British Journal of Medicine & Medical Research

16(11): 1-6, 2016, Article no.BJMMR.27498

ISSN: 2231-0614, NLM ID: 101570965

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The Effect of Breast Feeding on Eruption of First

Primary Tooth in a Group of 6-12 Month Saudi
Children
Raghd A. M. Al-Ansari1 and Nadia M. M. Farrag2,3*
1
Intern at the Faculty of Dentistry, Taibah University, KSA.
2
Pediatric Dentistry, Taibah University, KSA.
3
Pediatric Dentistry, Mansoura University, Egypt.

Authors’ contributions

This work was carried out in collaboration between the two authors. Author RAMAA designed the
study, wrote the protocol and collect the data. Author NMMF analysed the data, managed the
literature and finalized the manuscript. Both authors read and approved the final manuscript.

Article Information

DOI: 10.9734/BJMMR/2016/27498
Editor(s):
(1) Emad Tawfik Mahmoud Daif, Professor of Oral & Maxillofacial Surgery, Cairo University, Egypt.
(2) Karl Kingsley, Biomedical Sciences and Director of Student Research University of Nevada, Las Vegas - School of Dental
Medicine, USA.
(3) Salomone Di Saverio, Emergency Surgery Unit, Department of General and Transplant Surgery, S. Orsola Malpighi
University Hospital, Bologna, Italy.
Reviewers:
(1) Abu-Hussein Muhamad, Al-Quds University, Jerusalem, Palestine.
(2) Jorge Paredes Vieyra, Universidad Autonoma De Baja California, Campus Tijuana, Mexico.
Complete Peer review History: http://sciencedomain.org/review-history/15414

Received 4th June 2016

th
Original Research Article Accepted 7 July 2016
th
Published 17 July 2016

ABSTRACT
Eruption of primary teeth is a very important indicator to assess growth and development of the
children.
Aim: The present research studied the possible influence of the breast feeding on eruption time of
first primary tooth. Also, number of erupting primary teeth in both males and females up to 12
month in relation to type of feeding has been studied.
Study Design: This is an analytic cross sectional study.
Place and Duration of Study: The present sample was selected from 4 primary health care
centers in Al-Madinah Al-Monawarah, Kingdome of Saudi Arabia (KSA) between June and July,
2015.
Methodology: A total of 100 healthy children aged between 6-12 month with mean age of
(9.26±2.90) month were selected according to cluster random sampling. A questionnaire was
_____________________________________________________________________________________________________

*Corresponding author: E-mail: nadia.farrag@hotmail.com;

 Al-Ansari and Farrag; BJMMR, 16(11): 1-6, 2016; Article no.BJMMR.27498

completed by direct interview of the children's Mothers. They were asked about the type of feeding
(Breast or bottle feeding) they practiced for their children, the eruption age of the first appearing
primary tooth in the oral cavity for their children as well as the number of erupted primary teeth.
Results: In breast feeding children the mean time of eruption for first primary tooth was (7.48±1.64)
month, while it was (7.17±1.34) month for bottle feeding with no significant difference, p=0.477.
The mean number of erupting primary incisors teeth was lower in group of breast feeding
(1.72±1.84) than those in bottle feeding (3.12±2.82) with statistical significant difference (p=0.005).
For the whole sample, the mean number of erupting teeth was not affected by the gender. It was
(1.98±2.09) for males and (2.15±2.29) for females with no significant difference, p=0.706.
Multivariable linear regression analysis demonstrated that Increase in age and bottle feeding were
predicators of number of erupted teeth.
Conclusion: In this group of Saudi Children, breast feeding had no influence on eruption time of
first primary tooth. The number of erupting primary incisors teeth was significantly lower in the
group of breast feeding than those in bottle feeding. Eruption of primary teeth was not affected by
gender.

Keywords: Breastfeeding; bottelfeeding; eruption; primary teeth; Saudi children.

