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How to Prevent Nursing Bottle Caries?

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How to Prevent Nursing Bottle Caries?

4 min read


Nursing bottle caries is a type of tooth decay that occurs when a child sleeps with the bottle after feeding. Read below to know more.

Medically reviewed by

Dr. P. C. Pavithra Pattu

Published At February 22, 2015
Reviewed AtDecember 28, 2023


Nursing bottle caries are also called baby-bottle caries, nursing bottle tooth decay, or early childhood caries. The presence of excess sugar in the teeth causes cavities or caries. Parents need to be very cautious in the prevention of nursing bottle caries in children. Children who are between one to two years are mostly affected by this type of caries. Breastfed infants who doze off while breastfeeding are also prone to developing nursing bottle caries.

Which Teeth Are Affected by Nursing Bottle Caries?

The following teeth are affected by nursing bottle caries:

  • Upper deciduous dentition (milk teeth) namely the incisors and molars are affected.

  • Affected tooth parts involve enamel, dentin, and pulp.

Why Do Nursing Bottle Caries Affect Only the Upper Milk Teeth and Not the Lower Milk Teeth?

The lower milk teeth are not affected by nursing bottle caries because:

  • The upper incisors usually erupt first and hence they are exposed to cariogenic activity for a longer time.

  • The other teeth may also be exposed to cariogenic activity as they erupt but will be unaffected if the child discontinues the habit.

  • The position of the baby’s tongue is against the palate (roof of the mouth) during breastfeeding or when using an artificial nipple. This is the reason why the upper front teeth are the most commonly exposed teeth to nursing bottle caries.

  • The tongue protects the lower teeth by its cleansing action on the lingual surface (surface of teeth facing the tongue) of the lower teeth.

  • The constant flow of saliva from the submandibular salivary gland cleanses the lower teeth.

What Are the Causes of Nursing Bottle Caries?

The following are the causes of nursing bottle caries:

  • Breastfeeding at night to put the child to sleep.

  • Bottle feeding of milk and juices.

  • Use of pacifiers that are coated with honey or any other artificial sweeteners to stop the baby from crying.

  • The habit of keeping milk or foods with sugary content in the child's mouth for a prolonged time.

  • Nursing bottle caries develop when the baby’s teeth come in contact with too much sugar frequently. The bacteria present in the mouth consume the sugar, proliferate, and release acid as a waste product. This acid that is released by the bacteria invades the enamel of the tooth and forms caries.

  • Sugar is present in milk, infant formula, snacks, and juice.

  • If a baby goes to sleep with a bottle or uses a bottle or a sipper cup for a prolonged period, the sugar coats the teeth which can result in the formation of cavities by the action of bacteria.

What Are the Signs and Symptoms of Nursing Bottle Caries?

The signs and symptoms are as follows:

  • Caries can manifest in any teeth but are most common in the upper front teeth called ‘upper incisors’ in the case of nursing bottle caries.

  • White spots on the teeth.

  • The presence of dark or brown spots on the teeth denotes the presence of caries.

  • If the decay worsens, the child can suffer from pain and swelling around the teeth.

  • Infections.

  • Early loss of teeth.

How Are Nursing Bottle Caries Diagnosed?

The following are the few diagnostic methods to assess nursing bottle caries:

  • Intraoral periapical radiographs.

  • Panoramic X-ray.

  • Evaluating the status of the pulp.

  • A complete blood count (CBC) may also be required.

How Can Nursing Bottle Caries Be Treated?

Various treatment methods are as follows:

  • If the caries is diagnosed at an early stage, then fluoride application on the teeth will prevent the worsening of caries.

  • If caries involve only enamel (the outermost layer of the tooth), then restoration (tooth filling) can be done.

  • If caries involve enamel and dentin (the inner layer of the tooth next to enamel) then restoration (tooth filling) can be done.

  • If caries involve enamel, dentin, and pulp (the innermost layer of the tooth), depending upon the extent of caries in the pulp, pulpotomy (partial removal of the pulp) or pulpectomy (complete removal of the pulp chamber) can be done.

What Are the Complications of Nursing Bottle Caries?

The following are the complications of nursing bottle caries:

  • Early loss of tooth if the caries is left untreated.

  • Speech problems.

  • Poor eating habits.

  • The permanent teeth may grow haphazardly resulting in crowding if the deciduous dentition (milk teeth) falls off prematurely due to caries.

  • Chronic pain.

  • Serious infections.

  • Pain or difficulty in chewing.

What Are the Measures to Be Taken to Prevent Nursing Bottle Caries?

Attention to infants' oral health is highly essential. Educating the parents regarding the effects of early childhood caries and thereby preventing tooth decay is important. The following steps help prevent nursing bottle caries:

  • Feeding milk should be avoided when the child is asleep.

  • The child's mouth should be cleaned after feeding milk, juices, food, and so on.

  • The child should be given water to drink after feeding.

  • The consumption of sugary foods or drinks by the child especially between meals should be reduced.

  • The baby's gums should be cleaned at least once a day using wet gauze.

  • The child's teeth should be brushed gently with a toothbrush that contains a small head and soft bristles.

