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Clinical Reference Systems: Pediatric Advisor 10.0

Baby Bottle Tooth Decay: Prevention


Baby bottle tooth decay (BBTD) is the main type of tooth decay in infants. Infants that are allowed to have a bottle in bed or older toddlers that are allowed to carry around a bottle during the day are at risk for this type of tooth decay.

Although the decay can start soon after your child's baby teeth appear, the problem is often not noticed until about 1 year of age. The earliest sign is white spots on the baby teeth. The upper front teeth (incisors) are usually damaged first.


Tooth decay occurs when sugar in liquids is in contact with the teeth for a prolonged time. Milk, formula, juice, Kool-Aid, and soft drinks all contain sugar. If a child falls asleep with a bottle in the mouth or constantly drinks from a bottle during the day, the sugar coats the upper teeth. The normal bacteria in the mouth change the sugar to an acid. The enamel (protective coating) of baby teeth is only half the thickness of an eggshell. The acid gradually dissolves the enamel and allows decay to occur in the teeth.

The availability of plastic bottles instead of glass bottles has led many parents to be less concerned about giving their infant a bottle. Leaving a baby with a bottle of formula or juice may be used as a quick way to help a child go to sleep at night or deal with middle-of-the-night crying. The bottle may also come in handy when dealing with fussiness during the day. Many parents are unaware that these kinds of bottle habits can lead to tooth decay problems.


Dental repair of BBTD requires general anesthesia. If the problem is detected at an early level, the teeth can be covered with stainless steel caps. If the decay is severe, the decayed teeth will need to be pulled out.

Expected Outcome

If BBTD is not discovered and treated, decay will eventually destroy the teeth and they will break off at the gumline. The decay will continue to destroy the root of the tooth and cause ongoing pain.

If the child has teeth pulled, he may have the following problems:

  • The child will then have to chew with the teeth on the side of the mouth.
  • He may get teased about the missing teeth.
  • The permanent teeth may come in crooked or be crowded because the baby teeth are no longer there to save the appropriate space.

How to Protect Your Child from Baby Bottle Tooth Decay

  1. Never give your infant a crib bottle. Don't bottle-feed your baby until he falls asleep. This is the most common cause of bottle dependency and will eventually cause sleep problems because your child will expect a bottle as a transition into sleep, even following normal awakenings during the night. Separate the last bottle- feeding of the evening from bedtime. Even though baby teeth don't start coming in until 6 months, don't start a bad habit. In general, don't allow your infant to ever think that the bottle belongs to him. He won't voluntarily give it back.

  2. Don't allow your infant to have a tote or companion bottle during the day. Don't substitute a bottle for a pacifier, security object, toy, or being held. Give a bottle only during mealtimes.

  3. Introduce a cup by 6 months of age. Introducing a cup is the best way to prevent bottle dependency. Don't expect a child to start weaning himself unless he has been exposed to a cup. Also don't expect weaning to occur in 1 day or 1 week. It takes gradual exposure to a cup over 3 months or longer for a child to learn to prefer the cup over the bottle.

  4. If your infant has developed a bottle habit, continue to give him the bottle, but fill it only with water. Water cannot harm tooth enamel. Water is also boring and will help your child eventually give up the bottle. The bottle itself is not harmful.

Call Your Physician's Office During Normal Hours If:

  • Your child cannot give up the bottle.
  • You see white spots on the baby teeth.
  • You think your child might have BBTD.
  • You have other questions or concerns.

Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Copyright 1999 Clinical Reference Systems