Nursing Bottle Caries (Baby Bottle Tooth Decay)


Nursing bottle caries are also known  as early childhood cavities or baby bottle tooth decay. It is a unique pattern of dental cavities that are commonly seen in toddlers and infants, who exhibit improper feeding habits. Bottle feeding is the most commonly associated factor in development of nursing bottle caries. It is largely due to a bacterial infection and its prevalence is epidemic.


The pattern of decay is characteristic in the case of nursing bottle caries. It only affects the deciduous teeth (milk teeth) and follows a definite pattern of involvement of the teeth. First affected of the teeth are maxillary central incisors followed by the maxillary lateral incisors. Maxillary first molars and maxillary canines are the teeth which are affected next. As the disease progresses even mandibular molars get involved. However, mandibular incisors are not affected by nursing bottle caries mostly due to the protection from the tongue and cleansing action of saliva.

The initial lesion develops as a dull, white and opaque area on the tooth surface along the gum line, on the front aspect of maxillary upper incisors. Eventually demineralization becomes more evident and the white patches turn in to cavities. These cavities surround the neck of the tooth in a ring like manner. As the lesion progresses, the whole tooth is involved. The carious lesion destroys the entire crown part of the tooth, leaving behind brown, black root stumps.


The bacteria causing nursing bottle caries is known as Streptococcus mutans. It is transmitted to the infant primarily through mother. The bacterium accumulates on the tooth and produces large amounts of acids. this leads to demineralization of the tooth surface. The following factors are responsible for the nursing caries due to their high amount of fermentable carbohydrates :

  • Bovine milk
  • Milk substitutes
  • Breast milk
  • Fruit juices
  • Sugar syrups
  • Additional sweeteners such as honey or sugar dipped pacifiers.


The treatment is aimed at arresting and controlling of the carious process. Restoration of the affected teeth is of primary importance. Treatment varies according to the extent of the lesion, age of the patient and certain behavioral problems due to very young age of the child.

The treatment is a multi step process and requires several dental visits.

First visit comprises of excavation of all carious lesions followed by their restoration. Dental cements and dental composites are the materials used for restoring these teeth. Draining of abscesses has to be carried out in the first visit. Collection of the saliva samples for carious activity detection is done. Oral prophylaxis and topical application of fluorides is carried out.

Parent counseling regarding the child’s eating habits and diet pattern is also an essential part of the treatment. The second visit comprises of analysis of diet charts and reassessment of restorations. Caries activity test is performed in the second dental visit. Subsequent visits involve procedure such as restoration of all grossly decayed teeth. Endodontic therapy and extractions are carried out at this stage.

The patient is recalled after every 3 months for check-ups.

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