Baby Bottle Tooth Decay (Bottle Rot)

Evidence Based
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What Is Bottle Rot?

Baby bottle tooth decay, also called bottle rot, is caused by excessive bottle-feeding and allowing a baby to drink from a bottle in bed. If the substance in the bottle is high in sugar, the teeth will bathe in it, ultimately causing cavities.

The leading cause of bottle rot is from drinking fruit juice or milk from a bottle for a long period of time. The mouth’s environment changes the longer and more often teeth are exposed to sugar, which leads to the buildup of dental plaque and cavity-causing bacteria.

Can Cavities in Baby Teeth Affect Adult Teeth?

Healthy baby teeth result in healthy permanent teeth. Baby bottle tooth decay can negatively affect adult teeth in two ways:

  1. Partial eruption of adult teeth. Permanent (adult) teeth cannot get an infection from a primary tooth when they are under the gums. When the teeth remain under the gums, they are in a sterile environment. However, if the adult teeth have partially emerged through the gums, they can develop cavities.
  2. Misaligned adult teeth. If a primary tooth is removed due to severe decay, permanent teeth will grow into the open space, causing an incorrect bite and crowded teeth. Children will typically need orthodontic treatment, such as braces or clear aligners, once all permanent teeth grow in. If primary teeth are lost prematurely, space maintainers can be used to keep permanent teeth in alignment as they grow in.

How to Prevent Baby Bottle Tooth Decay

A baby’s first primary tooth erupts around 6 months of age. As they reach infancy (12 months old), the two bottom front teeth erupt. After all of the incisors erupt in the upper and lower jaws, a child’s “12-month” primary molars grow in. Then the canines erupt, along with the “24-month” molars. All baby teeth typically erupt by 3 years of age.

All baby teeth are more susceptible to tooth decay (cavities) because the enamel is thinner. It is crucial to take extra care of baby teeth during the infancy years to prevent cavities and other dental health conditions.


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To reduce the chance of decay, oral care habits should begin as soon as a child is born, throughout infancy, and beyond.

1. Oral Care During Pregnancy

During pregnancy, women should eat a nutritious diet and practice good oral health. This includes brushing twice a day, flossing every night, using fluoride, and visiting the dentist regularly to prevent cavities.

A child is three times more likely to develop cavities if his or her mother has untreated tooth decay.

2. Baby Feeding Tips for Cavity Prevention

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

  • Replace bottles with cups between 6 months and 1 year of age
  • Reduce the intake of sugary drinks, such as artificial sodas and juices
  • Only feed your baby breast milk, milk, or formula
  • Do not let babies sleep with a bottle in their mouth and gradually reduce the amount of liquid in the bottle by nighttime
  • Use naturally sweetened juices or teas
  • Eliminate pacifier use around 4 years of age and never dip them in honey or other sugary liquids

3. Cleaning Your Baby's Gums & Teeth

Before a baby’s first baby tooth grows in, it is important to clean the gums twice a day with a washcloth. This ensures bacteria and sugars are removed from the mouth.

Tooth decay is less likely to occur once the baby teeth begin to erupt. It also helps the baby become accustomed to a parent cleaning his or her mouth daily.

Other tips to prevent baby bottle tooth decay include:

  • Babies should begin visiting a pediatric dentist at least twice a year for teeth cleanings and dental exams after their first tooth erupts or before their first birthday
  • As your baby's teeth grow in, brush them lightly with a small toothbrush twice a day. This helps keep your infant's teeth healthy and aids in teething.
  • Use a small amount of toothpaste (about the size of a grain of rice) until about age 3
  • Flossing should also begin after all of the baby teeth have grown in

4. Fluoride Toothpaste & Water

Fluoride is a naturally occurring mineral found in rocks and soil that helps prevent tooth decay. Fluoride has been added to water supplies, toothpaste, mouthwashes, and professional dental materials to help strengthen tooth enamel in children and adults.

Studies have shown that fluoride reduces the risk of decay by up to 50 percent in baby teeth. It also reduces decay by up to 65 percent in permanent teeth of children exposed to fluoridated water since birth.

To help prevent early childhood caries (ECC), children need fluoride in their diets. If the water supply in an area is not fluoridated properly, a fluoride supplement is necessary.

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

Symptoms of Baby Bottle Tooth Decay

The upper front teeth are more prone to decay because the substances gather there when a baby falls asleep with a bottle. Early childhood caries (ECC) appear as dark brown spots or small holes on your child's teeth. Common symptoms of major decay include:

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

If the decay has become severe, symptoms may include:

  • Bleeding gums
  • Bad breath
  • Black spots on teeth

Baby Bottle Tooth Decay Treatment

If a child is experiencing any of the symptoms listed above, they will likely need a dental restoration to treat the infected tooth. Depending on the severity of the decay, a pediatric dentist will recommend a stainless steel crown or tooth extraction:

Stainless Steel Crowns (SSC)

Stainless steel crowns (SSCs) are used to restore decaying, damaged, or fractured baby teeth. If a baby’s tooth is decaying, but not severely decayed, SSCs help prevent further damage. These crowns are durable, strong, and rarely need follow-up treatment after placement.

stainless steel crown

Baby Tooth Extractions

The surgical removal of a tooth (extraction) is necessary when a baby tooth becomes severely decayed. Untreated tooth decay can lead to more serious oral conditions later on. For example, the bacteria from the decaying baby tooth can spread into the jaw, airway, bloodstream, or brain.

Front teeth are more prone to baby bottle decay than molars. However, front teeth are easier to extract because they have a single root, rather than multiple roots.

Tooth Sealants

After all of your child's baby teeth fall out and the adult teeth grow in completely, you can get sealants placed. Tooth sealants are usually applied to adult teeth that do not have cavities yet. The coating helps keep acid, food particles, and cavity-causing bacteria out of newly erupted teeth. 

tooth with dental composite filling

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Resources

Brown, Judith E. Nutrition through the Life Cycle. Brooks/Cole, 2019.

Emerging Trends in Oral Health Sciences and Dentistry. InTech, 2015.

Fluoridation Facts. American Dental Association, 2018.

Koch Göran, et al. Pediatric Dentistry: a Clinical Approach. John Wiley & Sons Inc., 2017.

Nowak, Arthur J. Pediatric Dentistry: Infancy through Adolescence. Elsevier, 2019.

https://www.aap.org/en-us/Documents/Dental_Care_During_Pregnancy.pdf

 

Updated on: September 2, 2020
Author
Alyssa Hill
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Medically Reviewed: September 27, 2019
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Lara Coseo
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