Have you ever seen a small child with rows of capped teeth and wondered what happened? It is usually the result of “baby bottle tooth decay” or “bottle rot.” The term is a little bit misleading, because it can happen even if a child isn’t on a bottle. The most medically correct term is “Early Childhood Caries.” Baby bottle tooth decay happens with the teeth have frequent and long-term exposure to liquids that contain sugars (milk, formula, juice, soda, and other sweetened drinks). It doesn’t really matter if the liquid comes from a breast, bottle, or sippy cup. It’s all results in the same cavities.

How does bottle rot happen?

There are many factors that contribute to the development of tooth decay. The first factor is the introduction of cavity causing bacteria into the infant’s mouth. Usually the infant gets colonized with the cavity causing bacteria from the mother through her saliva. This happens when the mother wipes a spoon or pacifier with her mouth and then places it into the baby’s mouth. (Avoiding doing this can delay when your child develops cavities).

The second factor is sugar. When an infant or toddler drinks sugary or sweetened liquids (essentially anything but water), the sugars pool around the infant’s teeth and gums. The sugars (along with acid) feed the bacteria and result in cavities. This process is exacerbated at bedtime and naptime. At those times, there isn’t as much saliva (which can help wash off the teeth), so there is more pooling of the harmful sugar.

Another factor in cavity development is fluoride. Fluoride prevents cavities. So if your infant or toddler isn’t getting enough fluoride, it can result in more cavities.

How do I prevent bottle rot?

Baby bottle rot is completely preventable. Here’s the do and don’t list:

Don’t:

1. Don’t share saliva (e.g., cleaning pacifiers in your mouth first).
2. Don’t put your baby to bed with a bottle or sippy cup.
3. Don’t allow your baby to breastfeed on and off all night (this usually happens with the co-sleeping infant). Even though the milk is from the breast, the mechanism of decay is the same (essentially giving you breastfeeding tooth decay).
4. Don’t let your child walk around with a sippy cup all day (the only liquid that is ok to do that with is water).
5. Don’t dip pacifiers in sugar, honey, or other sweetened things.
6. Don’t put juice in bottles.

Do:

1. Brush teeth before bed.
2. If you give your child milk (or any drink besides water) before bed, brush teeth after, before sleeping.
3. Assist your child in properly brushing teeth morning and night (most kids can’t do it well enough to be left to their own devices until 6 or 7).
4. Transition to a cup/sippy cup at a 1 year of age.
5. Start brushing teeth when they first show up (you can wipe gums with a clean damp rag prior to that).
6. Take your child regularly to the dentist (starting between 1-2 years old, every 6 months).
7. Supplement with fluoride if it’s not in your particular city’s water (ask your pediatrician if you need a prescription).

No one wants their child to have tooth decay. No one purposely does things to have it happen. My experience has been that most of the time, parents don’t even realize what little things they are doing (or not doing) that can cause this problem. If I can help raise awareness and prevent cavities, then I’d consider that a success!

Thanks to my patient’s cute mom who let me snap a pic of her child’s teeth. You’ll notice his teeth have a porcelain front to the silver caps (which is a cosmetic upgrade to traditional silver caps).