1. INTRODUCTION Usually the first tooth seen in the mouth of

children with different races is the lower primary
Primary teeth, which known as (milk teeth, baby central incisor [7-13].
teeth, and temporary teeth), are the first set of
teeth in the growth development of humans. Considering breastfeeding status as a possible
They form and develop during the embryonic source of variation in the timing of emergence of
stage of development. The eruption of these primary teeth, several researches had been
teeth begins at the age of six months and conducted with different results. Some reported
continues until twenty-five to thirty-three months delayed eruption of teeth in children who were
of age [1]. not breast fed [2,5], and earlier eruption in
children with exclusive breast fed compared to
Although eruption of primary teeth is a those partially breast fed [14]. Appreciable
physiological process, it is affected by climate, associations between breastfeeding status and
race, diet, nutrition, and disease. Consequently, emergence timing and patterns of eruptions of
primary teeth emergence has been used to first primary teeth was recently reported [15]. On
assess growth and development and for age the other hand, some other researchers found
estimation in children [2]. that breast feeding did not alter the eruption time
of primary teeth [16-19].
Milk is the major nutritional source in the first
years of child life. It is beneficial for the For this inconsistent results, the present research
development of teeth and bone [3,4]. studied the possible influence of the breast
feeding on eruption time of first primary tooth.
Breast milk is an essential nutrients for the Also, number of erupting primary teeth in both
healthy teeth development. It includes calcium, males and females up to 12 month in relation to
phosphorus, and vitamins A, C, and D. Calcium type of feeding has been studied.
and phosphorus are needed to properly form the
hydroxyapatite crystals, and their levels in the 2. MATERIALS AND METHODS
blood are maintained by Vitamin D. Vitamin A is
necessary for the formation of keratin, and A cross sectional study for a sample of 100
Vitamin C is for collagen. So the deficiencies of children (55 females and 45 males) aged 6-12
these nutrients can have a wide range of effects months who came for child's vaccination into four
on tooth development [5]. For these reasons, primary health care centers in, Al-Madinah
different health care workers such as dentists, Al-Monorah, KSA were selected according to
dietitians and nursing professionals have been cluster random sampling. Inclusion criteria were:
known to give recommendations to the public, for Saudi nationality as verified by identity cards of
breast feeding and weaning (3,4). Moreover, the parents ,clinically healthy, free from any diseases
World Health Organization (WHO) recommends or disorders and not receiving any medication
to maintain breast feeding up to the second year and normal full term born child as indicated by
of the life or even longer [6]. child medical record.

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Ethical approval was sought from the research Table 1. Characteristics of the children in four
committee, Faculty of Dentistry, Taibah primary health care centers in Al-Madinah
University, KSA before starting the study. Verbal Almonawarrah/KSA (n=100)
consent was obtained from the mother of every
child after explaining the purpose of the research Variables Mean±SD or N (%)
and before collecting data. A questionnaire was Age/months 9.26 (±2.90)
completed by direct interview of the mother by Gender
the first researcher. The mother was asked about Female 55 (55.0)
the sex and type of feeding of her child (breast or
Male 45 (45.0)
bottle). Also, she was asked about the time and
Child feeding
place of erupting first primary tooth. The number
of the erupting teeth in the child mouth was Breastfed 75 (75.0)
recorded as self reported by the mother. Bottle-fed 25 (25.0)
Whole sample teeth eruption
2.1 Data Analysis Erupted 64 (64.0)
Not erupted 36 (36.0)
Descriptive statistics was undertaken to report N (%) = Number and percentages
children characteristics. Continuous data (e.g.
age of children) was reported as mean±SD. The In respect of the number of erupting teeth in both
categorical data (e.g. children's gender) was breast and bottle feeding children, bottle feeding
reported as number (N) with percentages. The group showed higher number of erupting teeth
independent t-test was used to compare the than breast feeding with statistical significant
means of continuous variables across categorical difference. The mean number of erupting teeth in
variables (e.g. number of teeth erupted for both bottle fed children was 3.12±2.82 compared to
gender). Pearson product –moment correlation 1.72±1.84 for breastfed children, P=.005 as
coefficient was run to explore the relationship shown in Table 2. This differences was
between age and number of erupted teeth. prominent among children aged 12 months
Finally, multivariable linear regression analysis where bottle-fed children were more likely to
was run to find the significant predictors of have more erupted teeth 4.20±2.39 than
number of erupted teeth in a group of Saudi breastfed children 1.18±1.63, P=.001.
children (aged 6-12 months). Only predictors with
significant level of P≤.05 considered to enter the As for gender differences, with respect to erupted
regression model. For all analyses, a P≤.05 was teeth for the whole sample (aged 6-12 months),
considered statistically significant. Data was there was no significant differences between
analyzed using the statistical package IBM SPSS male children 1.98±2.09 and female children
software, version 20. 2.15±2.29, P=0.71 and likewise at age 12 for
males 4.08±1.85 and females children
3. RESULTS AND ANALYSIS 4.71±2.58, P=0.47 (Table 2).
This study was taking over 2 months, June and Finally, it was found a strong, positive correlation
July 2015. Table 1 shows the characteristics of between increase in age and number of erupted
the present participated children. teeth (r=0.690, P=0.0001). As the child getting
older, the number of erupted teeth increased.
Lower central incisor is reported by all the
mothers as the first appeared tooth in the mouth Multivariable linear regression analysis
of their children. demonstrated in (Table 3) that Increase in age
and bottle feeding were predicators of number of
Of the whole sample, 64 children were with
erupted teeth. These two variables contributed
erupted teeth (Table 1). Regarding the influence
by 49% of the variance (R=0.71, R2 =0.49,
of type of feeding on the time of eruption of first
N=100, P=0.001).
primary tooth, statistical analysis showed no
significant difference between breast and bottle
feeding. For breast feeding children the mean 4. DISCUSSION
time of eruption for first primary tooth
was7.48±1.64 month, while it was 7.17±1.34 The emergence of first primary tooth in the oral
month for bottle feeding, P=.48 as shown in cavity of the child is of great importance to
Table 2. assess child growth and development [20,21].

