How can I prevent my baby's tooth decay from a bottle or nursing?

Bonnie Lynn Wright, PhD
Geriatrics Nursing
The following are the questions, approved by local dentists, that Mosaic Primary Care Network asks on the Caries Risk Assessment as part of their Early Childhood Caries Prevention Program:
  1. Is the child seeing a dentist?
  2. Has the child’s mother had dental caries in the last two years?
  3. Does the child go to bed with a bottle containing anything but water?
  4. Is the child breastfed on demand during the night?
  5. Does the child have drinks other than water between meals?
  6. Does the child have more than three sweet and/or sticky snacks daily?
Breastfeeding on demand at night is a risk if the child is allowed to continue to have the breast in his mouth after feeding just as having a bottle in the mouth while sleeping is a risk as well. Sweet drinks and snacks are a risk. An adult should brush and floss children's teeth from the time of the eruption. As well, fluoride varnish can be applied every 6 months between one and three years of age, particularly if you live in an area without fluoridated water.
Diana Meeks
Diana Meeks on behalf of Sigma Nursing
Family Practitioner
Your baby's tiny teeth are adorable and perfect. They also must save space for the adult teeth that will emerge in a few years. That's why it's so important to prevent tooth decay in the first months of life.

Many babies go to bed with a bottle. This isn't a good idea unless you're putting only plain water in the bottle. Juice, formula and even breast milk contain sugar, which coats your baby's teeth when the bottle stays in the mouth too long. Bacteria in your baby's mouth feast on that sugar, producing acid that can lead to tooth decay. To prevent baby-bottle tooth decay, don't send your baby to bed with a bottle!

Breastfeeding may actually protect against tooth decay, provided that you don't introduce sugary foods while you are nursing. Stick to breast milk and water only.

Whether you are breastfeeding or bottle feeding, wipe down your baby's gums after feedings with a wet cloth to remove any bacteria or leftover milk.
You can prevent your baby from developing tooth decay by developing an oral hygiene routine within the first few days after birth.  

Begin by cleaning the baby's mouth after every breast or bottle feeding. Do this by wiping the baby's gums with a clean gauze pad. This removes plaque (a sticky film of bacteria) and residual food that can harm erupting teeth. As soon as teeth appear in the mouth, tooth decay can occur. Therefore, when your child's teeth begin to erupt, brush them gently with a child's size toothbrush and water. Brush the teeth of children over age two with a pea-sized amount of fluoride toothpaste. Be sure they spit out the toothpaste and rinse with water. (Ask your child's dentist or physician if you are considering using fluoride toothpaste before age two.) 

Infants should finish their bedtime and naptime bottle before going to bed. Place only formula, milk or breast milk in bottles; avoid putting sugary beverages such as juice or soda in bottles. It’s also important that caregivers take care of their own oral hygiene and avoid sharing saliva with the baby through common use of feeding spoons or licking pacifiers before giving them to babies.
Todd A. Welch, DMD
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.

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 gums with a clean, damp gauze pad or washcloth. This will remove plaque and bits of food that can harm baby teeth erupting. 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.
Prevention of tooth decay from a bottle or nursing is quite simple. Any fluid, breast milk included, except water has the potential to cause decay. The best way for you to deal with prevention is to treat your child’s teeth as you should know to treat your own. With each encounter eating the child’s teeth should be brushed or wiped with a clean wet cloth. The cloth should be used only if brushing proves to be difficult. It is best to continually introduce the toothbrush until the child becomes comfortable with it. If you give your child water, fluoridated is highly recommended to help strengthen the teeth. In the case you feel a bottle is necessary to help put your child to sleep NEVER put a child down for a nap, or to bed at night, with anything but water in their bottle.  
The most important way to prevent your baby from developing tooth decay is to never let your baby go to sleep with a bottle that contains milk or any other sweetened beverage. If your child must use a bottle, try using water or something unsweetened, otherwise use a pacifier to substitute for the bottle. You should also clean your baby's teeth with a moist cloth (from 6-12 months) or a child-sized toothbrush with a tiny amount of toothpaste (from 1-4 years) before bed. 

Most often, it is the upper teeth involved in "baby bottle cavities," because the tongue usually protects the lower teeth during bottle-feeding. The problem is that milk or other carbohydrate-containing liquids stay on the teeth and allow bacteria that are normally present in the mouth to attack the teeth by forming "plaque acids." These acids create holes in the teeth (cavities) and can lead to deeper infections of the tiny nerves within them. The susceptibility to cavities is also increased because the flow of protective saliva is greatly reduced during sleep (that is why it is so important to brush your teeth before bed). These infections can cause your child pain, and will require immediate treatment.
If you are nursing your baby, the best way to prevent tooth decay in your baby is to stick to breast milk as much as possible. Breast milk is the best food for your baby and for your baby's developing teeth because it helps stop bacterial growth as well as the production of damaging acids. But if you alternate breastfeeding with high-sugar drinks (like juice) in a bottle, you may actually speed up the process of tooth decay.

If you are bottle-feeding your baby, there are several steps you can take to help prevent tooth decay. These include the following:
  • Don't let your baby or toddler walk around with a bottle.
  • Aim to wean your baby off the bottle, and onto a cup, by age 12 to 14 months.
  • Don't offer your child more than 6 ounces of juice a day.
  • Don't put your child to bed with a bottle that contains juice, milk, or other drinks (although a bottle that has water in it is OK).
  • Until age 12 months, don't put anything except formula or breast milk into bottles.
By trying the steps above, as well as starting good oral habits early in your child, you will be doing a lot to prevent "baby bottle tooth decay."
Follow these tips to help prevent your baby from having baby bottle tooth decay:
  • Don't give your baby food or drinks at bedtime. Limit frequent eating during the day. Use a pacifier at bedtime instead of a bottle. If your baby must have a bottle at bedtime to sleep, fill the bottle with water.
  • After the bedtime feeding, brush your child's teeth with a very small amount of toothpaste with fluoride (2 to 3 tufts covered on the toothbrush). It is best to brush the teeth; wiping teeth is not as effective and should be avoided.
  • Never dip a pacifier in honey or syrup before you give it to your child.
  • Feed your child a balanced diet.
  • Give fluoride drops as directed by your doctor or dentist. Do not give your child milk with the fluoride drops because milk prevents the fluoride from being used by the body.
  • Do not wait for a problem before you bring your child to the dentist. Children should see a dentist at least by the age of one or when the first tooth erupts into the mouth.
  • Teach your child to drink from a cup as soon as possible (usually by one year old). You can use "sippy cups" to help prevent spills when your child is learning.
To help prevent baby's tooth decay, refrain from nursing or giving the bottle immediately before or during bedtime. The sugars in the milk will cause the dental plaque to produce acid which will eat into the teeth and can cause a cavity. The more time the teeth are exposed to milk, the greater the chance of developing a cavity. If feeding is immediately prior to going to bed, the fluids will stay on the teeth all night. If you must feed prior to bedtime, use a soft wet washcloth to wipe the teeth. 

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.