Purported role of human milk in early childhood caries development.

描述(申请人提供)：幼儿龋病(ECC)是婴幼儿常见的传染病。考虑到它与奶瓶喂养有关，它最初被贴上了“婴儿奶瓶龋齿”的标签。根据1977年的两份病例报告，母乳喂养可能也是龋齿发生的原因，最初更名为“哺乳龋齿”，后来更名为ECC。自从这些最初的报告发表以来，很少有研究机械地讨论母乳在龋齿发展中的作用，以及那些没有发现相关性的研究。同样，没有流行病学证据表明母乳喂养与龋齿之间存在联系，考虑到母乳对感染的保护作用、母乳中大量的抗微生物成分，以及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，这与人们的直觉不符。尽管最初的病例报告只是提示性的，随后也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警告说，不要在第一颗牙齿萌出后随意母乳喂养。这项建议的目的是全面了解母乳如何影响引起ECC的主要病原体(变形链球菌和远缘链球菌)的生存、定植和龋齿发展。在目标1中，我们将确定母乳在体外影响变形链球菌的生存能力，干扰牙釉质的附着、生物膜的形成和脱矿的能力。在目标2中，我们将使用断奶大鼠模型来研究变形链球菌在体内的定植和龋病的发展。我们将确定母乳是否单独会致龋齿，以及母乳是否可以防止蔗糖诱导的定植和龋齿发展。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，并导致抑制体外定植和生物被膜的形成。我们进一步假设，母乳不仅不会导致龋齿，而且还可以防止体内的定植、菌斑形成和感染发展为龋齿。这项研究有可能解决一方面口腔健康专家和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矛盾的看法。这项研究将补充关于母乳和龋齿发展的非常有限的可用信息，这些信息构成了目前关于母乳喂养乳牙儿童的建议。

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.