years Consecutive Brazil | With breastfeeding, more absence (69%) than presence (31%) of malocclusion. With no breastfeeding, more presence (54.8%) than absence (45.2%) of malocclusion (p = 0.007) | — | 5 |
Bueno et al.27 (2013) Cross-Sectional | 138 (-) -% M -% F 4–5 years Consecutive Brazil | Pacifiers were the factor most associated with openbite, overjet and posterior crossbite (p < 0.0001) | Exposure: Breastfeeding for over 6 months, Event: no overbite, OR 2.78 (1.074–7.246) p = 0.0314. | 5 |
Caramez da Silva et al.14 (2012) Cross-sectional in a cohort | 153 (80) 54.2% M (83) 45.8% F (70) 50 months ± 7.2. Consecutive Brazil | Breastfeeding (for over 12 months) protects against distocclusion (p < 0.001) | Exposure: Breastfeeding for over 12 months, Event: distocclusion, OR 0.44 (0.23–0.82) | 5 |
Raftowicz-Wojcik et al.6 (2011) Cross-sectional | 245 (2) -% M(-) -% F(-) 3–5 years Consecutive Poland | More openbite with breastfeeding for 0–6 months and over 12 months (p < 0.000). More overbite with breastfeeding for over 12 months (p < 0.01). More mesial occlusion with bottle-feeding | — | 3 |
Nahas-Scocate et al.13 (2011) Cross-sectional | 485 (-) 48.9% M (237) 51.1% F (248) 3–6 years Consecutive Brazil | With shorter breastfeeding duration, more likelihood of distal step (p < 0.001) | Exposure: No breastfeeding, Event: distal step, OR 3.54 p = 0.007. Exposure: breastfeeding for up to 3 months, Event: distal step, OR 4.10, p = 0.000 | 4 |
Romero et al.26 (2011) Cross-sectional | 1377 (1323) 50.1% M (-) 49.9% F (-) 3–6 years Consecutive Brazil | Breastfed children presented less openbite (p < 0.05) | Exposure: No breastfeeding, Event: openbite OR 7.10 (p = 0.000). Exposure: Exposure: breastfed for up to 6 months, Event: openbite, OR 5.35 (p = 0.000) Exposure: breastfed for 6–12 months, Event: openbite, OR 4.30 (p = 0.000) | 4 |
Massuia et al.18 (2011) Cross-sectional | 374 (14) -%M -%F 4.2 ± 0.8 years Consecutive Brazil | Exclusive breastfeeding for up to 6 months: malocclusion more prevalent.. Exclusive breastfeeding for over six months is a protective factor against overjet and anterior openbite | — | 4 |
Diouf et al.36 (2010) Cross-sectional | 226 (-) 54.42% M (123) 45.58% F (103) 5–6 years Randomized Senegal | Combination of breast and bottle feeding causes longer and deeper maxilla than breastfeeding alone. It could not be checked whether bottle-feeding alone caused these effects (P < 0.05) | — | 5 |
Kobayashi et al.22 (2010) Cross-sectional | 1377 (-) 50.1% M (690) 49.9% F (687) 3–6 years Consecutive Brazil | More posterior crossbite in children with no breastfeeding, less in those with over 12 months’ breastfeeding (p = 0.000). | Exposure: No breastfeeding, Event: posterior crossbite, OR 4.9 (compared to 6–12 months’ breastfeeding, p = 0.0000), OR 19.9 (compared to over 12 months’ breastfeeding, p = 0.0000) | 4 |
Leite-Cavalcanti et al.35 (2007) Cross-sectional | 342 (-) 57.3% M (196) 42.7% F (146) 3–5 year Randomized Brazil | NNSH less frequent in breastfed children | Exposure: Artificial (bottle) feeding versus breastfeeding, Event: malocclusion, OR 5.34 (2.89–9.85) p < 0.001. | 4 |
Peres et al.21 (2007a) Cross-sectional in a cohort | 359 (-) 53.8% M (190) 46.2% F (169) 6 years Consecutive Brazil | With few months’ breastfeeding, greater posterior crossbite (p = 0.03) | Exposure: breastfed for up to 9 months, Event: openbite, PR 1.2 (p = 0.8–1.7) Exposure: breastfed for less than 9 months, Event: posterior crossbite, PR 7.4 (1.4–38.3) | 6 |
Peres et al.25 (2007b) Cross-sectional in a cohort | 359 (-) 53.8% M (190) 46.2% F (169) 6 years Consecutive Brazil | Breastfeeding for up to 9 months related to greater openbite | Exposure: breastfed for up to 9 months, Event: openbite, OR 2.8 (1.6–4.8) p = 0.001 | 5 |
Lescano de Ferrer et al.20 (2006) Cross-sectional in a cohort | 290 (-) -% M -% F 5 years Consecutive Spain | Breastfeeding related to normal occlusion and less malocclusion. More overbite and less openbite with breastfeeding, no anterior crossbite with breastfeeding, anterior crossbite with artificial feeding. Posterior crossbite with artificial feeding, very low with breastfeeding (p = 0.06) | — | 4 |
Lopez del Valle et al.34 (2006) Cross-sectional | 540 (-) 52% F (-) 48% M (-) 28 ± 14 months Consecutive Puerto Rico | Breastfeeding associated with normal occlusion, less bottle feeding and less NNSH (p = 0.004) | — | 5 |
Viggiano et al.4 (2004) Retrospective in a cohort | 1130 (-) -% M -% F 3–5 years Consecutive Italy | Less posterior crossbite with breastfeeding, more frequent with bottle feeding (P = 0.0002) | — | 5 |
Warren et al.5 (2002) Longitudinal | 372 (328) -% M -% F 4–5 years Consecutive EEUU | No association between breastfeeding and occlusion | — | 5 |
Karjalainen et al.19 (1999) Cross-Sectional | 148 (31) 52.7% M (78) 47.3% F (70) 3 years (37.5 ± 2.2 months) Random Finland | No association between breastfeeding and openbite or overjet. Children with posterior crossbite had shorter breastfeeding period. | — | 6 |
