Baby Bottle Tooth Decay Defined

What is baby bottle tooth decay and how can I avoid it in my one year old son? This is a great service! Thank you!
San Anselmo, California

Dr. Greene’s Answer:

Your question comes at a great time. Most of the problems associated with falling asleep with a bottle begin to emerge after a child is one year old.

Cavities result from the interaction between normal mouth bacteria and carbohydrates in the diet. The sugars are converted to acids as they are fermented by the bacteria. The acid then etches the enamel of the teeth if there is prolonged contact. Saliva helps to prevent cavities by digesting the sugars and by washing the teeth.

When one falls asleep, saliva production decreases rapidly. Swallowing also decreases, and liquids present in the mouth at the time of falling asleep tend to pool for long periods.

Baby-bottle tooth decay is the specific form of severe decay found in the teeth of infants and toddlers who fall asleep with a bottle of milk, juice, or any sweetened liquid in the mouth. It is the only severe dental disease common in children under three years of age.

Unlike adult cavities, which are largely invisible, baby-bottle tooth decay causes cavities on the visible portion of the front teeth. The top four central teeth are the ones affected. Their counterparts in the lower gum, protected by the tongue during sucking and washed by saliva, usually remain sound.

The process of tooth decay is quite gradual. Over time the teeth are weakened. Usually, the enamel is finally breached sometime between 12 and 18 months of age. The cavities first appear at the gum line as subtle, white, decalcified streaks. The process then begins to accelerate. In advanced cases, the crowns of the four upper incisors are completely destroyed, leaving decayed brownish-black stumps which distort the spacing of the permanent teeth. I have seen this many, many times.

Cavities may not seem like a big deal, and your son could be happy even with them. But these are the only teeth he will have during the years when much of his personality and self-image are formed. Even though it may seem loving to give him a bottle to go to sleep, it may be more loving to help him fall asleep in other ways.

The most effective way to decrease the risk of baby bottle tooth decay is to avoid giving a child a bottle to fall asleep. If removing the nighttime feed is not possible, keeping a child awake for even fifteen minutes after feeding can significantly help his teeth.

The American Academy of Pediatric Dentistry also recommends starting a dental hygiene routine as soon as a child grows their first tooth. A soft toothbrush or washcloth can be used to clean an infant’s teeth at least twice a day. The AAPD also advises that children see the dentist for the first time at one year of age.

Dr. Alan Greene

As a father of four himself, Dr. Greene has devoted himself to freely giving real answers to parents' real questions -- from questions about those all too common childhood conditions to those that address the most recent and rare pediatric illnesses. His answers combine cutting edge science, practical wisdom, warm empathy, and a deep respect for parents, children, and the environment. He is also an electrifying public speaker, and has personally touched many during his talks in North America, Europe, Asia, and the Middle East.

Dr. Greene is a graduate of Princeton University and the University of California at San Francisco. Upon completion of his pediatric residency program at Children's Hospital Medical Center of Northern California he served as Chief Resident. He entered primary care pediatrics in January 1993.

Dr. Greene is the Past President of The Organic Center and on the Board of Directors of Healthy Child Healthy World. He is a founding partner of the Collaborative on Health and the Environment. He also consults for the Environmental Working Group.

In 1995, he launched, cited by the AMA as “the pioneer physician Web site” on the Internet. His award-winning site has received over 80 million Unique Users from parents, concerned family members, students, and healthcare professionals. In addition to being the founder of, he is the Medical Director for HealthTap.

In 2010 Dr. Greene founded the WhiteOut Movement to change how babies in the United States are fed. In 2012 he founded TICC TOCC - Transitioning Immediate Cord Clamping To Optimal Cord Clamping. He is also the founder of KidGlyphs, a free iPhone app that provides a tool for young children to express themselves beyond their verbal skills while teaching them important language skills.

Dr. Greene is the Founding President of the Society for Participatory Medicine and has served as both President and Board Chair of Hi-Ethics (Health Internet Ethics. He is on the Board of Directors for Healthy Child Healthy World, The Lunchbox Project, and The Society for Participatory Medicine. He has also served as an advisor to URAC for both their inaugural and their updated health web site accreditation program. He is a founding member of the e-Patient Scholars Working Group, and a founding board member of the Center for Information Therapy.

Dr. Greene is a regular columnist for Parenting Magazine. He is also the Pediatric Expert for The People’s Pharmacy (as heard on NPR) and Healing Quest (seen on PBS stations). He was the original Pediatric Expert for both Yahoo! and iVillage.

Dr. Greene is the author of Feeding Baby Green (Wiley, 2009), Raising Baby Green (Wiley, 2007), From First Kicks to First Steps (McGraw-Hill, 2004), The Parent's Complete Guide to Ear Infections (People's Medical Society, 1997), and a co-author of The A.D.A.M. Illustrated Family Health Guide (A.D.A.M., Inc., 2004). He is the medical expert for three additional books, The Parent's Soup A-to-Z Guide to Your New Baby, (Contemporary Books, 1998) The Parent's Soup A-to-Z Guide to Your Toddler, (Contemporary Books, 1999), and The Mother of All Baby Books, (Hungry Minds, Inc., 2002).

Dr. Greene is a frequent keynote speaker at important events such as Health 2.0 2011 held in San Diego, CA, IFOAM 2008 (International Federation of Organic Agriculture Movements), held in Modena Italy, the first European Internet health conference, held in Maastricht, the first International eHealth Association Conference, held in Jeddah, and the largest e-Healthcare World Conference, held in Las Vegas, and the first Green Power Baby Shower, held in Hollywood. Dr. Greene also appears frequently on TV, radio, websites, and in newspapers and magazines around the world, including such venues as the TODAY Show, Good Morning America, Fox and Friends, The Dr. Oz Show, CNN, ABC, CBS, and NBC network news, NPR, The New York Times, The Wall Street Journal, USA Today, Time Magazine, Parade, Parenting, Child, Baby Talk, Working Mother, Better Home's & Gardens, and the Reader's Digest.

Dr. Greene loves to think about challenging ideas, he enjoys being where nothing manmade can be seen, and he wears green socks.

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