Oral Health Topics
Early Childhood Tooth Decay (Baby Bottle Tooth Decay)
Introduction
Your child's baby teeth are important. Children need strong, healthy teeth to chew their food, speak and have a good-looking smile. Baby teeth also keep a space in the jaw for the adult teeth. If a baby tooth is lost too early, the teeth beside it may drift into the empty space. When it's time for the adult teeth to come in, there may not be enough room. This can make the teeth crooked or crowded. Starting infants off with good oral care can help protect their teeth for decades to come.
Symptoms
Your child’s baby teeth are at risk for decay as soon as they first appear-which is typically around age six months. Tooth decay in infants and toddlers is often referred to as Baby Bottle Tooth Decay or Early Childhood Caries (cavities). It most often occurs in the upper front teeth, but other teeth may also be affected. In some unfortunate cases, infants and toddlers have experienced decay so severe that the teeth cannot be repaired and need to be removed. The good news is that decay is preventable.
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| Mild Dental Decay | Moderate Dental Decay | Severe Dental Decay |
Tooth decay is a disease that begins with cavity-causing bacteria being passed from the mother (or primary caregiver) who has these bacteria in their mouth to the infant. These bacteria are passed through the saliva. When the mother puts the baby’s feeding spoon in her mouth, or cleans a pacifier in her mouth, the bacteria are passed to the baby.
Another factor for tooth decay is the frequent, prolonged exposure of the baby’s teeth to liquids that contain sugar, like sweetened water and fruit juice and potentially milk, breast milk and formula. Tooth decay can occur when the baby is put to bed with a bottle, or when a bottle is used as a pacifier for a fussy baby. The sugary liquids pool around the teeth while the child sleeps. Bacteria in the mouth use these sugars as food. They then produce acids that attack the teeth. Each time your child drinks these liquids, acids attack for 20 minutes or longer. After multiple attacks, the teeth can decay.
Pacifiers dipped in sugar or honey can also lead to tooth decay since the sugar or honey can provide food for the bacteria’s acid attacks.
Infants and toddlers who do not receive an adequate amount of fluoride may also have an increased risk for tooth decay since fluoride combines with the outer covering of the tooth (enamel) and makes the tooth more resistant to the acid attack.
Prevention
The good news is that tooth decay is almost completely preventable. You can help prevent tooth decay for your child by following the tips below:
- Lower the risk of the baby’s infection with decay-causing bacteria. This can be done two ways – by improving the oral health of the mother/caregiver which reduces the number of bacteria in her mouth and by not sharing saliva with the baby through common use of feeding spoons or licking pacifiers and giving them to babies.
- After each feeding, wipe the baby’s gums with a clean, damp gauze pad or washcloth. This will remove plaque and bits of food that can harm erupting teeth. When your child’s teeth begin to erupt, brush them gently with a child’s size toothbrush and water. (Consult with your child’s dentist or physician if you are considering using fluoride toothpaste before age two.)
- When your child can be counted on to spit and not swallow toothpaste (usually not before age two), begin brushing the teeth with a pea-sized amount of toothpaste. The American Dental Association recommends fluoride toothpaste; ask your dentist about your child’s fluoride needs.
- Brush your child’s teeth until he or she is at least six years old.
- Place only formula, milk or breastmilk in bottles. Avoid filling the bottle with liquids such as sugar water, juice or soft drinks.
- Infants should finish their bedtime and naptime bottles before going to bed.
- If your child uses a pacifier, provide one that is clean — don’t dip it in sugar or honey, or put it in your mouth before giving it to the child.
- Encourage children to drink from a cup by their first birthday and discourage frequent or prolonged use of a training (sippy) cup.
- Encourage healthy eating habits that include a diet with plenty of vegetables, fruit and whole grains. Serve nutritious snacks and limit sweets to mealtimes.
- Ensure that your child has adequate exposure to fluoride. Discuss your child’s fluoride needs with your dentist or pediatrician.
Treatment
When your child’s first tooth appears, talk to your dentist about scheduling the first dental visit. Treat the first dental visit as you would a well-baby checkup with the child’s physician. It’s beneficial for the first dental visit to occur within six months after the first tooth appears, but no later than your child’s first birthday. Although this may seem early, starting early is the key to a lifetime of good dental health.
