Tooth decay - early childhood
Tooth decay in early childhood occurs most often in the upper and lower front teeth (incisors) and can be a serious problem.
Bottle mouth; Bottle carries; Baby bottle tooth decay; Early childhood caries (ECC)
Your child needs strong, healthy baby teeth. These teeth help your child chew food, speak, and have enough space in his or her jaw for the adult teeth to grow in straight.
Tooth decay can happen when your child's teeth come in contact with too much sugar. This sugar helps bacteria grow. Acids that the bacteria make cause the teeth to decay.
Many of the liquids that your child drinks contain sugar, including milk, formula, and fruit juices. Eating snacks with sugar also places more sugar on your child's teeth.
How often your child drinks liquids containing sugar, and how long the sugar stays in the mouth are also important. When children sleep or walk around with a bottle or sippy cup in their mouth, sugar coats their teeth for longer periods of time, causing teeth to decay more quickly.
Breast milk by itself is the healthiest food for babies’ teeth. It tends to slow bacterial growth and acid production. However, when breast milk is alternated with sugary foods or drinks, the rate of tooth decay can be faster than with sugar alone.
Feeding tips to prevent tooth decay:
- Do NOT fill your child's bottle with fluids that are high in sugar, such as punch, gelatin, or soft drinks.
- Put your child to bed with a bottle of water only -- not juice, milk, or other drinks.
- Give children ages 6 - 12 months only formula to drink in bottles.
- Remove the bottle or stop nursing when your child has fallen asleep.
- Avoid letting your child walk around using a bottle of juice or milk as a pacifier. Avoid prolonged use of pacifiers and do NOT dip the pacifier in honey, sugar, or syrup.
- Begin teaching your child to drink from a cup at around 6 months of age. Try to stop using a bottle by age 12 - 14 months.
- Limit juice to fewer than 6 ounces per day during meals.
Tips for caring for your child's teeth:
- After each feeding, gently wipe your child's teeth and gums with a clean washcloth or gauze to remove plaque.
- Begin toothbrushing as soon as your child has teeth. Brush your teeth together, at least at bedtime. If you have an infant or toddler, place a small amount of non-fluoridated toothpaste on a washcloth and rub gently on their teeth. You can switch to fluoridated toothpaste when you are sure that your child spits out all of the toothpaste after brushing. Older children can use a toothbrush with soft, nylon bristles. Use a very small amount of toothpaste (no more than the size of a pea).
- Begin flossing children's teeth when all of the primary (baby) teeth have erupted (usually around age 2 1/2).
- If your baby is 6 months or older, use fluoridated water or a fluoride supplement if you have well water without fluoride. If you use bottled water, make sure it contains fluoride.
- Inspect your child's teeth regularly and begin dental visits when all of the baby teeth have erupted or at age 2 or 3, whichever comes first.
Douglass JM, Douglass AB, Silk HJ. A practical guide to infant oral health. Am Fam Physician. 2004;70:2113-2120.
Dental caries. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 304.
Ribeiro NM, Ribeiro MA. Breastfeeding and early childhood caries: a critical review. J Pediatr (Rio J). 2004;80:S199-S210.
Sexton S, Natale R. Risks and benefits of pacifiers. Am Fam Physician. 2009;79:681-685.
Touger-Decker RJ. Position of the American Dietetic Association: oral health and nutrition. J Am Diet Assoc. 2007;107:1418-1428.
Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.