The term “baby bottle tooth decay” refers to early childhood caries (cavities), occurring in infants and toddlers. Baby bottle tooth decay may affect any of the teeth, but is most prevalent in the top front teeth.

If the decay becomes too severe, the dentist may be unable to save the affected tooth. In such cases, the damaged tooth is removed, and a space maintainer is provided to prevent misalignment of the remaining teeth.

The most frequent cause of tooth decay is prolonged exposure to sugar liquids – which can happen when drinking liquids (including breast milk, baby formula, juice, and sweetened water) from a bottle (which is where the term ‘baby bottle tooth decay’ comes from).

Acid-producing bacteria in the oral cavity also causes tooth decay. You can pass these bacteria to your child through your saliva on things like pacifiers or spoons.

Infants who are not receiving an appropriate amount of fluoride are at increased risk for tooth decay. Fluoride works to protect tooth enamel, simultaneously reducing mineral loss and promoting mineral reuptake.

You can prevent tooth decay by scheduling regular checkups with a dentist, implementing a good homecare routine and avoiding transmitting bacteria to your child via saliva exchange (rinse pacifiers and toys in clean water, and use a clean spoon for each person eating).

Some other tips for prevention are:

• Clean gums after every feeding with a clean washcloth.
• Use an appropriate toothbrush along with an ADA-approved toothpaste to brush when teeth begin to emerge.  Fluoride-free toothpaste is recommended for children under the age of two.
• Use a pea-sized amount of ADA-approved fluoridated toothpaste when the child has mastered the art of “spitting out” excess toothpaste. Though fluoride is important for teeth, too much consumption can result in a condition called fluorosis.
• Do not place sugary drinks in baby bottles or sippy cups. Only fill these containers with water, breast milk, or formula. Encourage the child to use a regular cup (rather than a sippy cup) when the child reaches twelve months old.
• Do not dip pacifiers in sweet liquids (honey, etc.).
• Review your child’s eating habits. Eliminate sugar-filled snacks and encourage a healthy, nutritious diet.
• Do not allow the child to take a liquid-filled bottle to bed. If the child insists, fill the bottle with water as opposed to a sugary alternative.

The eruption of primary teeth (also known as deciduous or baby teeth) follows a similar developmental timeline for most children. A full set of primary teeth begins to grow beneath the gums during the fourth month of pregnancy. For this reason, a nourishing prenatal diet is of paramount importance to the infant’s teeth, gums, and bones.

Generally, the first primary tooth breaks through the gums between the ages of six months and one year. By the age of three, most children have a “full” set of twenty primary teeth. Dentists communicate with parents and children about prevention strategies.

As a general rule-of-thumb, the first teeth to emerge are the central incisors (very front teeth) on the lower and upper jaws (6-12 months). These (and any other primary teeth) can be cleaned gently with a soft, clean cloth to reduce the risk of bacterial infection. The central incisors are the first teeth to be lost, usually between 6 and 7 years of age.

Next, the lateral incisors (immediately adjacent to the central incisors) emerge on the upper and lower jaws (9-16 months). These teeth are lost next, usually between 7 and 8 years of age. First molars, the large flat teeth towards the rear of the mouth, then emerge on the upper and lower jaws (13-19 months). The eruption of molars can be painful. Clean fingers, cool gauzes, and teething rings are all useful in soothing discomfort and soreness. First molars are generally lost between 9 and 11 years of age.

Canine (cuspid) teeth then tend to emerge on the upper and lower jaws (16-23 months).  Canine teeth can be found next to the lateral incisors and are lost during preadolescence (10-12 years old). Finally, second molars complete the primary set on the lower and upper jaw (23-33 months). Second molars can be found at the very back of the mouth and are lost between the ages of 10 and 12 years old.

Though each child is unique, baby girls generally have a head start on baby boys when it comes to primary tooth eruption. Lower teeth usually erupt before opposing upper teeth in both girls and boys.

Teeth usually erupt in pairs – meaning that there may be months with no new activity and months where two or more teeth emerge at once.  Due to smaller jaw size, primary teeth are smaller than permanent teeth, and appear to have a whiter tone.

There are several things parents can do to make the first visit enjoyable.

