Definition

• Baby bottle tooth decay (BBTD) is the main type of tooth decay in toddlers.
• It’s caused by excessive exposure to milk or juice. That happens with crib bottles or tote bottles.
• The tooth damage is often not noticed until after 1 year of age. The earliest sign is white spots on the baby teeth. These spots start at the gum line.
• The upper front teeth (incisors) are usually damaged first. Decay appears later on the edges of the front teeth. Decay is yellow or brown in color.
• If BBTD is not discovered and treated, decay will eventually destroy the teeth. They will break off at the gumline. The decay will continue to destroy the root of the tooth. This will cause ongoing pain.

Health Information

Causes

• 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, the sugar coats the upper teeth. This can also occur if he constantly drinks from a bottle during the day. The normal bacteria in the mouth change the sugar to an acid. The enamel is the protective coating of the teeth. In baby teeth, it is only half the thickness of an eggshell. The acid gradually dissolves the enamel and allows decay to occur in the teeth.
• Here are the 3 most common mistakes: Leaving a baby with a bottle of formula or juice to help them go to sleep at night. Using the bottle to deal with middle-of-the-night crying. Using the bottle to deal with fussiness during the day. Many parents are unaware that these bottle habits lead to tooth decay problems.
• Caution: Too much contact with a sippy cup can also cause tooth decay.
• Fruit juice in a bottle is a common cause of BBTD. Don’t allow fruit juice before 1 year of age (American Academy of Pediatrics). Exception: needed for symptoms such as constipation.

Why Prevention is Important

• Treatment of BBTD is not easy. It requires general anesthesia and hours of dental work.
• If the problem is detected at an early stage, the teeth can be covered with stainless steel caps.
• If the decay is severe, the decayed teeth will need to be pulled out.
• That’s why prevention of BBTD is so important.

Care Advice

Prevention of BBTD

1. Never Give Your Baby a Crib Bottle:
   • Don’t let your baby fall asleep with a bottle of milk in his mouth. Don’t use the bottle as a pacifier.
   • Separate the last bottle-feeding of the evening from bedtime and going into the crib. Make feeding the first step in the bedtime ritual. Then read a book. Then put them in the crib. For best results, feed them in a different room, not in their crib room.
   • Baby teeth don’t start coming in until 6 months. It’s wise to not start a bad habit before then.
2. Don’t Allow Your Toddler to Carry Around a Bottle During the Day:
   • This is called a tote or companion bottle. It causes habit-drinking (comfort-drinking)
   • Don’t use the bottle as a security object or toy.
   • Give a bottle only during mealtimes.
   • The same goes for a sippy cup, which can cause similar tooth decay.
3. Don’t Let Your Baby Think the Bottle Belongs to Him:
   • Reason: If you do, it won’t be easy to get it back.
   • That’s why you should hold your baby when you bottle feed him.
   • Pretend you own the bottles and this is only a way to feed him.
4. Introduce a Sippy 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 several months. A child learns to slowly prefer the cup over the bottle.
5. Fill Bottles with Water for Severe Bottle Habits:
   • If your baby won’t give up the bottle, fill it only with water.
   • Water cannot hurt tooth enamel. Water is also boring and will help your child eventually give up the bottle. The bottle itself is not harmful.
   • If he complains, hold him and comfort him.

Call Your Doctor If

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

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

 #AAP