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
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
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.
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
- 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
How to Protect Your Child from Baby Bottle Tooth Decay
- 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.
- 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.
- 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.
- 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.