ADA expresses concern over recent study on pacifier sharing

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“A study recently published in Pediatrics…about the immunological benefits of adult saliva is limited in scope and does not take into consideration that adult saliva may also contain a variety of microorganisms which may be harmful to health,” the ADA stated May 6 in a press release.

“A child’s teeth are susceptible to decay as soon as they begin to erupt,” Jonathan Shenkin, DDS, MPH, a pediatric dentist in Maine and a pediatric dental spokesperson for the ADA said in the press release. “Cavity-causing bacteria, especially Streptococcus mutans, can be transferred from adult saliva to children that may increase their risk of developing cavities,” Dr. Shenkin said.

“Licking a pacifier, as promoted in the study, can potentially transfer cavity-causing bacteria from the parent to baby which may increase the baby’s chance of developing tooth decay as they grow,” the ADA statement continues.

Bill Hesselmar, MD, PhD, an associate professor at the Queen Silvia Children’s Hospital and the Department of Pediatrics at the Sahlgrenska Academy at the University of Gothenburg in Sweden, and colleagues reported their findings in an article published online May 6 in Pediatrics.

When asked about the ADA’s concerns, the researchers said they are not well founded. “There is no convincing evidence that ‘close salivary contact’ between parents and child [is] causally related to enhanced risk of caries,” said coauthor Agnes Wold, MD, PhD, a professor in the Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, in an email interview. “Actually, the opposite has been reported in a study: ‘close salivary contact’ is inversely related to the risk of caries development. Large meta-analysis studies show that there is no correlation at all between pacifier use, per se, and caries development.”

“We have looked quite deep into the published literature to look for the evidence that ‘transfer of cariogenic bacteria’ from parent to infant is a causative factor behind caries. We have not found any convincing evidence of causality,” Dr. Wold continued.

“It is clear that S mutans is transferred via saliva from people in the family to the baby. However, S mutans cannot establish before the teeth have erupted. This means that transfer of parental mouth bacteria prior to tooth eruption will lead to establishment of a microflora in the infant, but not of S mutans. Once the teeth erupt, there is a possibility that S mutans can colonize. The question is: Is there a greater or lesser possibility that a caries-driving microflora will establish in a child who has been exposed to parental saliva prior to tooth eruption?” Dr. Wold continued.

“We do not know this, but we know that if we have a rich normal flora in the gut, it is more difficult for a pathogenic bacterium to establish, a phenomenon called ‘colonization resistance.’ Thus, it is possible that early transfer of saliva from parent to child protects against S mutans colonization, enhances the risk of S mutans colonization, or plays no role,” Dr. Wold concluded.

Not all dentists agree with the ADA’s position either. Saliva is sometimes thought of in a negative way, but this study should help to change that, according to Joel H. Berg, DDS, president of the American Academy of Pediatric Dentistry, who commented on the controversy in an interview.

“The main point it brings to light is the fact that there are many unknown or underappreciated benefits of saliva…. It’s one of the great protectors of the body — nature’s way of protecting us against cavities, naturally cleansing the teeth, and in this case, it apparently imparts a kind of immune protective effect,” explained Dr. Berg, who was not involved in the controversial study.

“The minerals that help to heal cavities that are forming emanate from saliva,” Dr. Berg added.

“Keep an Eye on Salivary Research”

Dr. Berg cautioned that this is only 1 study, and clinicians should not be telling parents to clean their child’s pacifier by sucking it. Corroborating studies are needed, he said.

“Given that it’s the first time a study like this has shown what it showed, surely there will be other studies…to corroborate the findings,” Dr. Berg said.

“I would tell clinicians to keep an eye on salivary research,” Dr. Berg added.

 

        

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THE STUDY….

Parents who clean their baby’s pacifier by sucking on it may be protecting their infants from developing allergies, according to an article published online May 6 in Pediatrics.

Bill Hesselmar, MD, associate professor of pediatric allergology at the University of Gothenburg in Sweden, and colleagues analyzed the records of 184 infants born at Mölndal Hospital in Gothenburg whose mothers were recruited into the study. Parents kept diaries covering the first year of life for the infants, and a pediatric allergist examined the children at 18 and 36 months of age. Saliva samples were collected from infants at 4 months of age, and all pacifier cleaning practices were obtained through parental interviews.

The researchers found that children (n = 65) whose parents sucked their pacifiers to clean them before giving them to the children were less likely to have asthma (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.01 – 0.99), eczema (OR, 0.37; 95% CI, 0.15 – 0.91), and sensitization to potential allergens (OR, 0.37; 95% CI, 0.10 – 1.27) at 18 months of age than children whose parents did not suck the pacifiers (n = 58). The protective effect against eczema remained at age 36 months (hazard ratio, 0.51; P = .04).

When the researchers adjusted for delivery mode and mother’s education, they found that parents who delivered vaginally were significantly more likely to suck pacifiers than parents of cesarean-delivered infants (P = .02) and that the protective effect of pacifier sucking against eczema remained with the child during the first 18 months (OR, 0.27; 95% CI, 0.086 – 0.819; P = .02).

Children born vaginally and exposed to parental oral microbiota had the lowest prevalence of eczema, at 20%, compared with 54% for cesarean-born children not exposed to parental oral microbiota.

The evidence suggests that having their parents suck on their pacifiers and being exposed to bodily fluids during vaginal birth positively influences infants’ microbiota composition, the researchers write.

The small scale of the study may be a weakness, the researchers note, but it also may be a strength because of the detailed and structured follow-up that was possible.

"By no doubt, this habit allows for a close oral contact between parents and child," the researchers write, "facilitating bacterial transfer at a very young age, before the child starts to use spoons."

 

 

        

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