Tooth decay due to bottle feeding. Should bottle feeding be banned?

You must have heard many stories about tooth decay in children who sleep with bottles in their mouth. This is called Baby Bottle Tooth Decay (BBTD), nursing bottle caries, nursing caries, bottle caries, and infant bottle caries and so on. As the name suggests, you must be thinking the root cause of all dental problems in infants and children is bottle feeding. But read this and it will amaze you. Bottle has nothing to do with the tooth decay.

First, some facts about the cause of tooth decay. Tooth decay is caused by interplay of four major factors, namely tooth, bacteria or germs, carbohydrates or food and the time for the germs to act on the food. (See fig 1). The black area shows tooth decay.

Fig 1

So when the baby goes to sleep we have all the ingredients of decay i.e. baby’s teeth, milk as food, germs already present in his mouth for the whole night. Now you might wonder, the baby sleeps after drinking milk then how is the milk present in the mouth for the whole night? The answer lies in the fact once the child sleeps; he doesn’t gulp the milk which gets pooled above his tongue near the upper front teeth.

So culprit of this tooth decay is the milk and not the bottle. This also implies to the breast milk as well. Mother’s milk like any other milk contains lactose which is a natural sugar, which the bacteria can break down to form acids and cause tooth decay.

So, nursing bottle caries is a misnomer and the American Society of Dentistry for Children (ASDC) has changed the name of this form of decay from nursing bottle to a broad category of Early Childhood Caries (ECC)

The usual signs of early child hood caries are:

1. White spots on the teeth. These white spots are the starting of decay and can be reversed.
2. Brownish discoloration of teeth. The first teeth to be affected are the upper front teeth (remember the milk pools near these teeth. See Fig 2) on the outer surface usually at the level where gums meet the teeth, followed by the biting surfaces of lower molars.
3. Later in the advanced stage, all the teeth might get decayed.
4. The child complains of discomfort in eating and drinking especially hot and cold food or even might stop eating from the fear of pain.
5. Pain and swelling may ensue if the condition is left untreated.

Fig 2

Parents usually complain that the child doesn’t leave nursing with bottle or breast during night and when they try to wean the child off the bottle, the child cries and doesn’t sleep well. What should the parents do in such a situation?

We would suggest that you should:

1. Try to wean the baby off the bottle or breast feed by putting him on semi solid diet after 1 year of age. Feed the child with all kinds of food he likes. It will not only reduce the child dependence on milk but will also provide essential nutrients.
2. If the child still wants milk during sleep, then put a bottle of water in his mouth after he finishes his milk. Even if the child sips a little water, his mouth will be clean throughout the night.
3. Brush the child’s teeth before he goes to sleep to reduce the bacteria or germ count in the mouth.
4. Give fluoride supplements, as recommended by your child’s physician.
5. Plan the child’s first dental visit at his first birthday.