Updated on February 1, 2024
6 min read

What Is Bottle Rot and How Do You Prevent It?

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What Is Bottle Rot?

Bottle rot is a term for tooth decay in infants, babies, or toddlers. It usually occurs in the upper front teeth. The upper front teeth are more prone to decay because that’s where the milk residue usually gathers.

All baby teeth typically erupt by three years of age. Thinner enamel makes them more susceptible to tooth decay or cavities.

What Causes Bottle Rot?

Bottle rot mainly occurs due to excessive bottle-feeding with milk formulas high in sugar or fruit juices. Here are other reasons that could lead to a bottle rot:

  • Prolonged exposure to sugary liquids — The mouth’s environment changes from longer and more frequent exposure to sugar. This leads to the buildup of dental plaque and cavity-causing bacteria.
  • Frequent bottle use — If you allow your baby to drink from a bottle in bed, their teeth are exposed to sugar for longer, ultimately causing cavities.
  • Poor oral hygiene — Babies and infants without proper oral hygiene have teeth more susceptible to decay.
baby drinking milk from a bottle

Symptoms of Bottle Rot

Bottle rot or early childhood caries (ECC) appear as dark brown spots or tiny holes in your child’s teeth. Common symptoms of major decay include:

  • Tooth pain
  • Tooth sensitivity
  • Red, swollen, or tender gums

If the decay has become severe, symptoms may include:

  • Bleeding gums
  • Bad breath
  • Black spots on teeth

4 Tips to Prevent Bottle Rot

It’s crucial to take extra care of baby teeth during infancy to prevent cavities and other dental health conditions. To reduce the chance of decay, oral care habits should begin as soon as birth, throughout infancy, and beyond.

1. Oral Care During Pregnancy

Good oral care during pregnancy involves:

  • Brushing twice daily
  • Flossing every night
  • Using fluoride products
  • Visiting the dentist regularly

Women should also adopt healthy eating habits to supplement this routine. A child is three times more likely to develop cavities if their mother has untreated tooth decay.1

2. Baby Feeding for Cavity Prevention

To prevent baby bottle tooth decay, practice good oral hygiene and follow these baby feeding practices:

  • Replace bottles with cups between 6 months and one year of age
  • Reduce the intake of sugary drinks, such as artificial soft drinks and juices
  • Only feed your baby breast milk, milk, or formula
  • Don’t let babies sleep with a bottle in their mouth
  • Gradually reduce the amount of liquid in the bottle by nighttime
  • Use naturally sweetened juices or teas
  • Eliminate pacifier use around four years of age and never dip them in sugary liquids

3. Cleaning Your Baby’s Gums & Teeth

Before a baby’s first primary tooth appears and grows, cleaning the gums twice daily with a washcloth is essential. This ensures the elimination of bacteria and sugar from the mouth.

Practicing this routine will make tooth decay less likely to occur once baby teeth begin to erupt. It also helps the baby become accustomed to a parent cleaning their mouth daily.

When it comes to cleaning your baby’s gums and teeth, you can also:

  • Bring your baby to a pediatric dentist at least twice a year for teeth cleanings and dental exams after their first tooth erupts or before their first birthday
  • Brush your baby’s teeth lightly with a small toothbrush twice daily (this can also help with teething)
  • Use a small amount of toothpaste (about the size of a grain of rice) until around age 3
  • Begin flossing after all of the baby teeth have grown in

4. Fluoride Toothpaste & Water

Children need fluoride in their diets to help prevent early childhood caries (ECC). If the water supply in an area isn’t fluoridated adequately, a fluoride supplement is necessary.

The American Academy of Pediatric Dentistry recommends that children between 6 months and three years of age need .25mg of fluoride daily. Children between 3 and 6 need .5mg of fluoride.

