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Little ones bring a lot of joy and their smile fills your day with brightness. But dental cavities in young children can cause toothache and stained teeth. Doesn’t sugar in the diet cause dental cavities? So how could a bottle-fed child get dental cavities?

Nursing bottle caries are defined as dental caries that usually occur in toddlers and infants due to feeding bottles. Several other terms have been used to describe this peculiar caries condition, such as baby bottle-fed tooth decay, nursing caries, early childhood caries, blanket caries, and early childhood tooth decay.

The main cause of nursing bottle caries is inappropriate nursing practices for toddlers and infants. Additionally, improper design of feeding bottles in early childhood also leads to nursing bottle caries.

Why do feeding bottles cause caries?

Nursing bottle caries are associated with the use of inappropriate baby bottles. Using baby bottles containing sweet milk for too long, especially before going to bed is one of the main factors causing nursing bottle caries.

Milk or formula contains lactose and other sweet compounds that trigger nursing bottle caries. Several studies have confirmed that there is a strong correlation between bottle feeding and bottle sleeping and the incidence of nursing bottle caries.

Apart from bottle-fed babies, breast milk-fed babies are also susceptible to dental caries. Breast milk is an essential nutritional component for infants. Breastfeeding provides various health benefits to the infant, such as a reduced risk of respiratory and gastrointestinal infections.

However, there is one potential disadvantage: softening of tooth enamel in infants can occur due to prolonged contact between tooth enamel and breast milk.

Prolonged exposure to breast milk or cow's milk on the tooth surface and inadequate oral hygiene practices contribute significantly to the development of carious lesions and tooth eruption in infants and toddlers. In addition, lowered saliva production in infants and toddlers at night increases the risk of nursing bottle caries.

Less saliva leads to higher lactose levels and persistent dental plaque. At night, a decrease in the protective power of saliva and a shift in the balance towards demineralization in the baby's mouth causes persistent dental plaque.

Carbohydrate content in breast milk can be fermented into simple sugars such as lactose by oral bacteria such as Streptococcus sobrinus and Streptococcus mutans. These pathogens produce acids that can dissolve the tooth structure, thereby triggering a carious lesion.

Prevention

Several different strategies are necessary to prevent nursing bottle caries. Since dental caries can have a negative psychosocial impact and it is difficult to treat cavities in early childhood, preventative measures are the first strategy used.

Patient education is a critical tool in prevention strategies. Nursing bottle caries are more common in disadvantaged groups or low socioeconomic groups.

In general, training mothers and caregivers on how to safely use a feeding bottle is a very important factor. Providing a healthy diet in early childhood can minimize the risk of bottle-feeding caries. Since cariogenic bacteria can transfer from mothers and other caregivers to babies, educating mothers/caregivers is crucial.

The American Academy of Pediatric Dentistry has published guidelines to prevent nursing bottle caries.

These guidelines include bottle feeding and dental/ oral hygiene care in early childhood. The use of bottles filled with milk should be done in a careful manner for a limited time to prevent prolonged exposure to the baby's tooth enamel.

Mothers can wean their babies from bottles after one year of age. At night, avoid foods that are sweet and rich in carbohydrates for early childhood.

Using fluoride in the form of toothpaste, mouthwash, or lozenges can optimize oral and dental hygiene in children.

Furthermore, concentrated topical fluoride with resin (known as fluoride varnish) is the right choice for preventing caries in early childhood. Fluoride varnish increases the exposure of fluoride to tooth enamel when exposed to saliva. The risk of caries and demineralization in early childhood teeth can be significantly reduced by the application of fluoride varnish.

Treatment

Nursing bottle caries treatment can be done through various medical interventions based on the severity and age of the child. A dental exam, x-ray, and detailed history are done before developing a treatment plan.

Restorative therapy can be used to treat carious lesions. For some children, general anesthesia may be required for conducting restorative therapy. Restorations using stainless steel crowns may be performed in case of severe caries in the primary and permanent teeth enamel. The procedure can restore the shape of the teeth damaged by nursing bottle caries.

Atraumatic Restorative Treatment (ART) is another procedure that can be done to treat caries in early childhood. It is a procedure to remove carious tooth tissue. This medical intervention is carried out through cavity restoration using adhesive restorative materials such as glass ionomer.

It is a pain-free, cost-effective, and reliable medical procedure. ART also does not traumatize children because it does not use complex medical instruments and does not require local anesthesia.

Glass ionomer cement in ART procedures is used to produce chemical adhesion to the tooth surface thereby optimizing fluoride exposure and biocompatibility in the mouth of early childhood. This glass ionomer cement can cover the gaps and cavities of adjacent teeth. All stages of the ART procedure must be carried out by dentists to optimize dental restoration efforts in early childhood. ART is a popular treatment with favorable outcomes to treat nursing bottle caries.

Conclusion

Recent estimates suggest that about 85% of children experience cavities before their sixth birthday. Nursing bottle caries can be prevented or minimized when dentists and parents work together toward that goal.

Key takeaways

Bottle-fed infants, as well as breast-fed infants, are prone to getting dental cavities, also known as caries.

Nursing bottle caries are caused by the softening of tooth enamel in infants due to prolonged contact between tooth enamel and bottle formula or breast milk.

Patient education is a critical tool in prevention strategies.

Treatment may involve surgery to remove the damaged teeth, or by using dental cement to cover the gaps and cavities of adjacent teeth.

References:

Alhabdan, Y.A., Albeshr, A.G., Yenugadhati, N. and Jradi, H. (2018). Prevalence of Dental Caries and Associated Factors among Primary School Children: A Population-Based Cross-Sectional Study in Riyadh, Saudi Arabia. Environ Health Prev Med.

Anil, S. and Anand, P.S. (2017). Early Childhood Caries: Prevalence, Risk Factors, and Prevention. Front Pediatr.

Colak, H., Dülgergil, C.T., Dalli, M. and Hamidi, M.M. (2013). Early Childhood Caries Update: A Review of Causes, Diagnoses, and Treatments. J Nat Sci Biol Med.

Dahas, Z.A., Khormi, H.A., Vishwanathaiah, S., et. al. (2020). Correlation of Feeding Practices and Dental Caries among Preschool Children of Jazan, Ksa: A Cross-Sectional Study. Int J Clin Pediatr Dent.

Duangthip, D., Chen, K.G., Gao, S.S., Lo, E.C.M. and Chu, C.H. (2017). Managing Early Childhood Caries with Atraumatic Restorative Treatment and Topical Silver and Fluoride Agents. Int J Environ Res Public Health.

Ercan, E., Dülgergil, C.T., Soyman, M., Dalli, M. and Yildirim, I. (2009). A Field-Trial of Two Restorative Materials Used with Atraumatic Restorative Treatment in Rural Turkey: 24-Month Results. J Appl Oral Sci.

Latifi-Xhemajli, B., Rexhepi, A., Veronneau, J., Kutllovci, T., Ahmeti, D. and Bajrami, S. (2021). Streptococcus Mutans Infections in Infants and Related Maternal/Child Factors. Acta Stomatol Croat.

American Academy of Pediatric Dentistry. Policy on Early Childhood Caries (Ecc): Classifications, Consequences, and Preventive Strategies.

Van Loveren, C. (2004). Sugar Alcohols: What Is the Evidence for Caries-Preventive and Caries-Therapeutic Effects? Caries Res.

Weintraub, J.A., Ramos-Gomez, F., Jue, B., Shain, S., Hoover, C.I., Featherstone, J.D. and Gansky, S.A. (2006). Fluoride Varnish Efficacy in Preventing Early Childhood Caries. J Dent Res.

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