Additional Resources
- ADA Tooth Eruption Charts
- ADA Baby Teeth
- ADA Statement on Early Childhood Caries
- ADA Child’s First Visit to the Dentist (PDF)
- ADA Diet and Oral Health
- ADA Interim Guidance on Fluoride Intake for Infants and Young Children
- ADA Bottled Water
- ADA Fluoride Supplements
Related Web Sites
American Academy of Pediatric Dentistry
- Dental Care for your Baby
- Policy on Baby Bottle Tooth Decay (BBTD)/Early Childhood Caries (ECC) (PDF)
- Policy on Early Childhood Caries (ECC): Unique Challenges and Treatment Options (PDF)
- Policy on the Use of a Caries-Risk Assessment Tool (CAT) for Infants, Children and Adolescents
American Academy of Family Physicians
American Academy of Pediatrics
- Where We Stand: Fruit Juice
- AAP Oral Health Initiative—Families Web Page
- Oral Health Risk Assessment Timing and Establishment of the Dental Home Policy Statement
National Maternal and Child Oral Health Resource Center
- Promoting Awareness, Preventing Pain: Facts on Early Childhood Caries (ECC) (PDF)
- Child and Adolescent Oral Health Issues (PDF)
- Oral Health and Learning (PDF)
- Additional Fact Sheets and Other Relevant Materials
Introduction
Early Childhood Caries is an infectious disease defined as the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries) or filled tooth surfaces in any primary tooth in a preschool-age child between birth and 71 months of age. The Association recognizes that early childhood caries is a significant public health problem in selected populations and is also found throughout the general population. Although dental caries has declined significantly among school-aged children since the early 1970s, dental caries has remained the most prevalent chronic disease of childhood. For 2–4 year-olds, prevalence of dental caries in primary teeth has increased from approximately 18% to 24% between 1988–1994 and 1999–2004.
ADA News
Curbing caries, boosting access goals of IHS initiative (01/26/2010)
Seeking a solution (01/25/2010)
ADA, ADAF join with AAP to train pediatricians as oral health advocates (12/16/2009)
Evidence indicates sealants improve children's oral health (11/03/2009)
Focus on the dental home (08/27/2009)
Wisconsin Dental Association produces dental home DVD (08/21/2009)
ADA urges boost to IHS dental care (03/26/2009).
February JADA looks at restorations in children (02/03/2009)
Making dental-medical history (02/04/2009)
AAPD/Head Start initiative kicks off in six states (09/16/2008)
New infant dental clinic experience for UIC College of Dentistry students (07/21/2008)
American Indian/Alaska Native outreach grows (03/17/2008)
Summit participants address American Indian/Alaska Native oral health issues (03/17/2008)
AADR urges Congress to boost oral health research dollars (03/14/2008)
JADA
- Is Income Inequality Related to Childhood Dental Caries in Rich Countries? (February 2010)
- Early Childhood Caries (October 2009)
- Infant Formula and Enamel Fluorosis: A Systematic Review (July 2009)
- Fluoridated Toothpaste and the Prevention of Early Childhood Caries: A Failure to Meet the Needs of Our Young (June 2009)
- Beyond the dmft: The Human and Economic Cost of Early Childhood Caries (June 2009)
- Providing Dental Care to Pregnant Patients: A Survey of Oregon General Dentists (February 2009)
- Cariogenicity of Soft Drinks, Milk and Fruit Juice in Low-Income African-American Children: A Longitudinal Study (July 2008)
- Using a Caries Activity Test to Predict Caries Risk in Early Childhood (January 2008)
ADA Caries Risk Assessment Forms
- Download Instructions (PDF)
- Caries Form (Patients Ages 0–6 Years) (DOC)
- Caries Form (Patients Over 6 Years ) (DOC)
- Survey on ADA Caries Risk Assessment Forms
Early Childhood Caries Symposium
- Panel Report: Symposium on Early Childhood Caries in American Indian and Alaska Native Children (PDF/1MB)
ADA Positions and Statements
ADA Web Sites
- ADA Caries
- ADA Tooth Eruption Charts
- ADA Diet and Oral Health
- ADA Interim Guidance on Fluoride Intake for Infants and Young Children
- ADA Bottled Water
- ADA Fluoride and Fluoridation
- ADA Fluoride Supplements
- ADA Public Service Announcement—Baby Bottle Tooth Decay
ADA Brochures:
Why Baby Teeth are Important W282
Your Child’s First Visit to the Dentist W110
Tips on Teething W348
Training Cups: Choose Carefully, Use Temporarily W233
Early Childhood Caries: A Healthy Start is Smart W166
Early Childood Caries W154
Happiness is a Health Smile: A Message for Parents W290
The Developing Smile: Primary and Permant Teeth W216
Thumb Sucking, Finger Sucking and Pacifier Use W218
Your Child’s Teeth, 0-6 W236
Your Child’s Teeth W177
Healthy Smiles for Mother and Baby W196
Pregnancy and Oral Health W100
The Benefits of Fluoride Nature’s Cavity Fighter W 102
Bottled Water: Get the Facts W295
Science in the News
- Pediatric Journal Highlights Need for Translational Research, Medical-Dental Collaboration to Improve Children's Oral Health (Posted 12/28/09)
Evidence-based Clinical Recommendations
- Professionally-Applied Topical Fluoride (PDF)
- Professionally-Applied Topical Fluoride (Executive Summary) (PDF)
Related Web Sites
American Academy of Pediatric Dentistry
- Dental Care for your Baby
- Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies (PDF)
- Policy on Early Childhood Caries (ECC): Unique Challenges and Treatment Options (PDF)
- Policy on the Use of a Caries-Risk Assessment Tool (CAT) for Infants, Children and Adolescents (PDF)
American Academy of Pediatrics
- Where We Stand: Fruit Juice
- AAP Oral Health Initiative
- Oral Health Risk Assessment Timing and Establishment of the Dental Home Policy Statement
