Bottle rot, or early childhood caries (ECC), is severe tooth decay affecting infants and young children. It can begin as soon as a baby’s first teeth emerge, typically impacting children between birth and 71 months of age.
Understanding Bottle Rot
Bottle rot impacts deciduous (baby) teeth. It describes the rapid progression of tooth decay, often appearing in the upper front teeth first, as these are frequently exposed to liquids from bottles. Bacteria in the mouth convert sugars into acids, which then erode the tooth enamel.
Early signs of bottle rot can include chalky white or yellow spots or lines on the tooth surface, particularly near the gum line. As the decay progresses, these spots may turn brown or black, eventually leading to visible holes or pits in the teeth. Affected children might experience pain or sensitivity, and in more advanced stages, swollen or red gums and bad breath can develop.
How Common is Bottle Rot?
Early childhood caries is a global public health issue. Approximately half of all preschool children worldwide are affected, with a global pooled prevalence estimated at 48%. Prevalence varies considerably across regions and countries.
For example, studies indicate that the prevalence can range from 30% in Africa to as high as 82% in Oceania. In North America, the prevalence has been reported around 63%, while Asia shows a prevalence of about 52%. Socioeconomic factors often influence the commonality of this condition, with lower socioeconomic populations facing an increased risk.
Main Causes of Bottle Rot
Bottle rot primarily results from prolonged exposure of teeth to sugary liquids. This often occurs when infants fall asleep with a bottle containing milk, formula, juice, or other sweetened beverages. Sugars in these liquids feed naturally occurring mouth bacteria, such as Streptococcus mutans and Lactobacillus.
These bacteria metabolize the sugars and produce acids that attack and demineralize the tooth enamel. During sleep, decreased saliva production reduces the mouth’s natural ability to wash away sugars and neutralize acids, allowing them to linger on teeth. Frequent snacking or sipping on sugary drinks throughout the day also contributes by continuously bathing the teeth in sugar. Additionally, bacteria can be transmitted from caregivers to infants through shared saliva, such as by sharing utensils or cleaning a pacifier in the mouth.
Preventing Bottle Rot
Preventing bottle rot involves adopting oral hygiene and dietary habits from an early age. Parents should avoid putting babies to bed with bottles containing anything other than water, as even milk contains natural sugars that can contribute to decay. If a bottle is needed for comfort at bedtime, it should only contain plain water.
Introducing a cup by around 12 to 18 months of age is beneficial, as prolonged bottle use can increase the risk of tooth decay and potentially affect jaw development. Cleaning a baby’s gums with a soft, damp cloth twice a day, even before teeth erupt, helps remove bacteria and prepares them for future brushing. Once the first tooth appears, it is recommended to begin brushing twice daily with a soft, small-bristled toothbrush and an age-appropriate amount of fluoride toothpaste, typically a smear or rice-grain size for children under three.
Scheduling a child’s first dental visit by their first birthday or within six months of their first tooth erupting is important. These early visits allow dentists to assess risk, provide guidance on proper oral care, and offer preventive measures. Regular dental check-ups and consistent at-home oral care protect a child’s dental health.