Keeping Baby’s Pearly Whites

from Shine Newsletter, Summer 2007

Baby bottle tooth decay (BBTD) is the main type of tooth decay in infants. Although decay can start soon after your child’s baby teeth appear, the problem often goes unnoticed until she is about one-year-old. The earliest sign is white spots on the baby teeth, and upper front teeth are usually damaged first.

Q & A

What causes tooth decay?

When sugar is in contact with teeth for a prolonged time, decay can happen. Milk, formula, juice and soft drinks all contain sugar. If a child falls asleep with a bottle or constantly drinks from a bottle during the day, the sugar coats the teeth. Normal bacteria in the mouth change the sugar to an acid. Because baby teeth enamel is only half the thickness of an eggshell, this acid dissolves the enamel and progresses to decay.

What happens if my child is diagnosed with BBTD?

Without treatment, decay will eventually destroy the teeth, and they may break off at the gum line. The decay continues on the root of the tooth and causes ongoing pain. Dental repair of BBTD requires general anesthesia. When detected early, teeth can be covered with caps. If damage is severe, decayed teeth will need to be pulled out.

Call your child’s physician during

office hours if:

- Your child cannot give up the bottle.

- White spots appear on the teeth.

- You think your child might have 

   baby bottle tooth decay (BBTD).

- You have other questions or 

   concerns.

What are some side effects of pulling baby teeth?

When teeth must be pulled as a result of BBTD, one side effect is a necessity to chew with teeth on the side of the mouth. Permanent teeth may come in crooked or crowded because baby teeth are no longer there to save appropriate space.

What if my infant does not want to give back the bottle at bedtime?

Don’t bottle-feed your baby while she falls asleep. A common cause of dependency, your child will expect a bottle as a transition into sleep. To prevent this, separate the last bottle-feeding from bedtime. Create good habits early, even before your infant’s teeth come in. Give a bottle only during mealtimes. Don’t substitute a bottle for a pacifier, security object, toy or being held.

When should I try using a cup instead of a bottle?

It is helpful to introduce a cup by six to nine months of age. Don’t expect a child to start weaning himself. Also don’t expect weaning to happen within a day or even a week. It takes gradual exposure to a cup for three months or longer in order for a child to prefer it.

If your infant has developed a night-time bottle habit and is over one-year-old, continue to give him the bottle, but only with water, which doesn’t harm tooth enamel.

Copyright 1988–2007. Barton Schmitt, MD. Revised February 2007.