Purported role of human milk in early childhood caries development.

描述（申请人提供）：幼儿龋齿（ECC）是婴幼儿常见的感染性疾病。它最初被标记为“婴儿奶瓶蛀牙”，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，名称最初改为“哺乳龋齿”，后来改为ECC。自从这些最初的报告出现以来，很少有研究从机制上解决母乳在龋齿发展中的作用，有些研究没有发现两者之间的联系。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，鉴于母乳喂养可以防止感染，人乳含有大量抗菌成分，而且在按需母乳喂养通常持续18至36个月的文化中，儿童龋齿的发生率可以忽略不计，这将是违反直觉的。尽管最初的病例报告仅仅具有暗示性质，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说，在第一颗牙齿长出来后不要随意母乳喂养。本提案的目的是全面了解母乳如何影响ECC的主要病原体（变形链球菌和sobrinus链球菌）产生的生存能力，定植和龋齿发展。在目的1中，我们将确定母乳对变形链球菌生存能力的影响，以及对体外牙釉质粘附、生物膜形成和脱矿的影响。在第二阶段，我们将采用断奶大鼠模型来研究变形链球菌的定植和体内龋齿的发展。我们将确定单独的母乳是否会导致龋齿，以及母乳是否可以防止蔗糖诱导的定植和龋齿的发展。我们假设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，母乳不仅不会导致龋齿，而且还可以防止体内菌斑的定植、形成和感染蛀牙的进展。这项研究有可能解决口腔健康专家和美国儿科学会和医学研究所关于母乳喂养和儿童口腔健康的相互矛盾的观点。这项研究将增加关于母乳和龋齿发展的非常有限的现有信息，这些信息形成了目前对乳牙儿童母乳喂养的建议。

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.