  • Pacifiers should strictly not be coated with honey or any other sweetening agents.

  • Honey should strictly not be given to infants below 12 months of age for any reason.

  • The child should not be put to sleep immediately after feeding on milk or juice since the sugar from the liquid will stay in the infant’s teeth for a prolonged time.

  • The child must be encouraged to drink from a cup when they enter six months of age and must be weaned from bottle feeding gradually.

  • The amount of juice given to a child should be limited. The American Academy of Pediatrics puts forth the fact that no more than six ounces of juice per day be given to young children. Babies who are below six months of age should be refrained from giving any kind of juice.

  • Children should be encouraged to practice and follow healthy eating habits and the consumption of sweets should be limited.

  • The brushing routine must begin as soon as the infant’s teeth begin to erupt.

  • The infant’s gums should be wiped with a clean cloth to remove food debris.

  • The whole family should brush at bedtime so that the child follows the same.

  • Fluoridated toothpaste enables the teeth to resist acid. Once the child is old enough to not swallow the toothpaste, fluoridated toothpaste can be used. It can be hazardous if the child swallows the fluoridated toothpaste, hence supervision by the parents is necessary until the child gets the hang of it.

  • When all the teeth erupt, dental floss can be used.

  • Regular check with a dentist is recommended.


Poor dental health can extend its effects beyond just affecting the oral cavity. It can interfere with the child’s chewing and talking ability, and interfere with eating, drinking, or speaking. They may be rebuked by their peers which affects their physical, mental, and psychosocial development. A pediatric dentist (a specialized dentist who treats children) can identify dental issues like caries in the early stages and treat them. Hence, a regular visit to the dentist is necessary to maintain healthy oral care in children.

Frequently Asked Questions


How to Avoid Nursing Bottle Caries?

Nursing bottle caries can be prevented by:
Before tooth eruption, gently wipe the child's gums with a wet cloth after every bottle feed.
As the tooth erupts, begin to brush the baby’s tooth with a soft-bristled toothbrush. Brush for at least two minutes using back-and-forth scrubbing.
Start to wean the milk bottle from the child when they are around one year old. 
Do not put the child to sleep with a milk bottle.
Bring the child to the dentist for early dental checks.
Give fluoride supplements.
Brush twice a day. Once in the morning, and once after the last food or milk feed, just before bedtime.


What Are the Causes of Nursing Bottle Caries?

Babies who are bottle-fed are more susceptible to nursing bottle caries, as the bottle nipple often stays in the mouth for longer duration; the newly formed teeth get damaged as the milk can form a coating on the teeth and cause cavities. Pacifiers coated with milk or sugar can also cause nursing bottle caries.


What Is Known as Nursing Bottle Syndrome?

Nursing bottle tooth decay is caused when a child goes to bed with a nursing bottle filled with juice or milk. This is also known as nursing caries or baby bottle caries. It often affects children between one and two years of age.


Is It Possible to Reverse Nursing Bottle Caries?

Suppose nursing bottle caries are detected in the beginning. In that case, it can be reversed with fluoride treatments, but as decay progresses, restorative dental treatment may be used to treat the cavities.


What Are the Symptoms of Nursing Bottle Caries?

The distinguishing feature of nursing bottle caries is the decay on the upper front teeth. Tooth decay can appear as brown spots on the teeth. The children might experience swelling around the teeth and pain as the decay worsens.


Which Baby Teeth Are Barely Affected by the Nursing Bottle Syndrome?

The lower incisors (lower front teeth) are mildly affected or completely healthy in patients with nursing bottle caries.


Does Alignment of the Teeth Affect Bottle Feeding?

Prolonged bottle feeding can make the top front teeth slant outward, and the lower front teeth slant inward. As a result, the palate may become narrower, and the alignment change may affect the child's chewing ability.


Why Is Long-Term Bottle Feed Not Recommended?

Extended bottle feeding is not recommended for babies because it causes dental caries and can lead to abnormal tooth alignment, affecting the child's dental development and feeding ability.


Will There Be Speech Problems Due to Bottle Feeding?

Bottle feeding for a prolonged period can cause an open jaw that can affect the child's speech. An open jaw makes it harder to pronounce certain sounds. Also, when the child has a pacifier in their mouth, it affects their vocal play because of restricted tongue movement leading to delayed speech development.


When Should Bottle Feed at Night Be Stopped?

It is recommended to stop night bottle feeding from 12 months of age. By this period, babies get enough nutrients from the food they consume throughout the day.


When Is It Recommended to Stop Bottle Feeding?

It is recommended to stop night bottle feeding between 12 to 18 months of age. And it is advised to introduce a cup as early as six months of age.


Is Nursing Bottle Caries Occurring Due to Negligence?

The nursing bottle caries is a sign of neglect. Anyone taking care of the child should properly maintain tooth health and check for the early signs of tooth caries.


What Is the Logic Behind Nursing Bottle Caries?

Nursing bottle caries develop when the child's teeth come into frequent contact with sugar. Bacteria present in the mouth feed on the sugar, multiply and produce acid that attacks the tooth enamel, resulting in tooth decay.
Dr. Nivedita Dalmia
Dr. Nivedita Dalmia



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