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Tooth anatomy
Tooth anatomy

Baby bottle tooth decay
Baby bottle tooth decay


Early childhood caries (ECC) is a dental condition in which there is significant decay in a child's teeth, particularly the upper and lower cutting teeth (incisors).

Alternative Names:

Bottle mouth (Bottle carries); Baby bottle tooth decay


ECC used to be blamed on inappropriate bottle use, which is why it is sometimes called baby bottle tooth decay. However, it is now known that the tooth decay results from a combination of tooth strength, sugar exposure, and mouth bacteria. ECC certainly can be triggered by bottle use, but also by sippy cups and even sugary snack foods.

ECC is often triggered by frequent and prolonged exposure to liquids containing sugars . The worst types are juices, punches, soft drinks, gelatin, sugar water, or other sweetened liquids. Milk and formula can also contribute to decay, especially if the child is also getting sweets from another source.

Bacteria on the teeth uses these sugars as an energy source to form acids that attack tooth enamel. If there is an almost constant supply of sugar (such as an infant with a bottle of juice in his mouth most of the day), decay can occur on a continuous basis rather than just at feeding time.

Breast milk by itself is the healthiest food for babies’ teeth, day or night. It tends to slow bacterial growth and acid production. However, when breast milk is alternated with sugary foods or drinks, the rate of tooth decay can be faster than with sugar alone.


  • DO NOT fill your child's bottle with fluids that are primarily sugar such as punch, gelatin, or soft drinks.
  • DO NOT put your child to bed with a bottle.
  • Give children age 6 - 12 months only water or plain milk to drink between meals.
  • Limit juice to fewer than 6 ounces per day during meals.
  • Start routine dental care at age 12 - 15 months.
  • Avoid prolonged use of pacifiers and DO NOT dip the pacifier in honey, sugar, or syrup.
  • After each feeding, gently wipe your child's teeth and gums with a clean washcloth or gauze to remove plaque.
  • Begin toothbrushing as soon as your child has teeth. Brush your teeth together at least at bedtime. If you have an infant or toddler, place a small amount of fluoridated toothpaste on a washcloth and rub gently on their teeth. Older children can use a toothbrush with soft, nylon bristles. You will need to supervise and assist. Use a very small amount of toothpaste (no more than the size of a pea).
  • Begin flossing teeth of children when all of the primary (baby) teeth have erupted (usually around age 2 1/2).
  • If your baby is 6 months or older, use fluoridated water or a fluoride supplement if you have well water without fluoride. Tap water is better regulated than bottled water with fluoride.
  • Inspect your child's teeth regularly and begin dental visits when all of the baby teeth have erupted or at age 2 or 3, whichever comes first.


Azevedo TD. Feeding habits and severe early childhood caries in Brazilian preschool children. Pediatr Dent. 2005;27(1): 28-33.

De Grauwe A, Aps JK, Martens LC. Early Childhood Caries (ECC): what's in a name? Eur J Paediatr Dent. 2004 Jun;5(2):62-70.

Douglass JM, Douglass AB, Silk HJ. A practical guide to infant oral health. Am Fam Physician. 2004 Dec 1;70(11):2113-20.

Nainar SM, Mohummed S. Diet counseling during the infant oral health visit. Pediatr Dent. 2004 Sep-Oct;26(5):459-62.

Ribeiro NM, Ribeiro MA. Breastfeeding and early childhood caries: a critical review. J Pediatr (Rio J). 2004 Nov;80(5 Suppl):S199-210.

Seminario AL. Early childhood caries. Acta Medica. 2003; 46(3): 91-4.

Touger-Decker RJ. Position of the American Dietetic Association: oral health and nutrition. J Am Diet Assoc. 2007 Aug;107(8):1418-28.

Review Date: 4/10/2008
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, Greg Juhn, MTPW, David R. Eltz, Kelli A. Stacy, ELS. Previously reviewed by Daniel Rauch, M.D., FAAP., Director, Pediatric Hospitalist Program, New York University School of Medicine, New York, NY. Review provided by VeriMed Healthcare Network (7/26/2007).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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