الفهرس 
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Abstract
Early childhood caries (ECC) is a serious oral health condition that affects a large number of young children. If untreated, ECC can lead to serious health problems, significant pain, interference with eating, overuse of the emergency room, and loss of school time. Severe ECC can also affect a child’s ability to eat and grow properly, speak and communicate with others.
Several etiological factors play a significant role in the initiation and progression of the disease including children’s early feeding practices, dietary habits, level of awareness and practice of oral hygiene measures, socioeconomic status and maternal oral health,.
Breastfeeding has long been accused of being the main cause of ECC; although the cariogenicity of human milk is still the subject of some controversy. Many studies examined the association between breastfeeding and ECC; however, their findings produced conflicting results.
Subsequently, this study aimed to investigate the impact of breastfeeding and bottle feeding on the incidence of ECC and assess the acidogenic and cariogenic potential of different types of milk in terms of their effect on bacterial fermentation and growth, as well as their influence on enamel demineralization and remineralization in primary teeth.
The current study was based on 2 main phases, in the first phase, 200 children were enrolled from the Pediatric Dentistry and Dental Public Health Department clinic, Faculty of Dentistry, Ain Shams University. Subjects were recruited according to certain inclusion criteria and a written consent was signed by their parents before conducting the research. A questionnaire interview, with the children’s mothers, was done by one operator aiming at investigating the main risk factors related to ECC then children were clinically examined to assess their caries experience.
In the second (in vitro) phase of the study, the cariogenicity of breast milk and infant formula was evaluated. Based on our survey, the most commonly used formula among Egyptian children, Biomil ® 2, was used in the study. Moreover, mature human breast milk donations were collected from nursing mothers with infants of ages 12 weeks to 2 years and 10 children diagnosed with ECC were selected for saliva collection. Immediately after collection, all samples were transferred to microbiology laboratory. Salivary samples were cultured and incubated to obtain a culture of S.mutans. In the 2 groups (breast milk and infant formula), milk specimens were inoculated with S.mutans and incubated for 72 hours. Following incubation, plates were assayed for the number of colony forming units (cfus) of S. mutans. Also, the pH changes associated with bacterial fermentation were also assessed by comparing the pH of each culture plate before and after 72 hours of culture using a pH meter.
In order to assess the effect of these types of milk on the mineral content of primary teeth enamel, 24 sound primary incisor teeth were used in the study. These teeth were suspended in S.mutans suspension and incubated to achieve in vitro enamel colonization. They were then divided into 2 groups (breast milk and formula); each tooth was immersed in an individual glass bottle containing the corresponding type of milk. Milk solutions were freshly replenished every day for 1 week. After this period of time, the mineral content of each tooth was evaluated using SEM-EDXA.
Based on data from questionnaire interviews, the most common risk factors associated with the development of ECC were prolonged bottle feeding, high frequency of sugary snacks and sharing of utensils.
Microbiological testing showed that infant formula was highly cariogenic as it supported maximal bacterial growth while breast milk didn’t induce any bacterial growth. Subsequently, there was a significant DROP in culture pH in formula group and no change in pH in breast milk group. Regarding mineral content, breast milk enhanced remineralization by an increase in mean Ca and P weight % after immersion of the teeth. Although this change was not statistically significant, there was a significant increase in mean Ca/P ratio. On the other hand, demineralization occurred in formula group by a significant decrease in mean Ca and P weight %.