Purported role of human milk in early childhood caries development.

描述（由申请人提供）：幼儿龋齿（ECC）是婴幼儿中常见的传染病。它最初被称为“奶瓶蛀牙”，因为它与奶瓶喂养有关。根据1977年的两个病例报告，母乳喂养也可能导致龋齿的发展，最初的名称改为“护理龋齿”，后来改为ECC。自从这些最初的报告出现以来，很少有研究机械地解决母乳在龋齿发展中的作用，那些没有发现任何关联的研究。同样，没有流行病学证据表明母乳喂养与龋齿之间存在关联，这与直觉不符，因为母乳喂养可以防止感染，母乳中含有大量抗菌成分，在按需母乳喂养通常持续18至36个月的文化中，儿童的龋齿频率可以忽略不计。尽管最初的病例报告仅仅是提示性的，并且随后缺乏将母乳喂养与龋齿发展联系起来的证据，但美国儿科牙科学会和一些儿科口腔健康专家仍然警告不要在第一颗牙齿萌出后随意母乳喂养。本提案的目的是全面了解人乳如何影响ECC主要病原体（变形链球菌和远缘链球菌）产生的活力、定植和龋齿发展。在目标1中，我们将确定人乳影响变形链球菌活力的能力，以干扰体外牙釉质的粘附、生物膜形成和脱矿。在目标2中，我们将采用断乳大鼠模型来研究变形链球菌在体内的定植和龋齿的发展。我们将确定单独的人乳是否是致龋的，以及人乳是否可以防止蔗糖诱导的定植和龋齿的发展。我们推测，母乳的抗微生物活性将无法支持变形链球菌的生长，并导致体外定植和生物膜形成的抑制。我们进一步假设，人乳不仅不能引起龋齿，而且还可以防止体内定植、牙菌斑形成和蛀牙感染的进展。这项研究有可能解决一方面口腔健康专家和另一方面美国儿科学会和医学研究所对母乳喂养和儿童口腔健康的相互冲突的意见。这项研究将补充非常有限的关于母乳和龋齿发展的信息，这些信息形成了目前对乳牙母乳喂养儿童的建议。

DESCRIPTION (provided by applicant): Early childhood caries (ECC) is a common infectious disease among infants and toddlers. It was initially labeled "baby-bottle tooth decay" given its association with bottle-feeding. Based on two case reports in 1977 that breastfeeding may also be responsible for caries development, the name changed initially to "nursing caries" and later to ECC. Since these initial reports appeared, few studies have mechanistically addressed breast milk's role in caries development, and those that have found no association. Similarly, there is no epidemiological evidence for an association between breastfeeding and caries, which would be counterintuitive given breastfeeding's protection against infection, human milk's numerous antimicrobial components, and the negligible caries frequency among children in cultures where breastfeeding on demand typically continues for 18 to 36 months. Despite the merely suggestive nature of the original case reports and the subsequent lack of evidence linking breastfeeding to caries development, the American Academy of Pediatric Dentistry and some pediatric oral health experts nevertheless cautions against ad libitum breastfeeding after eruption of the first teeth. The objective of this proposal is to develop a comprehensive understanding of how human milk affect viability, colonization and caries development produced by the major pathogens responsible for ECC (Streptococcus mutans and Streptococcus sobrinus). In Aim 1, we will determine the ability of human milk to affect viability of mutans streptococci, to interfere with adherence to, biofilm formation on, and demineralization of enamel in vitro. In Aim 2, we will employ a weanling rat model to investigate colonization of mutans streptococci and caries development in vivo. We will determine whether human milk alone is cariogenic and whether human milk can protect against sucrose-induces colonization and caries development. We hypothesize that the anti-microbial activity of human milk will fail to support growth of mutans streptococci and causes inhibition of colonization and biofilm formation in vitro. We further hypothesize that human milk not only fails to cause caries but also that it protects against colonization, plaque formation and the progression of infection to tooth decay in vivo. This study has the potential to resolve the conflicting opinions held about breastfeeding and oral health in children by on the one hand oral health experts and on the other hand the American Academy of Pediatrics and The Institute of Medicine. The study will augment the very limited available information about human milk and caries development that shape current recommendations on breast-feeding children with deciduous teeth.