Fluoride is a naturally occurring mineral that helps prevent tooth decay. Studies have shown that fluoride reduces the risk of decay by up to 50 percent in baby teeth. It also reduces corrosion by up to 65 percent in permanent teeth of children exposed to fluoridated water since birth.2

Bottle Rot Treatment

If a child is experiencing bottle rot symptoms, they’ll likely need a dental restoration to treat the infected tooth. Depending on the severity of the decay, a pediatric dentist will recommend:

  • Fluoride treatments — Fluoride is a mineral that can help strengthen tooth enamel. These treatments involve applying a fluoride solution or gel directly to the affected tooth or teeth.
  • Stainless steel crown This is a durable and long-lasting dental restoration that can protect the remaining tooth structure.
  • Tooth extractionThis is recommended for severe tooth decay and involves fully removing the affected tooth.

After your child’s baby teeth fall out and the adult teeth grow completely, you can get tooth sealants. You apply them on adult teeth that don’t have cavities yet. The coating keeps acid, food particles, and cavity-causing bacteria out of newly erupted teeth. 

Can Cavities in Baby Teeth Affect Adult Teeth?

Dental caries is one of the most prevalent childhood diseases.3 Studies show that tooth decay in children under six can lead to a higher risk of compromised permanent teeth.3,4

Healthy baby teeth result in healthy permanent or adult teeth. Bottle rot can negatively affect adult teeth in two ways:

Partial Eruption of Adult Teeth

If the adult teeth partially emerge through the gums, they can develop cavities. Permanent (adult) teeth can’t get an infection from a primary tooth when under the gums because they’re in a sterile environment.

Misaligned Adult Teeth

If you extract the primary tooth due to severe decay, permanent teeth will grow into the open space. This might cause an incorrect bite and crowded teeth.

Children will typically need orthodontic treatment, such as braces or clear aligners, once all permanent teeth grow. If they lose primary teeth prematurely, space maintainers can keep permanent teeth in alignment as they grow.

What Experts Are Saying

We reached out to Dr. Shahrooz Yazdani, CEO and Director of Yazdani Family Dentistry Kanata, to learn more about bottle rot. Here’s what he has to say:

“To prevent bottle rot, ensure you clean your baby’s mouth with a damp washcloth after feeding. Do not expose them to your own saliva or other people, as this can transmit cavity-causing bacteria.” 

“Be sure to take care of their teeth by brushing gently once they come in. Use just water to start and then a bit of fluoride toothpaste once the baby has multiple teeth. Never coat bottles or pacifiers in sugary substances, and do not leave a baby with a bottle for nap time.”

“Check your baby’s teeth for white or brown spots each time you brush, which can be indicative of decay. If you do see a spot, it is best to book an appointment with a dentist to assess your child’s oral health. Brushing with fluoride toothpaste regularly can help reverse mild signs of decay, but it is best to seek a professional opinion for your child’s unique condition.”


  • Bottle rot describes tooth decay that happens in babies or infants
  • Baby teeth decay usually stems from bottle-feeding with high-sugar liquids
  • Taking extra care of your baby’s teeth can help prevent bottle rot
  • Various bottle rot treatment options are available, depending on the decay’s severity

Last updated on February 1, 2024
7 Sources Cited
Last updated on February 1, 2024
All NewMouth content is medically reviewed and fact-checked by a licensed dentist or orthodontist to ensure the information is factual, current, and relevant.

We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
  1. Pregnancy and Oral Health.” Centers for Disease Control and Prevention, 2022. 
  2. Fluoride.” National Institutes of Health, 2023.
  3. Singh et al. “Early Childhood Caries.” Illustrated Pediatric Dentistry (Part I), 2022.
  4. Das, A. “Nursing Bottle Syndrome: An Overview.” Indian Journal of Forensic Medicine & Toxicology, 2020.
  5. 2021 Fluoridation Facts.” American Dental Association, 2018.
  6. Koch et al. “Pediatric Dentistry: a Clinical Approach.” John Wiley & Sons Inc., 2017.
  7. Nowak, A. “Pediatric Dentistry: Infancy through Adolescence.” Elsevier, 2018.
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