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Table 2. Aspects and comparisons of erupted teeth between breast and bottle fed children

Variable †N (%) Mean±SD t P-value

First tooth eruption time/month
Breastfed 46(71.9) 7.48±1.64 0.477
Bottle-fed 18(28.1) 7.17±1.34
N (%)^
Feeding and mean number of erupted teeth among children aged 6-12 months
Breastfed infants 75(75.0) 1.72±1.84 2.86 0.005
Bottle-fed infants 25(25.0) 3.12±2.82
N (%)*
Feeding and erupted teeth among children aged 12 months
Breastfed 17 1.18±1.63 3.91 0.001
Bottle-fed 10 4.20±2.39
N (%)^
Gender and erupted teeth among children aged 6-12 months
Female 55(55.0) 2.15±2.29 0.379 0.706
Male 45(45.0) 1.98±2.09
N (%)*
Gender and erupted teeth among children aged 12 months
Female 14 4.71±2.58 0.730 0.471
Male 13 4.08±1.85
N (%)^ = The whole sample; *Sample of children aged 12 months;
†N (%) = Sample of children with the first time of erupted teeth

Table 3. Multivariable linear regression up to 12 month in relation to type of feeding has

analysis for predicators of number of erupted been investigated.
teeth
Regardless the feeding type, the results showed
Predictors Standardized 95% P-value that the first erupting primary tooth is the lower
beta confidence central incisors which agrees with all previous
coefficient interval different populations [7-13,23] including a
Age .661 0.49-0.77 0.0001 research for Saudi children [8].
Type of .154 0.04-1.50 0.038
feeding
Present study showed that the time of eruption of
first primary tooth was not influenced by the type
Nutrition is considered one of multiple factors of feeding (breast or milk) as shown in Table 2.
affecting the timing and pattern of tooth eruption
[14,17]. This result is running with several studies who
did not show effect of breast feeding on the time
Milk in different forms either breast or bottle of eruption and pattern of teeth eruption within
formula is considered the major source of the first 12 month of children life [13,16,17-19].
nutrition in the first 12 month of children's life
[3,4]. Within this period of life breast feeding may On the other hand, it contradicts the results of
be terminated, so its effect may be more Holman and Yamaguchi [2] who showed that
important during this period as shown by Martin, children who were not breastfed at all showed
[22]. delay emergence of the central incisors.
However, Aziz [11] found that the lower central
For the aforementioned reasons the present incisors erupted earlier in beast-fed group than
study adopted the age of 6-12 month. Moreover, bottle-fed group with significant difference. He
the first primary tooth is suggested to erupt within attributed his results to the nutritional advantages
this age range [10,16,23]. of the breast feeding. Moreover, Oziegbe et al.
[14], reported that exclusively breast fed children
Opinion is still unresolved regarding the role of had earlier erupting primary teeth in comparison
nutritional status in dental development to those who were partially breast fed.
[15,23,24] so, this study is carried out to clarify
the influence of the breast feeding on eruption In respect of the number of erupting teeth in both
time of first primary tooth. Also, number of breast and bottle feeding children, bottle feeding
erupting primary teeth in both males and females group showed higher number of erupting teeth

