baby boy brushing his teeth

Did you know that dental decay is the most widespread disease among children? It’s 5 times more common than asthma, 4 times more common than childhood obesity and 20 times more common than childhood diabetes – and it’s almost entirely preventable.

What is bottle rot?

Baby bottle decay – also called Nursing Bottle Syndrome or bottle rot, is the development of tooth decay (cavities) and early loss of baby teeth in infants and toddlers. This type of dental decay has an early onset, is dietary-induced and of an aggressive nature with rapid progression. It typically affects the upper incisors, but other teeth can also be affected and cases vary from mild to severe.

Causes of tooth decay or bottle rot in babies

If an infant or toddler goes to sleep while sucking on a bottle filled with sugary liquids (anything sweetened or naturally containing sugar like milk, formula or fruit juice), the tongue closes off the throat and the teeth – especially the upper teeth – are bathed in this sugary liquid. In this way, the tongue almost protects the bottom teeth.

Bacteria thrive on sugar. When teeth are frequently exposed to sweetened liquids or those with natural sugars for long periods of time, in the presence of plaque, tooth decay will form. It is the acid that is produced by the bacteria that will start the demineralisation of the enamel, with decay as the end result.

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Another factor increasing the chances of tooth decay in babies is the decrease in the flow of saliva caused by the major saliva glands shutting down at night. This means less antibacterial and protective properties. Tooth decay can lead to pain, discomfort and infection – this may affect the child’s long-term oral health and permanent dentition. The discomfort and pain might lead to an inability to eat that leads to an unwell child.

What does baby bottle tooth decay look like?

In mild cases…

bottle rot: mild tooth decay in a baby who falls asleep drinking from a bottle

In more severe cases…

bottle rot: tooth decay in babies caused by drinking from a bottle

Why is it important to look after the baby teeth?

Many parents wonder why it’s important to look after the baby teeth and ask why they can’t just be extracted when the decay eventually leads to pain. Firstly, baby teeth are important for chewing, speech development, healthy self-esteem and they act as space holders for the permanent teeth. Early extractions will let the permanent teeth drift uncontrollably and will need early intervention of orthodontic treatment – not to mention the emotional trauma when the child gets teased about their appearance.

What can parents do to prevent bottle rot and tooth decay in children and babies?

Do your best not to put your baby to sleep while sucking on a bottle with anything other than water. Remove the bottle as soon as your baby is asleep and replace it with a pacifier if need be.

From the day your child is born, use a piece of gauze to wipe the gums and tongue after each feed to remove plaque and excess sugar. Although a baby is born with a sterile mouth, the first interaction with humans will transfer bacteria from their mouths to the baby’s mouth. For this reason, it’s advisable to limit close contact with a newborn, especially regarding kissing the baby on the lips.

As soon as the first teeth erupt (this usually happens between 4 and 6 months), start brushing them with a soft baby toothbrush or a finger brush twice a day. There is no need to use toothpaste, as the baby won’t be able to spit out the excess. By following this regime from an early age, brushing teeth will be easier as the child gets older, because the routine will already be established.

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Should you be flossing your child’s teeth?

When your baby is a year old, you can introduce a toothpaste containing fluoride because you can teach him or her to spit out the remaining toothpaste and not swallow it. There will naturally be spaces between the baby teeth, which will make it too difficult to floss. But between 25 and 33 months, the second molars will erupt and it’s important to start flossing between the two baby molars that will most likely be touching each other.

It’s important to understand that by reducing the number of bacteria through brushing the teeth and wiping the gums and tongue, the chances of decay forming are greatly reduced. It’s vital that all efforts are made to clean your baby’s mouth, from when no teeth have erupted and continue as teeth erupt. In doing so, a cleaning routine is established from an early age. Encourage your toddler to drink from a cup as soon as possible (normally from around 6 months). Also try to wean them off the bottle completely as soon as possible.

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How do you know if your baby has tooth decay?

Early signs of tooth decay will present as little white spots, called white spot lesions. There can be other reasons for these white spots, so best to consult your dentist or hygienist if you notice these. Sometimes the lesions can be addressed before they turn into a full-blown cavity. Teeth with more severe decay will present with brown or black spots and the teeth may be sensitive.

Identifying white spot lesions

bottle rot and tooth decay in babies: white lesions

Identifying brown lesions

bottle rot and tooth decay in babies: brown lesions

What to do if your baby’s teeth are already decayed

If chalky white spots or lines are detected early, the dentist or hygienist may apply fluoride to remineralise the teeth and, in doing so, prevent the lesion from developing into a cavity. To prevent this demineralisation, it’s important to use toothpaste containing fluoride from about 1 year old. Fillings might be needed when the decay is obvious or if the teeth are sensitive.

If the decay has reached the pulp chamber (nerve), pulp therapy or an extraction is needed. Discuss the different options with your dentist. Together with the dental hygienist, they will recommend a treatment plan to reduce the chances of future decay.

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When should I take my child to the dentist or hygienist for the first time?

Start with your first visit to the dental hygienist as soon as your toddler is willing to sit in the dental chair (this can be as early as 3 yrs old) or if you notice any discoloration or something that doesn’t look normal.

Sarie Liebenberg traded a glamorous career as a lecturer at a finishing school for a new adventure as a dental hygienist and lecturer when she went to university to retrain at the age of 31. Sarie found her passion in helping people, saying ‘it’s much more than working on someone’s mouth, it’s restoring confidence, creating opportunities and being part of making it all happen, not only for the patient, but also for myself.’ A mom of one herself, Sarie has a special interest in working with children. You can get in touch with Sarie here