Once your baby’s teeth come in, it can be hard work keeping them in tip-top shape. Not only do babies and toddlers eat every few hours, but they also aren’t always the most compliant tooth-brushers — all of which can set them up for dental problems down the road.
One common cause of tooth decay that can affect tots is baby bottle tooth decay (BBTD), also known as bottle rot or early childhood caries. The name is somewhat misleading though, since toddlers and breastfed babies are also susceptible to the condition.[1]
While your child’s baby teeth will start to fall out when she’s around 6, it’s still critical to care for them in the meantime: Though temporary, baby teeth set the foundation for your little one’s future dental health. Luckily, there are ways to avoid — and treat — baby bottle tooth decay.
What is bottle rot?
Bottle rot is a form of tooth decay that can appear when a child’s teeth have frequent and prolonged exposure to milk (including breast milk), formula, juice or other sugary beverages.[2]
It often develops when a baby or toddler sips from her bottle or sippy cup throughout the day or while falling asleep in bed — not just during mealtimes. This constant sipping bathes tiny teeth in a steady stream of sugar, which is then converted into acids by common bacteria living in the mouth. That acid then breaks down the outer part of the teeth (the enamel), eventually leading to cavities.
Causes of bottle rot in babies and toddlers
Bottle rot tends to occur when babies or toddlers continually sip juice or milk from a bottle or sippy cup. Though either day- or nighttime sipping can contribute to baby bottle tooth decay, bottles in bed are a common culprit. A baby who often takes her bottle to bed and drinks from it throughout the night has a higher risk of tooth decay.
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Even so, tooth decay can also affect breastfed children, since breast milk, like formula and cow’s milk, contains sugar, says Michelle Kelman, D.D.S., a pediatric dentist in Los Angeles, California, and member of the What to Expect Medical Review Board. Breastfed babies who frequently fall asleep while nursing with unswallowed milk in their mouths — either from a breast or bottle filled with breast milk — are also at risk for tooth decay, according to the American Academy of Pediatrics (AAP).[3]
Signs of bottle rot in babies and toddlers
Your cutie’s upper front teeth are the most likely to develop bottle rot — in part because they’re one of the first teeth to come in — so check them for chalky white or yellow spots or lines. White spots can also appear on the gum line. If you spy some, that’s an early sign that tooth decay is settling in — the first stage before cavities appear.
Early childhood caries may first be noticed by white spots on the teeth near the gum line or as brown or dark spots on the teeth, Dr. Kelman says.
Sometimes, a child may complain that her teeth hurt — if that happens, hurry in for a dental checkup. That pain might mean the tooth decay has spread beneath the enamel.
How to prevent bottle rot in your baby or toddler
More than 1 in 5 kids between ages 2 and 5 have cavities, according to the Centers for Disease Control and Prevention (CDC).[4] But early childhood cavities are preventable. Help instill good dental habits and avoid baby bottle tooth decay with these strategies:
- Fill her sippy with water. If you give your child a sippy cup in between meals, make sure it holds only water, which won’t coat teeth in sugar the way milk, formula or juice does. Tap water often contains fluoride, which also helps protect teeth from tooth decay (you can check to see if your community’s water has fluoride on the CDC’s website).
- Keep an eye on your nursing baby. If your little one falls asleep while breastfeeding, remove your breast from her mouth, since unswallowed breast milk can contribute to decay. It’s also a good idea to gently wipe her teeth with a warm washcloth or gauze.
- Don’t put your baby or toddler to sleep with a bottle. This is one of the most common causes of baby bottle tooth decay, as milk, breast milk or formula in your child’s bottle coats the teeth while she sleeps.
- Clean her mouth regularly after feedings. If your tot is still toothless, gently wipe her gums with a damp gauze or a washcloth to remove bacteria. Once her first tooth erupts, start brushing with an infant toothbrush and a smear of fluoride toothpaste. As she gets older and more pearly whites appear, you can switch to a child-sized toothbrush. Use a small dab of fluoride toothpaste (no bigger than a grain of rice), and brush once in the morning and once before bedtime, when mouth bacteria have more time to do their dirty work. When your toddler sprouts two teeth that are touching, usually around the age of 2 or 3, you can also start a flossing routine.[5]
- Be mindful when handling pacifiers. Bacteria that cause tooth decay can move from your mouth to your baby’s, so avoid putting a pacifier (or spoon or cup) in your mouth then passing it to your little one.
- Visit the dentist. Lastly, be diligent about scheduling regular dental checkups and cleanings twice a year, starting when your child’s first tooth appears or on her first birthday, whichever happens first.
How to treat bottle rot in your child
If you catch baby bottle tooth decay early on, your child’s dentist may be able to reverse some of the damage. Your dentist will usually start by cleaning off any plaque on the tooth — that’s the sticky film of bacteria that has settled on the tooth — and provide a re-mineralizing treatment such as fluoride treatment, which will help strengthen the enamel, says Dr. Kelman.
There are also treatments that contain calcium and phosphate, minerals that can help repair the damaged area of the tooth.[6] “You can reverse the decay if you catch it while it’s white or just turning brown or yellow,” she says.
If a cavity does form, your child’s dentist can use silver diamine fluoride if the cavity has not reached the pulp to stop it, or remove the caries by hand.
The good news is that, in many cases, tooth decay can be detected and treated early. Before you know it, your child’s pearly whites will likely be just that — pearly and white.
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