We used to call them “baby bottle cavities” or “nursing caries.” Today, severe decay and tooth destruction in children less than five years old goes by the name of “early childhood caries.”  In the AAP’s A Pediatric Guide to Children’s Oral Health*, the authors elaborate:

[W]e now understand that the process of caries is independent of the route of feeding but is dependent on the frequency of refined carbohydrates in the diet. Early childhood caries is a particularly virulent form of caries that spreads rapidly within the mouth and typically results in severe dental disease.


By the time the first tooth erupts (in most children, between 6-9 months of age), babies should be able to get through the night without breastfeeding or bottle-feeding.  If nighttime feedings are still occurring at this age, wiping or brushing of these first teeth are advised.  Other suggestions regarding the bottle:

  • The only things that should be offered in a bottle is expressed breast milk, infant formula, or water (and not fruit juices, soft drinks, or teas).
  • Don’t let a baby hold his or her own bottle while lying down, especially at nap time or bedtime.  Falling asleep with a bottle in the mouth can lead to the overexposure to sugar, acid, and bacteria, leading to tooth decay (and increasing the risk of ear infections as well).
  •  If a baby with teeth takes a bottle (or nurses from the breast) prior to falling asleep, try to wipe the teeth down with a soft, wet cloth for the night.
  • Your pediatrician will discuss the rapid transition away from a bottle and onto a sippy cup at the 12 month checkup.


A sippy cup can be introduced once a baby is able to sit up on his own.  Only water or formula in the cup is recommended.  Fruit juices should be avoided, and other sugary beverages (soft drinks, sweetened tea, sports drinks) should not be permitted with any regularity, for any young child (especially one with the vulnerable enamel of primary teeth).  Whole milk replaces formula only after the 12 month checkup, and only in a sippy cup (never a bottle).

Most babies today begin eating baby foods at six months of age. Encouraging healthy choices (“real” foods like high nutrient fruits, vegetables, and minimally processed whole grains, rather than highly processed, low nutrient, calorically-dense packaged foods) and avoiding foods that stick to the teeth (raisins, fruit “snacks”, chewy and hard candies) are important principles that should be followed by all children.  Since the bacteria that ultimately cause tooth decay can be transmitted, parents should be discouraged from swapping saliva by pre-tasting, pre-chewing, or sharing utensils.  Finally, for the same reasons, parents should not attempt to clean a fallen pacifier with their own mouths(!).

On the subject of pacifiers:

  •  Pacifiers should never be dipped in sugary substances such as honey and sugar.
  •  Pacifiers should never be used to replace or delay meals and should be offered only when the caregiver is certain the child is not hungry.
  •  Pacifiers should be one piece and made of a durable material, replaced when worn, and never tied by a string to the crib or around a child’s neck or hand.
  •  Physiologic pacifiers are preferable to conventional pacifiers because they may have less dental effects.


Tomorrow, we’ll finish our look at pediatric dental health by discussing toothbrushing, flossing, and fluoride.

(*American Academy of Pediatrics. A Pediatric Guide to Children’s Oral Health. Elk Grove Village, IL: American Academy of Pediatrics; 2009)