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Parents weren’t good parents if they would not wish all the best to their children. Small children often cry to get attention, which immediately forces the parents (especially those young and inexperienced) to search for the causes of crying and ways to quickly calm the child. In order to calm the child, parents resort to various “means and methods” of which breastfeeding or putting pacifier or bottle of milk into baby’s mouth often proved to be the most effective. In those moments (especially at night), parents generally do not think about the possible adverse effects that may be hazardous to dental health of their children. In fact, breastfeeding and consumption of food and/or liquids that contain sugar, including milk or formula, may have permanent consequences on primary teeth, causing specific form of caries that in the academic literature are described as – bottle caries, infant caries, circular cavity, early childhood dental caries, baby bottle tooth decay, rampant caries etc.
What is the baby bottle caries?
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How is baby bottle decay developed?
1) there must be a tooth (host) present in the mouth on which caries may develop;
2) there must be bacteria in the mouth whose actions destroy tooth;
3) there must be a substrate (food for bacteria) – sugar (from milk, formula, food or sweet beverages);
4) enough time must pass to develop caries under the action of bacteria.
If only one of these preconditions is not fulfilled, decay will not develop.
How to identify bottle caries?
Although cavities normally do not occur so often on these teeth, bottle caries primarily affects upper front teeth and primarily their labial (outer), and then the palatal (inner) surface. The damages initially occur along the neck of the tooth, near the gum line, initially as a smaller demineralized areas off dimly white color, which quickly transform to real lesions and cover the entire tooth. When the entire tooth is covered with caries, it is the so-called circular bottle caries. The crown of the tooth that has been extensively affected by caries very quickly becomes completely destroyed, and the tooth root is often aligned with the level of the gums. The rest of the tooth has a tan color that stands out from the surrounding white milk teeth.
After the decay has destroyed the upper front four incisors, it can spread to the upper canines, and the biting surfaces of the upper molars. In contrast to the upper teeth, lower teeth are rarely affected by bottle caries, probably because they are closer to the tongue which, together with the saliva, mechanically removes dangerous food leftovers and sugary liquids from the teeth surface.
What are the consequences?
Milk teeth have a phonetic role, because they are involved in the proper development of speech. The loss of the front teeth may disturb pronunciation of consonants “f”, “s”, “v” and “z” which leads to unclear and slurred speech of the child.
In advanced stage of bottle caries, shattered teeth become a potential source of various infections that may create numerous inconveniences such as pain, bleeding gums, bad breath and others, so going to the dentist can be extremely traumatic experience because of all the painful accompanying symptoms. It is often necessary to give antibiotics to the child. Also, primary (milk) teeth keep place for the proper display of the permanent successors. The premature loss of primary teeth can cause difficulties in eruption of permanent teeth, their abnormal position in the dental arch and compaction due to the inappropriate size of the jaw which becomes reduced for placement of permanent teeth.
Primary teeth also have a psychological role in child development. If these teeth are extensively destroyed by decay, that often leaves a certain psychological effects on the child which, depending on the child’s character, can manifest either with withdrawal into hiimself or with increased activity of the child. Sometimes it happens that a child affected by bottle caries is jealous to his peers because of their healthy teeth, and ask parents to “buy” him new teeth. Parents should not allow that a child, because of his damaged teeth, feels neglected and less valuable. He should be comforted and consoled that, if properly and regularly brushes his teeth, new, bigger and more beautiful teeth will appear. Some of the best teeth brushing songs can help in that regard.
Due to the fact that in the modern society healthy and beautiful teeth are a symbol of youth, health, beauty and success, for most parents it is important that their children, from the earliest age of life, have beautiful teeth which can both be proud of. This perception of oral health, although very positive, also has a potentially negative side. In fact, in developed countries in North America and Europe, poor oral health in children (such as bottle caries, premature loss of teeth, acquired malocclusion, etc.) is considered a form of child abuse, which is called dental neglect. Negligence of child’s oral health can cause pain with lasting consequences, as with any other form of abuse. In reality this means that if the dentist notices that the child has poor oral health, he should notify the social service which would check whether the parents are able to care for their child. This is what all parents must pay attention to, because there is a large number of actions in which public encourages children to report any form of abuse.
How to avoid bottle caries?
Although caries is the most common chronic disease in childhood, it can be completely prevented. To avoid baby bottle caries, the consumption of refined carbohydrates and the number of cariogenic bacteria in the oral cavity should be reduced with proper diet and regular oral hygiene. Additionally, it is good to apply fluorides because they increase tooth resistance to the action of acid generated by metabolism of bacteria. The dentist may smear the surface of the milk teeth with fluorides. It is also desirable that the child’s toothpaste contains fluorides or xylitol, and that parents control how much the toothpaste is placed on the toothbrush.
How to treat baby bottle tooth decay?
Early childhood dental caries is treated depending on the clinical picture at the time of the child’s dental visit. If the decay is discovered quite early, when there are only demineralized areas visible on the teeth in the form of white spots and lines, it is possible to recover teeth and to encourage their remineralization by the application of fluorides and changing child’s diet. In order for these procedures to be effective, it is necessary to visit the dentist to assess a child’s risk of developing caries and possibly recommend additional preventive and therapeutic measures. Special dental care is needed for children with autism.
Although the general practice dentist can provide dental care for a child, the removal of caries and dental treatment, especially in more complex cases such as when the child is less cooperative, is best to be left to the dentist specialist in pediatric dentistry who is specially trained and equipped to work with children. Although most procedures can be performed under the effect of local anesthesia, sometimes, especially with very small and/or uncooperative children, sedation or general anesthesia will be required.
It is desirable to bring the child to the dentist every 3 to 6 months in order to monitor the growth and development of the jaws. Specifically, if noticed that, due to the extracted deciduous teeth, disturbances in the normal development of the jaw are present, it is necessary to consult a dentist specialist in orthodontics in order to prevent the occurrence of major anomalies by usage of proper orthodontic appliances.
Bottle caries is a condition which emergence is entirely preventable, and that deprives both the child and parents of unpleasant emotional and health problems and potential financial costs in the future. The responsibility is on parents who need to be aware of the importance of oral health of their child. Along with daily oral hygiene care, parents should also provide the proper dental care by taking the child regularly to the dentist. Although even after bottle caries is cured the child can have normal permanent teeth, we should not forget that healthy and beautiful milk teeth precede healthy and beautiful permanent teeth.