Baby Bottle Tooth Decay
BABY BOTTLE TOOTH DECAY
Baby bottle tooth decay (BBTD) is a type of early childhood caries (ECC) that affects primary teeth. BBTD is attributed to prolonged bottle feeding, usually during sleep, of cariogenic liquids, such as milk. It occurs in young children who have inadequate dental plaque removal. Some reports suggest that good oral hygiene can delay or prevent BBTD, even when prolonged feeding occurs. BBTD is alternatively called nursing bottle mouth, baby bottle caries, or baby bottle syndrome.
While the etiology of BBTD is still controversial, animal models suggest that milk alone is not causative. Other liquids such as juices, carbonated drinks, and fruit-flavored drinks can support a pattern of decay identical to BBTD. Most experts would attribute BBTD to the combined precipitating factors of a cariogenic liquid containing sugar, susceptible dentition, and the presence of cariogenic microorganisms such as Streptococcus mutans. Identical caries patterns have been reported to occur with prolonged or frequent breastfeeding or feeding with a transitional container such as a "sippy cup."
BBTD has a characteristic clinical pattern, but a strict definition is not agreed upon. The following are indicators of BBTD:
- Decay in two or more of the maxillary primary incisors (top front teeth).
- The mandibular incisors (bottom front teeth) are generally not affected.
- Other primary teeth, may also show decay.
- Dental caries on tooth surfaces usually considered resistant to decay, such as the facial and/or lingual surfaces of the teeth.
- Rapid and early occurrence of dental caries in the life of the primary teeth.
The prevalence of BBTD varies among different populations. It ranges from about 5 percent in the general population to well over 50 percent in selected groups such as Native Americans and some immigrant groups. Within low-income groups, prevalence is about 20 percent, according to some studies. Risk factors that predict BBTD are inadequate plaque removal, a diet rich in cariogenic liquids, and prolonged or frequent feedings with cariogenic liquids. Secondarily, studies have implicated parental lifestyles and ignorance of the condition, child behavioral and sleep problems, a need for frequent feedings, and virulent microflora as additional risk factors.
Prevention of BBTD aims to eliminate risk factors and includes education of parents about causality; the use of alternative liquids such as water for night feeding; substituting another object for the bottle, such as a pacifier or toy; weaning a child from the bottle; and daily plaque removal. Secondary prevention involves the use of home-applied topical fluoride in dentifrice or gel form or office-applied fluoride varnish to halt the decalcification of incipient carious lesions, and, if needed, restoration of early lesions with a material such as a dental cement or composite resin. These
PAUL S. CASAMASSIMO
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