Effect of Cow’s Milk Protein Allergy on the Frequency of Dental Caries in 2–6-year-old Children
Abstract
Cow’s milk protein allergy is the most common type of food allergy in the first year of life, in which the child’s dairy consumption should be limited, and it can have a significant impact on dental health. This study aimed to assess the frequency of dental caries in children with cow’s milk protein allergy and t to examine he relationship between this outcome and cow’s milk protein allergy.
In this matched case-control study, 51 children aged 2 to 6 years with cow’s milk protein allergy, and 51 healthy children were studied in 2 groups. A questionnaire regarding general information, socioeconomic status, health conditions, habits, nutritional information, dental history, and oral hygiene was completed for all children by asking their parents. Dental examinations were also performed, and the decayed, missing, and filled teeth (dmft) index was calculated. The Wilcoxon signed-rank and McNemar tests were used for statistical analyses, at a significance level of 0.05.
The mean dmft score was 5.74±5.55 in children with cow’s milk protein allergy and 1.92±2.55 in the control group. A significant relationship existed between cow’s milk protein allergy and increased frequency of dental caries. Also, the number of caries-free children was significantly lower in the group with cow’s milk allergy.
Given the significant impact of dairy consumption in the early years of life on dental health, it seems necessary to implement more serious caries prevention measures, such as fluoride therapy and follow-up sessions, in children with cow’s milk protein allergy.
2. Shoaee S, Saeedi Moghaddam S, Masinaei M, Sofi-Mahmudi A, Hessari H, Heydari MH, et al. 2022. Trends in dental caries of deciduous teeth in Iran: a systematic analysis of the national and sub-national data from 1990 to 2017. BMC Oral Health. 23;22(1):634.
3. Abudrya MH, Alkizy M, Bakhshandeh A, Dige Irene, Dommisch H, Duijster D, et al. Innovations in preventive dentistry. 1th ed. Quintessence publishing, Deutschland; 2021: Chapter 1.
4. Hao L, Wang S, Ji W. Cow's milk protein allergy: A comprehensive review of epidemiology, pathogenesis, clinical manifestations, diagnostics, and management strategies. Asia Pac J Clin Nutr. 2025;34(3):298-307.
5. Pourpak Z, Farhoudi A, Arshi S, Movahedi M, Gharegozlou M, Yazdani F, et al. Common Food Allergens in Iranian Children. Iranian J Med Sci. 2015;28(1):17-22.
6. Vitaliti G, Cimino C, Coco A, Praticò AD, Lionetti E. The immunopathogenesis of cow's milk protein allergy (CMPA). Ital J Pediatr. 2012;38:35.
7. He M, Hu J, Deng J, Chen X, Liu C, Olatunji OJ, Suttikhana I, et al. Cow milk allergy: Its clinical aspects, mechanisms, and innovative mitigation strategies beyond enzymatic hydrolysis. J Functional Foods. 2025;130:106933.
8. Neville MC, Keller RP, Casey C, Allen JC. Calcium partitioning in human and bovine milk. J dairy Sci. 1994;77(7):75-1964.
9. Vitiello F, Bourgeois D, Orilisi G, Orsini G, Carrouel F. Non-Cariogenic Effect of Milk and Dairy Products on Oral Health in Children and Adolescents: A Scoping Review. Children. 2024;11(2):149.
10. Kooshki F, Moshref M, Ghorbani Z, Molaasadollah F. Investigating the relationship between the consumption pattern of dairy products and early tooth decay among 6-year-ago children at elementary schools in Districts 3 and 5 of Tehran. Yafte. 2024; 25(4):99-111.
11. Faezi M, Farhadi S, NikKerdar H. Correlation between DMFT, diet and social factors in primary school children of Tehran-Iran in 2009-2010. J Mashhad Dental school. 2012;36(2):8-141.
12. Mahmodian J, Naghavi, Nekoie H. Evaluation of the relationship between milk consumption and dental caries in 3-5 years old children in Ray city. J Dent Med-tums. 1994;7(2):10-8.
13. Altan H, Cosgun A, Altan A. Cow’s Milk Protein Allergy in Pediatric Dentistry: A Narrative Review. J Ped Rev. 2019;7(1):6-11.
14. Moimaz SA, Amaral MA, Garbin CA, Saliba TA, Saliba O. Caries in children with lactose intolerance and cow's milk protein allergy. Braz Oral Res. 2018;32.
15. Andersson-Wenckert I, Blomquist HK, Fredrikzon B. Oral health in coeliac disease and cow's milk protein intolerance. Swed Dent J. 1984;8(1):9-14.
16. Malekiantaghi A, Aghajani M, Shabani-Mirzaee H, Vigeh M, Eftekhari K. Growth in healthy infants with cow's milk protein allergy fed extensively hydrolyzed or amino acid-based formulas. BMC nutrition. 2024;10(1):101.
17. Sadeghi Shabestari M, Siahsangi P, Rafeey M, Hosseinpour Sarmadi M, Habibi P. The survey of clinical manifestations of infants with cow’s milk allergy according to the COMISS questionnaire. Med J Tabriz Uni Med Sciences Health Services. 2021;42(6):659-66.
18. Khakpour M, Moazzen N, Khakshour A, Norouzi Asl S, Talebi S, Kianifar H. Growth Pattern Investigation in Cow’s Milk Allergic Proctocolitis in Those Who are Under Elimination Diet. Int J Pediatr 2020; 8(11):12455-460.
19. Karami H, Borna S, Hosseinzadeh F, Mahmoodi E, Lashtoo Aghaee B, Rezai MS. Using Probiotics in Infants with Cow’s Milk Allergy: A Randomized Clinical Trial. J Pediatric Perspectives. 2021;9(12):15067-75.
20. Ahanchian H, Nouri Z, Jafari SA, Moghiman T, Amirian MH, Ezzati A, et al. Synbiotics in children with cow's milk allergy: a randomized controlled trial. Iranian J pediatrics. 2014;24(1):29.
21. Coelho MA. ICDAS and dmft/DMFT. Sensitivity and specificity, the importance of the index used: a systematic review. Journal of Dentistry & Public Health (inactive/archive only). 2020 Nov 3;11(2):176-87.
22. Linnett V, Seow WK, Connor F, Shepherd R. Oral health of children with gastro‐esophageal reflux disease: a controlled study. Aust Dental J. 2002;47(2):156-62.
23. Ersin NK, Önçağ Ö, Tümgör G, Aydoğdu S, Hilmioğlu S. Oral and dental manifestations of gastroesophageal reflux disease in children: a preliminary study. Pediatric dentistry. 2006;28(3):279-84.
24. Smutkeeree A, Rattanapakdeekul N, Lapirattanakul J, Tosrisawatkasem O, Surarit R. Cariogenic potential of lactose-free infant formulas: An in vitro analysis of Streptococcus mutans biofilm and acidogenicity. J Int Soc Prevent Communit Dent. 2025;15:265-74.
25. Rattanapakdeekul N, Lapirattanakul J, Tosrisawatkasem O, Surarit R, Smutkeeree A. Evaluation of Streptococcus mutans biofilm formation and acidogenicity of infant milk formulas for treating cow milk allergy: An in vitro study. Caries Res. 2024;58(5):478-87.
| Files | ||
| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| Child Cow’s milk protein allergy Dental caries Hypersensitivity | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |

