Dental: Baby Bottle Tooth Decay

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Early childhood caries, also known as, “baby bottle tooth decay" is the severe decay of the baby teeth of infants and young children.  It is called baby bottle tooth decay, but frequent, long-lasting feedings, especially at night, can cause it, too.

What Causes Baby Bottle Decay

When liquid that contains sugar (such as breast milk and formula) is given at nap time or bedtime, the sugar stays on the teeth.  Bacteria (germs) in the mouth turn the sugar in these liquids into acid. The acid eats away at the enamel (the outer coating of the teeth) and tooth decay begins. The enamel of baby teeth is thinner than the enamel of permanent teeth. This makes it easier for the acid to destroy the teeth.

During the day, saliva in the mouth helps wash away some of the sugary liquid from the teeth.This helps a little but you still need to brush or clean the teeth. At nap time or at night the flow of saliva slows down and the baby swallows less often. Bacteria have more time to work on the sugars to produce the acid that causes decay.

The upper front teeth and first molars are damaged first. The lower front teeth are not usually hurt.

Why Healthy Baby Teeth Are Important

It is important to keep baby teeth clean and healthy because baby teeth:

  • Make eating and chewing easier.
  • Help form the shape of the child's face.
  • Make it easier for the child to talk more clearly.
  • Hold spaces open for the permanent (adult) teeth to come in.

Tooth decay causes:

  • Mouth pain and discomfort.
  • Need for costly dental care.
  • Damage to the permanent teeth underneath the gums.
  • Loss of the space needed for permanent teeth to come in.
  • Missing school or needing emergency care.
  • Infections that can affect the child's total health.

How to Prevent Tooth Decay

clean childs mouth well once a day

  • Clean your baby's teeth after each bottle or Breast Feeding and after giving any medicine or cough syrup that contains sugar (Picture 1).
  • Don't put liquids that contain sugar in your child's bottle when you put him to bed for nap time or at night.  It's best never to give a baby a bottle in bed.
  • Don't let your child fall asleep while nursing from either the breast or bottle (especially at night).
  • Don't use the bottle as a pacifier.
  • Sucking is a natural need for all babies. If your baby seems to need more time for sucking after being fed, give him either a pacifier or a bottle of plain water.

For Bottle-fed Babies

  • Don't give your baby milk or other sweetened liquids at bedtime.
  • Avoid bedtime or nap time feedings (longer than 30 minutes).
  • Don't use a bottle as a pacifier.
  • Use the bottle for feedings only.
  • For toddlers, other liquids should be given in a cup.
  • Wean your baby from the bottle to a cup by 12 months of age.

For Breast-fed Babies

  • Avoid feedings that last more than 30 minutes.
  • Avoid all-night feedings. And don't let baby go to sleep while nursing.
  • Avoid frequent, on-demand feedings.

Cleaning Your Child's Mouth

always support child's head when cleaning teeth

Even before the teeth begin to come in, clean baby's mouth at least once a day with a clean gauze pad or soft cloth (Picture 2).  This should become a regular habit. 

  1.  Depending on your child’s age, use one of these methods to clean the teeth and gums:

    -Hold an infant on your lap and support the head with your hand so you can see easily into the mouth

    -With the child seated in a high chair, stand behind him and brush the teeth. (Picture 1).

    -Sit on a sofa with your child's head in your lap (or, if someone is helping you, place the child's head in your lap with his feet toward your helper).

  2. Place a clean gauze pad or soft cloth over your finger. Dip it in water so that it's damp but not soaking wet. Wipe the child's teeth and gums gently.

  3. When the child's teeth start coming in, begin to use a small, soft toothbrush to brush his teeth. Be sure to brush all surfaces of the teeth, including the gums.
  4. You don’t need to use toothpaste, but if you do, use a small amount of fluoride toothpaste (about the size of a small pea).
  5. Children should be able to brush their teeth by themselves by age 11. Until then, parents should watch or help, based on their child’s abilities.

If you have any questions, be sure to ask you dentist or doctor, or call the Dental Clinic at (614) 722-5650.

Dental: Baby Bottle Tooth Decay (PDF)

HH-IV-12 11/84, Revised 7/10 Copyright 1984-2010, Nationwide Children's Hospital