Early Childhood Tooth Decay - What is "Bottle Rot"? By Dr. Narmin Azizova

Children typically begin to grow their first teeth around the age of 6 months. From this point on, they are at risk for tooth decay. In infants and children between 12 to 18 months, tooth decay is commonly referred to as “bottle rot” or “early childhood caries.” It usually affects the upper front teeth, but any of the teeth in the mouth can be affected. Sometimes, the decay progresses rapidly, making dental treatments ineffective and leading to the extraction of the affected teeth. However, it is important to remember that tooth decay is a preventable disease.

Tooth decay is a contagious condition that occurs when bacteria that cause decay are transmitted from the mother or another close contact through saliva. This typically happens when the caregiver tests the temperature or taste of the child’s food using their own mouth or cleans the baby bottle nipple with their saliva. These bacteria are spread through saliva and can lead to the development of cavities in young children.

Additionally, tooth decay can be caused by the frequent and prolonged consumption of sugary substances by infants. For example, syrup, honey milk, fruit juices, and formula can increase the risk of decay. If a baby is accustomed to drinking sugary liquids before bedtime or using a bottle as a pacifier to fall asleep, this creates an ideal environment for the development of tooth decay. Sugary liquids collect between the teeth, and the bacteria in the mouth feed on these sugars to produce acids. The teeth are exposed to these acids for 20 minutes or longer each time, and repeated exposure leads to the breakdown of the enamel and the formation of cavities.

Some parents mistakenly believe that primary (baby) teeth are not important because they will eventually be replaced. However, this is a major misconception. Primary teeth play an essential role in chewing, speaking, and the development of proper oral habits. Decay in primary teeth can affect the growth of the jaw and misalign permanent teeth, causing orthodontic problems in the future. Additionally, the appearance of primary teeth impacts a child’s speech development. Misformed or missing front teeth can lead to speech disorders, such as difficulty pronouncing certain sounds. Aesthetic issues may also cause emotional and psychological problems for the child, affecting their self-esteem.

How to Prevent Bottle Rot and Tooth Decay
By following these guidelines, you can help protect your child from tooth decay:

1. Visit the Dentist Early: Schedule your child’s first dental visit as soon as their first tooth appears, or at least by their first birthday. Early dental check-ups help ensure proper oral health development.
2. Prevent Bacterial Transmission: Consider where the bacteria that cause decay might have come from. Be mindful of oral hygiene for caregivers and avoid transferring bacteria by not sharing spoons, bottles, or pacifiers.
3. Clean After Meals: Wipe your baby’s gums or teeth with a clean cloth after each meal. This helps remove food particles and prevents plaque buildup. Once teeth are fully visible, start brushing with a soft toothbrush and water.
4. Use Fluoride Toothpaste: Once your child can spit out toothpaste (around age 2), you can begin using fluoride toothpaste. Fluoride helps prevent decay and strengthens enamel.
5. Supervise Brushing Until Age 8: Children typically lack the fine motor skills to brush effectively until they are about 8 years old. Supervise and assist with brushing until then.
6. Avoid Sugary Liquids: If you use a bottle for feeding, avoid filling it with anything other than formula, breast milk, or plain water. Steer clear of sugary liquids like juice, sweetened milk, or honey, as they increase the risk of cavities.
7. No Bottle in Bed: Avoid putting your child to bed with a bottle of sugary liquid. If they are used to falling asleep with a bottle, provide only water to avoid exposing their teeth to sugars overnight.
8. Don’t Dip Pacifiers in Sugar: Avoid dipping pacifiers in honey or sugar, which increases the risk of cavities. Also, avoid cleaning pacifiers by sucking on them yourself, as this can transfer decay-causing bacteria to your child.
9. Introduce a Cup by Age 1: Start transitioning your child from the bottle to a sippy cup by the age of 12-14 months. This helps reduce the prolonged exposure to sugary liquids.
10. Encourage Healthy Snacks: Offer a variety of fruits and vegetables. Limit sugary snacks, and try to reduce your child’s intake of chocolate and candy.
11. Brush Twice a Day: Children under the age of 2 should have their teeth brushed once a day, ideally before bedtime. After 2 years old, aim for brushing at least twice a day—morning and night.
12. Use Age-Appropriate Toothbrushes: Choose a toothbrush with soft bristles that fits comfortably in your child’s mouth. Ensure the brush is the correct size for their age and development.
13. Use the Right Fluoride Toothpaste: Dentists recommend using toothpaste with 500 ppm fluoride (0.05% fluoride) for children under 6 years old. For older children, use toothpaste with 1000-1500 ppm fluoride (0.1-0.15%). Be sure to choose a fluoride toothpaste without fruit or sugar flavors to avoid accidental swallowing.

Statistical Information
According to the World Health Organization (WHO), dental diseases such as tooth decay affect nearly 60-90% of school-age children and a significant proportion of adults worldwide. Early childhood caries is a leading cause of dental problems in children, and it has long-term consequences for oral health if left untreated. Preventive care is crucial to reduce the global burden of dental disease, and early intervention significantly decreases the likelihood of severe decay later in life.

To prevent such widespread problems, WHO advocates for better oral health practices, including reducing the consumption of sugary foods and drinks, promoting good oral hygiene habits, and ensuring that children receive dental care from an early age.

By following these preventive measures and seeking regular dental care, you can help your child maintain healthy teeth and avoid the consequences of bottle rot and early childhood tooth decay.