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Baby Bottle Caries



None of the parent wants to see their child in pain, and yet some parents are hurting their children’s dental health without even knowing it. Providing a bottle filled with milk, juice, etc. is comforting, but such a considerable action could actually be rotting away the child’s teeth.

Baby bottle caries is the presence of severe caries in infants or young children. It is a very common bacterial infection. It is also known as “Early childhood caries “, or “Nursing caries”.

It is a major health concern that affects the oral health of infants and children today.

It can impact the total wellbeing of a child.

Normal tooth anatomy

The teeth consist of two main parts: Crown and Root


The visible part of the tooth projecting above the gums is the crown.

The crown has three layers:

  • Enamel: It is the hardest outermost part of teeth. It is white in colour and is made of calcium hydroxyapatite. The enamel layer is thinner in deciduous teeth, about 1mm.
  • Dentin: It lies below both the enamel and cementum layer of tooth and is softer than enamel which makes it more susceptible to decay. It is yellowish in colour.
  • Pulp: It is present at the centre of the tooth and is commonly referred to as the ‘nerve’ of the tooth. It is softer, living inner structure of teeth and made up of blood vessels and nerves. The pulp chamber is larger in deciduous teeth.
  • Root: The deciduous teeth have longer and more flared roots. It is that part of the tooth that is embedded inside the jawbone. This portion is made up of dentin overlying which a mineralized layer is called cemented.Cementum contains very small fibres called periodontal ligament fibres which help in anchoring the teeth to the bone.Inside the roots, there are small canals through which the main blood vessels and nerves pass to the pulp chamber. These are referred as root canals

Overview of baby bottle caries

What is baby bottle caries?

Baby bottle caries is a condition characterized by severe dental caries with a child’s primary teeth. It is promoted by sugars, acids and sometimes streptococcus mutants. It occurs in children and infants.

Signs and Symptoms

  • It occurs in the most visible portion of front teeth.
  • Pain on biting or brushing.
  • White spots on the surface of the teeth.
  • White lines at the base of the teeth along the gum line.
  • Early development of cavities – cavities look like small holes or dark pits.
  • Difficulty in speaking or chewing.
  • Fever
  • Bleeding gums.
  • Early in onset and progresses rapidly.


  • It’s not just what you put in your child’s bottle that causes decay, but how often and how long it is there.
  • Allowing your child to fall asleep with a bottle during naps or at night can also harm the child’s teeth.
  • The primary culprit is a group of bacteria called streptococcus mutants.
  • Frequent and prolonged consumption of liquids containing fermentable carbohydrates.
  • Eruption of first teeth – The tooth surface is not hardened and they are susceptible to caries.
  • Tooth decay occurs when child’s teeth come in contact with too much sugar Bacteria use this sugar as food and producing acids that affect teeth.
  • During sleep saliva production is decreased.

Treatment Options


The symptoms may not be obvious until the decay has caused a bit of damage to the teeth and gums.

Visual Examination:

Oral Examination: Examination of oral cavity

Examination of front teeth for any caries

X-rays: X-rays are taken to confirm the presence and extent of the decay.


In case of baby bottle caries it is necessary to prevent further dental destruction.

Treatment depends on the stage it’s in:

3 Stages:

  • Very early detection: Demineralization on teeth, chalky white spots or lines. Here fluoride application and diet modification is done.

Fluoride varnish: is a thin coating of resin that is applied to the tooth surface of all teeth. The purpose of applying fluoride varnish is to retard, arrest, and reverse the process of cavity formation. The varnish application should be repeated at 3 –month intervals for high risk children and 6 –month intervals for low risk children.

Diet modification: A series of small changes over a period of time is usually easier, and eventually leads to better oral health.

Gradually dilute the bottle with water. The only safe liquid to put in a bottle to prevent tooth decay is water.

Decrease the consumption of sugar.

  • If obvious decay is present: Restored with fillings or caps. Here glass ionomer cement is used .Glass Ionomer is a tooth coloured filling material commonly used for baby teeth. It bonds to the tooth structure and releases fluoride to strengthen teeth and prevent decay. Crowns are applied if the decay is extensive and there is limited tooth structure.
  • If decay reaches the pulp: Here pulp therapy or extraction is needed. During pulp therapy, the nerve and blood vessel tissue or pulp is removed along with decayed portions of the tooth. The roots are then filled with a sealing material and the tooth is filled.

A crown may be placed if needed.

Extraction: Alternative to pulp therapy is a tooth extraction, in which the entire tooth is removed. Extractions are usually avoided, as other teeth move around in the space and leads to crowding.

Prognosis: With timely diagnosis and treatment, the progression of tooth decay can be stopped relatively painlessly. The longer the decay goes untreated, the more destructive it becomes and the longer and more intensive the treatment will be.


Prevention is the best treatment .Preventive and therapeutic measures are often necessary because children with this type of caries are at greater risk for subsequent caries development.

  • Night time bottle feeding should be avoided.
  • Bottle should be given only during feeding.
  • Don’t fill the bottle with sugar water, milk or juices instead plain water can be used.
  • After each feeding wipe the baby’s gums with a clean damp wash cloth.
  • Encourage children to drink from cup.
  • Begin tooth brushing as soon as your child has teeth.
  • Inspect your child’s teeth regularly.
  • Use of fluoridated water by the age of 6 months or older.
  • Begin flossing when all primary teeth are erupted.
  • Regular visit to dentist.
  • Australian Dental Association
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  • cbhs
  • hicaps
  • medicare
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