Baby Bottle Caries & Breastfeeding

One serious form of decay among young children is baby bottle tooth decay. This condition is caused by frequent and long exposures of an infant's teeth to liquids that contain sugar.

Baby Bottle Tooth Decay (BBTD) also known as Early Childhood Caries (ECC) is a disease that causes severe rapid decay of baby teeth.

Among these liquids are milk (including breast milk), formula, fruit juice and other sweetened drinks. Putting a baby to bed for a nap or at night with a bottle other than water can cause serious and rapid tooth decay. Sweet liquid pools around the child's teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel. If you must give the baby a bottle as a comfort at bedtime, it should contain only water. If your child won't fall asleep without the bottle and its usual beverage, gradually dilute the bottle's contents with water over a period of two to three weeks.

It usually affects the upper front teeth of infants and toddlers who fall asleep with a bottle of milk, formula, fruit juices, or any sweetened liquid. Lower front teeth are in general less affected since they are covered by the tongue. The process of tooth decay is the result of teeth being exposed for long periods of time to liquids containing sugars. The cavities first appear at the gum line as subtle, white, decalcified streaks. The process then begins to accelerate. In advanced cases, the crowns of the four upper incisors are completely destroyed, leaving decayed brownish-black stumps. By this time, baby teeth may either require crowns, root canal therapy, or even extraction.

Prolonged and unrestricted nighttime breastfeeding is also a cause of nursing decay. However, breastfeeding is associated with a low risk of developing tooth decay, compared with bottle feeding. Nevertheless, breast milk does contain sugars, and some infants who breastfeed for long periods throughout the day or night may develop tooth decay. Although we encourage breastfeeding, to reduce the likelihood of nursing decay, infants should be removed from the breast when they finish feeding and have their front teeth wiped with a damp cloth. Additionally, it is now recognized that mothers are the most common source of transmission of decay causing bacteria to their infants. Babies are not born with the bacteria that cause decay. Instead their mouth becomes "infected" from their mother's saliva through food-tasting, pacifier-cleaning, and kisses.

Since some medications are more than 50% sugar, they can also cause cavities to form. Be sure to have your child rinse or brush after taking medications.

Avoiding "Baby Bottle Caries"

As mentioned above, milk contains sugars that can cause decay. For this reason, tooth decay is common in young children but can be avoided by following a few tips:

  • Avoid giving milk or other drinks in the bottle at night.
  • Avoid nursing children to sleep.
  • Do not put honey or sugar on pacifiers.
  • Avoid "at-will" breast feeding once the first teeth have erupted.
  • Start dental visits by your child's first birthday.
  • Start to teach your child to drink from a cup at about six months of age. Plan to stop using a bottle by 12 to 14 months at the latest.
  • Try not to let your child walk around using a bottle of milk or juice as a pacifier.
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