Some helpful tips are listed below:

• Take another adult along for the visit: Sometimes infants become fussy when having their mouths examined. Having another adult along to soothe the infant allows the parent to ask questions and to listen to any advice the dentist may have.
• Leave other children at home: Other children can distract the parent and cause the infant to fuss. Leaving other children at home (when possible) makes the first visit less stressful for everyone.
• Avoid intimidating language: Our staff are trained to avoid the use of language like drills, needles, injections, and bleeding. It is imperative for parents to use positive language when speaking about dental treatment with their child.
• Provide positive explanations: It is important to explain the purposes of the dental visit in a positive way.  Explaining that the dentist “helps keep teeth healthy” is far better than explaining that the dentist “is checking for tooth decay and might have to drill the tooth if decay is found.”

Caring for your child’s dental health is critical for the following reasons:

• Speech production and development: Learning to speak clearly is crucial for cognitive, social, and emotional development.  The proper positioning of primary teeth facilitates correct syllable pronunciation and prevents the tongue from straying during speech formation.
• Eating and nutrition: Children with malformed or severely decayed primary teeth are more likely to experience dietary deficiencies, malnourishment, and to be underweight.  Proper chewing motions are acquired over time and with extensive practice.  Healthy primary teeth promote good chewing habits and facilitate nutritious eating.
• Straighter smiles: One of the major functions of primary teeth is to hold an appropriate amount of space for developing adult teeth. In addition, these spacers facilitate the proper alignment of adult teeth and also promote jaw development. Left untreated, missing primary teeth cause the remaining teeth to “shift” and fill spaces improperly. For this reason, dentists often recommend space-maintaining devices.
• Excellent oral health: Badly decayed primary teeth can promote the onset of childhood periodontal disease. As a result of this condition, oral bacteria invade and erode gums, ligaments, and eventually bone. If left untreated, primary teeth can drop out completely. To avoid periodontal disease, children should practice an adult-guided oral care routine each day, and infant gums should be rubbed gently with a clean, damp cloth after meals.

Fluorine, a natural element in the fluoride compound, has proven to be effective in minimizing childhood cavities and tooth decay. Fluoride is a key ingredient in many popular brands of toothpaste, oral gel, mouthwash and can also be found in most community water supplies. Though fluoride is an important part of any good oral care routine, overconsumption can result in a condition known as fluorosis. The pediatric dentist is able to monitor fluoride levels, and check that children are receiving the appropriate amount.

Fluoride fulfills two important dental functions: it helps staunch mineral loss from tooth enamel, and it promotes the remineralization of tooth enamel.

Pregnancy is an important time for the unborn child’s oral and overall health. The “perinatal” period begins approximately 20-28 weeks into the pregnancy, and ends 1-4 weeks after the baby is born. With so much to do to prepare for the new arrival, a dental checkup is often the last thing on an expectant mother’s mind.

There are links between maternal periodontal disease (gum disease) and premature babies, babies with low birth weight, maternal preeclampsia, and gestational diabetes.  It is of paramount importance therefore, for mothers to maintain excellent oral health throughout the entire pregnancy.

Since sucking is a natural, instinctual baby habit, infants derive a sense of comfort, relaxation, and security from using a thumb or pacifier as a sucking aid.

According to research from the American Academy of Pediatric Dentistry (AAPD), the vast majority of children will cease using a pacifier before the age of four years old. Thumb sucking can be a harder habit to break and tends to persist for longer without intervention. Children who continue to suck thumbs or pacifiers after the age of five (and particularly those who continue after permanent teeth begin to emerge) are at high-risk for developing dental complications.

Pacifier and thumb sucking damage can be difficult to assess with the naked eye, and both tend to occur over a prolonged period of time. Below is an overview of some of the risks associated with prolonged thumb sucking and pacifier use:

• Jaw misalignment: Over time, pacifiers and thumbs can guide the developing jaws out of correct alignment.
• Tooth decay: Many parents attempt to soothe infants by dipping pacifiers in honey, or some other sugary substance. Oral bacteria feed on sugar and emit harmful acids. The acids attack tooth enamel and can lead to pediatric tooth decay and childhood caries.
• Roof narrowing: The structures in the mouth are extremely pliable during childhood. Prolonged, repeated exposure to thumb and pacifier sucking actually cause the roof of the mouth to narrow (as if molding around the sucking device). This can cause later problems with developing teeth.
• Slanting teeth: Growing teeth can be caused to slant or protrude by thumb and pacifier sucking, leading to poor esthetic results. In addition, thumb sucking and pacifier use in later childhood increases the need for extensive orthodontic treatments.
• Mouth sores: Passive sucking is much less harmful than aggressive sucking. Aggressive sucking (popping sounds when the child sucks) may cause sores or ulcers to develop.