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Baby Bottle Tooth Decay

baby-bottleA healthy, beautiful smile begins when your child is an infant. Healthy habits taught early will continue to provide benefits throughout your child’s life. But without appropriate care and attention, even babies can develop serious and painful dental disease. The most common cause of tooth loss in children isn’t accidents or injuries – it’s Baby Bottle Tooth Decay (BBTD), a pattern of severe and rapid tooth decay in infants and toddlers

What causes Baby Bottle Tooth Decay?

Tooth decay in a baby requires three elements: a tooth, plaque, and foods containing sugars and starches.

Everyone’s mouth has plaque, even an infant with new “baby” teeth. Plaque is a sticky, colorless film of bacteria that constantly forms on tooth surfaces. When it comes in contact with sugars and sweets, the bacteria in plaque produces acids that attack and dissolve the tooth enamel. This breakdown of the enamel leads to the formation of a cavity.

Every time your baby consumes sugary or sweet liquids, the acids produced by the plaque attack the baby teeth. After numerous attacks by these acids, cavities can begin to form. In bottle-fed or nursing infants, the teeth most susceptible to BBTD are the upper front teeth, but the molars or back teeth can also be affected.

Surprisingly, liquids that are good for your baby, such as formula, milk, breast milk and fruit juices, all contain some form of sugar. These nourishing liquids can be a primary contributor to the development of cavities in your baby’s teeth and gums.

Why is Baby Bottle Tooth Decay so bad for children?

Baby Bottle Tooth Decay not only can cause painful toothaches; it can create feeding and nutritional problems and may lead to middle ear infections. In very severe cases, decayed teeth can become so infected that they may need to be removed. If a child loses a tooth too early, it can result in poor eating habits, speech problems and loss of self-esteem. Baby teeth also play an essential role as space holders for permanent or adult teeth. Premature loss of baby teeth may create changes in the growth of the jaw. If adult teeth cannot assume their proper position in the jaw, extensive orthodontic repair may be required later on.

How can Baby Bottle Tooth Decay be prevented?

Be vigilant. Because baby teeth are susceptible to decay almost as soon as they appear, parents should be especially careful about what they feed their children. It’s important for your baby to get the essential nourishment that comes from milk, formula and fruit juices even though they contain sugar. It’swhen you give your baby these foods that can make a big difference in the health of your child’s teeth.

Don’t use a sugary liquid as a pacifier. Many parents will use a bottle with milk or juice to pacify their baby at naptime, bedtime and long periods outside of regular meal times. While this can give short-term comfort, it also can be damaging to your child. These sugary liquids pool around the teeth and gums, starting the formation of cavities. Remember that tooth decay is usually related more to the length of time the liquid is in the mouth than to the amount of sugar in the liquid.

Good care now means a lifetime of smiles!

Good habits established today create a foundation for healthy smiles in the future. Instilling good oral hygiene habits from the very beginning – limiting intake of sugar-laden foods, brushing and flossing regularly, and scheduling routine check-ups with the dentist – is the best way to prevent dental disease and to help your children take a healthy bite out of life.

Copyright 2001, California Dental Association, All Rights Reserved


From baby bottle to cup

Choose training cups carefully, use them temporarily

Tooth decay can occur as soon as a baby’s teeth appear. One of the risk factors for early childhood caries (some-times called “baby bottle tooth decay”) is frequent and prolonged exposure of a baby’s teeth to liquids containing sugar—including milk, formula and fruit juice.

Because decay can destroy the teeth of an infant or young child, parents should encourage their children to drink from a cup by their first birthday.

As you make the change from baby bottle to training cup, be very careful about

  • what kind of training cup you choose;
  • what goes into the cup;
  • how frequently your child sips from it;
  • not allowing your child to carry the cup around.


The best training cup for your child is one with no valve. Stores offer a large and often confusing variety of training cups (also called “sippy cups” or “tippy cups”). Many if not most of these are “no-spill” cups—nothing more than baby bottles in disguise. “No-spill” cups include a valve beneath the spout, which does stop spills. However, cups with valves do not allow your child to sip. The only way your child can get liquid from a cup with a valve is by sucking (as from a baby bottle). This defeats the purpose, as it prevents your child from learning to sip.

When shopping for a training cup, avoid those that have no-spill valves. A useful training cup will have a snap-on or screw-on lid with a spout. If you can find a cup with two handles, that may be best. A useful cup also may be self-righting, with a weighted base that pulls the cup upright when it tips, keeping spills to a minimum.


Do not let your child constantly sip liquids containing sugar (including milk and juice drinks), because that encourages tooth decay. Offer these liquids only at mealtimes—understanding that mealtimes for little ones may be more frequent than the standard three times a day for adults. (Saliva production increases during a meal and helps neutralize acid production and rinse food particles from the mouth.) If your child is thirsty between meals, offer water in the cup.

Do not let your child carry the training cup around, or get into the habit of keeping it within reach while riding in a car or stroller. At-will, frequent sips of sugary liquids encourage tooth decay. Another problem is that toddlers often are unsteady on their feet. They take an unnecessary risk if they try to walk and drink at the same time. Falling while drinking from a cup can injure the mouth. Do not let your child walk or run around with a training cup.

A training cup should be used temporarily. Once your child has learned how to sip, the training cup has achieved its purpose. It can and should be set aside when no longer needed.

Prepared by the ADA Division of Communications, in cooperation with The Journal of the American Dental Association, March 2004. Unlike
other portions of JADA, this page may be clipped and copied as a handout for patients, without first obtaining reprint permission from the ADA Publishing Division.

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