Baby Bootle Tooth Decay

Early childhood caries, often referred to as baby bottle tooth decay or nursing bottle caries, results from allowing infants to drink from a bottle containing fermentable carbohydrates, such as juice or milk, for prolonged periods of time. This preventable disease occurs between one and three years of age, develops rapidly, and can cause severe dental pain and infection.

In children allowed to fall asleep while sucking on a bottle, the sweetened liquid pools around the teeth, initiating the demineralization of enamel. This action, combined with diminished salivary flow during sleep, leads to decay of the primary teeth. Early childhood caries also puts a child at greater risk for future dental caries.15

Early signs of baby bottle tooth decay are white spot lesions on the gingival one-third of the maxillary front teeth.5 Within six months, these lesions may progress to a dull white band of demineralization along the gingival margins of the upper incisors and, if the disease advances further, the four maxillary incisors may be completely destroyed. In advanced stages, the maxillary and mandibular molars and canines also may be involved.

Prevention involves educating parents before the child’s primary teeth erupt. Education in the dental office can begin when a pregnant woman receives her routine dental care. All caregivers of infants— parents, grandparents, day care providers—should be counseled on appropriate feeding practices. Nap or nighttime bottle feeding in bed should be discouraged. If a child is offered a bedtime bottle, the only safe liquid is water. Similarly, breast-fed infants should be removed from the breast when they fall sleep.

Fruit juices should not be offered before six months of age and should only be offered in a cup.16 When fruit juice is served, it should be part of a meal or snack. Younger children should not be allowed to sip juice throughout the day. Fruit juice can be offered as one serving (four to six ounces) of the recommended two servings from the fruit group for young children (one to four years) each day. Besides promoting dental caries, high intakes of juice in young children can contribute to diarrhea, malnutrition, and short stature.16