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 Al-Ansari and Farrag; BJMMR, 16(11): 1-6, 2016; Article no.BJMMR.27498

than breast feeding with statistical significant answers by the mothers), we can come to the
difference as shown in Table 2. following conclusions:

This result is surprising. Although 75% of the Breast feeding had no influence on the time
mothers positively responded to breast feeding of eruption of first primary tooth. Number of
as social desirability, they maybe actually erupting teeth within the age range of 6-12
practiced partial breast feeding with short month was lower in breast fed children rather
durations and frequencies. Meanwhile, the than bottle fed children. Eruption of primary
presence of enriched formula of bottle milk as teeth was not affected by gender. There was
well as the change in life style with increased a strong positive correlation between
consumption of junk food which is not healthy increase in age and number of erupted teeth.
and lacking a lots of vitamins and minerals may
justify this result. This result contradicts other Further study using a larger sample size
investigators who found that the number of including different districts in KSA is
erupting teeth is greater in exclusively breast fed recommended. This study would prove a useful
children [11,14,18]. At the same time, Folayan basis of comparison with other future researches.
and et al. [17] failed to find relation between
breast feeding and number of teeth erupted COMPETING INTERESTS
within the first 12 month of life. Recently, Kohli
and et al. [15] reported that only breastfeeding Authors have declared that no competing
frequencies had significant impact on timings and interests exist.
patterns of eruption than durations of breast
feeding. REFERENCES
Similar to previous study [17], age seems to play
an important role in number of erupting teeth. 1. Ash Major M, Stanley J. Nelson Wheeler’s.
th
The differences in erupted teeth was prominent 8 ed. Dental Anatomy, Physiology, and
among children aged 12 months where bottle-fed Occlusion; 2003.
were more likely to have more erupted teeth as 2. Holman DJ, Yamaguchi K. Longitudinal
shown in Table 2. analysis of deciduous tooth emergence: IV.
Covariate effects in Japanese children.
Contrary to others (17) who found age as the American Journal of Physical
only factor significantly influence the number of Anthropology. 2004;126(3):352–58.
erupted teeth, current study showed that age and 3. King NM, Hai Ming W. More milk, stronger
bottle feeding were predictors of number of teeth? (Part I). Dental Asia. 2006;17-21.
erupted teeth as shown in Table 3. 4. Valaitis R, Hesch R, Passarelli C, Sheehan
D, Sinton J. A systematic review of the
Statistical analysis showed that eruption of relationship between breastfeeding and
primary teeth in the present study was not early childhood caries. Can J Public
affected by gender as shown in Table 2. This Health. 2000;91(6):411-17.
result is in agreement with Hollman study [2] who 5. The American Dental Hygiene Association.
did not find significant sex differences in eruption Nutritional factors in tooth development.
of primary teeth. On contrary, other studies for Retrieved December 10; 2005.
different children populations reported earlier 6. World Health Organization. Dentition
eruption of primary teeth in males compared to status and criteria for diagnosis and coding
th
females in Sudanese children [13] and Saudi (Caries). 4 ed. Oral Health Surveys -
children [8]. Nepalese [25] and Indian children Basic Methods. Geneva: WHO. 1997;39-
[11,15] showed an earlier emergence of primary 44.
teeth in females compared to males. The 7. Choi NK, Yang KH. A study on the eruption
inconsistent results may be related to different timing of primary teeth in Korean children.
study populations, sample size, study designs, ASDC J Dent Child. 2001;68(4):244-9.
nutritional, climatic and racial background. 8. Al-Jasser NM, Bello LL. Time of eruption of
primary dentition in Saudi children. J
5. CONCLUSION AND RECOMMENDA- Contemp Dent Pract. 2003;4(3):65-75.
TIONS 9. Singh K, Gorea RK, Bharti V. Age
estimation from eruption of temporary
Within the limitations of this cross sectional study teeth. J Indian Academy of Forensic
(small sample's number and self reported Medicines. 2004;26(3):107-9.

