Baby bottle tooth decay: causes, early signs and prevention

Baby bottle tooth decay, also called early childhood caries, is decay in the baby teeth of infants and toddlers, often on the upper front teeth. It usually develops when a child falls asleep with a bottle of milk, formula or juice, or sips sweet drinks for long periods during the day. The first sign is a chalky white line near the gum. It can be prevented by avoiding the bottle in bed, brushing as soon as the first tooth appears and having a first dental visit by the age of one.

Why it happens

Milk, formula and juice contain sugars. Bacteria in the mouth turn these sugars into acid, which dissolves the enamel. During sleep, saliva flow drops, so the liquid stays on the teeth for hours. The upper front teeth are most affected because the bottle teat lies against them, while the tongue protects the lower front teeth.

Frequent sipping during the day, a bottle used as a comforter, sweetened drinks in a sippy cup and dipping a dummy in honey or sugar have the same effect. Bacteria that cause decay can also pass from parents to children, for example by sharing spoons or cleaning a dummy in an adult’s mouth.

Early signs to look for

1. White, chalky spots or lines along the gum line of the upper front teeth. At this stage the damage can often be reversed with fluoride and better habits.
2. Yellow or light brown areas, where the enamel has started to break down.
3. Brown or black holes, broken edges or teeth that look worn down.

Lift your child’s upper lip once a month and look at the front teeth near the gum. Pain, swelling or difficulty eating mean that decay is already advanced.

Why baby teeth are worth protecting

Baby teeth are needed for eating, speaking and smiling, and they keep the space for the permanent teeth. Decay can cause pain and infection, affect sleep and eating, and in severe cases require treatment under sedation or general anaesthesia. Read should cavities in baby teeth be treated?

How to prevent it

• Do not put your child to bed with a bottle of milk, formula or juice. If a bottle is needed at bedtime, give it before brushing, or offer only water in bed.
• Do not let your child walk around sipping from a bottle or cup of sweet drink all day. Keep juice for mealtimes, diluted, or avoid it.
• Introduce an open cup from around 6 months and aim to stop the bottle around 12 to 18 months.
• Brush twice a day from the first tooth, with a smear of fluoride toothpaste (the size of a grain of rice) under 3 years.
• Never dip a dummy in honey, sugar or syrup, and avoid putting your child’s spoon or dummy in your own mouth.
• Breastfeeding has many benefits; once teeth are present, wiping or brushing the teeth before sleep helps, and frequent night feeds in older toddlers are worth discussing with your dentist.

See also our practical guide to preventing tooth decay in children and to fluoride and fissure sealants.

When to see a dentist

Book a first dental visit by your child’s first birthday, or within six months of the first tooth. Come sooner if you see white spots, brown areas, a broken tooth or swelling of the gum, or if your child has pain when eating. Early white spots can often be treated without drilling, with fluoride varnish and changes in habits.

Children’s dentistry at Ajam Dental Clinic in Tripoli

At Ajam Dental Clinic, all children’s dental care is provided by Dr. Soumaya Ajam, our paediatric dentist. She checks the teeth gently, explains to parents what she sees and how to prevent decay at home, and treats cavities when needed. The clinic is on Fouad Chehab Boulevard in Tripoli, and families come from across Tripoli — Al-Qobbeh, Bab al-Tabbaneh, Jabal Mohsen and Dam wa Farez — and from the rest of North Lebanon.

For babies and young children, contact Dr. Soumaya Ajam by WhatsApp or phone.

This article provides general information for patients. It does not replace an examination by a dentist, who can advise you on your own situation.