5
 Al-Ansari and Farrag; BJMMR, 16(11): 1-6, 2016; Article no.BJMMR.27498

10. Oziegbe EO, Adekoya-Sofwora CA, Esan 18. Patrinova ME, Kroll CD, Berzin F.
TA, Owotade FJ. Eruption chronolgy of Sequence and chronolgy of eruption of
primary teeth in Nigerian children. J Clin deciduous teeth in children from Itajai city.
Paediatr Dent. 2008;32:341-5. Rev Sul-Bras Odontol. 2010;7(4):406-13.
11. Aziz HK. Age estimation of first deciduous 19. Folayan MO, Sowole CA. Association
tooth and sequence of Erupion for the between breast feeding and eruption of the
primary dentition in relation to the nursing first tooth in preschool children in Nigeria.
habits among the kerbala children. J of Eur J Paediatr Dent. 2013;14(1):51-4.
Kerbala University. 2010;8(3):12-19. 20. ADA Division of communications ADA
12. Soliman NL, Zainy MH, Hassan RM, Aly council on scientific affairs. For the dental
RM. Timing of deciduous teeth emergence patient. Tooth eruption: The primary teeth.
in Egyptians. East Medit Health J. 2011; J Am Dent Assoc. 2010;136:1619.
17(11):875-881. 21. Woodroffe S, Mihailidis S, Hughes T,
13. Eid EA, Abo Affan AH. Time and sequence Bockmann M, Seow WK, Gotjamanos
of eruption of primary teeth in relation to T, et al. Primary tooth emergence in
breast feeding in Sudanese children. Braz Australian children: Timing, sequence and
Dent Sci. 2014;17(3):67-73. patterns of asymmetry. Aust Dent J.
14. Oziegbe EO, Adekoya-Sofowora, Esan TA, 2010;55:245-51.
Owotade FJ, Folayan MO. Breast feeding 22. Martin Moreno V, Molina Cabeizo MR,
pattern and eruption of primary teeth in Gomez C. Relationship among the
Nigerain children. Ped Dent J. 2010;20: eruption of the first temporal teeth, the
1-6. breast feeding duration and the
15. Kohli MV, Patil GB, Kulkarni NB, Bagalkot anthropometric development in the first two
K, Purohit Z, Dave N, Sagari SG, years of life. Nutr Hosp. 2006;21:362-8.
Malaghan M. A changing trend in 23. Vejdani J, Heidarzade A, Ebrahimi SM.
eruption age and pattern of first deciduous Eruption time of the first primary tooth and
tooth: Correlation to feeding pattern. J of its relationship with growth parameters in
Clin and Diag Research. 2014;8(3): children. Journal of Dentomaxillofacial
199-201. Radiology, Pathology and Surgery.
16. Folayan M, Owotade F, Adejuyigbe E, Sen 2015;3:4. Winter
S, Lawal B, Ndukwe K. The timing of 24. Gran SM, Russeii AL. The effects of
eruption of the primary dentition in Nigerian nutritional extremes on dental
children. American Journal of Physical development. Am J Clin Nutr. 1971;24:
Anthropology. 2007;134(4):443-48. 285-286.
17. Folayan MO, Oziegbe EO, Esan AO. 25. Gupta A, Hiremath SS, Singh SK, Poudyal
Breastfeeding, timing and number of S, Niraula SR, Baral DD, et al. Emergence
erupted teeth in first twelve months of life of primary teeth in children of Sunsary
in Nigerian children. Eur Arch Paediatr district of Eastern Nepal. Mcgill J Med.
Dent. 2010;11:279-82. 2007;10(1):11-15.
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