What is Bottle Rot?

Early childhood caries (ECC), commonly called “Bottle Rot,” is a term to describe decay that occurs in toddlers and infants.

How does it occur?

ECC occurs when the teeth are frequently exposed to sugars or acids for too long. An example would be frequently sipping on juice throughout the day or falling asleep with milk (which contains sugar) in the mouth after being bottle or breast fed.

ECC often appears on the top front teeth due to the position of the tongue sitting underneath the bottle/nipple. A pool of milk is created and the top teeth end up bathing in all of the sugar! However, this doesn’t mean that the back teeth are immune as they can end up affected too.

Early childhood decay with abscess formation.

How to avoid ECC

1. Always try to clean out the mouth before sleeping.

Teeth should be cleaned daily as soon as they break through the gum. This can be done with fluoridated toothpaste. Up until 5 years of age, we recommend using an amount, the size of a grain of rice. From 5 onwards, we recommend an amount the size of a pea.

2. Avoid putting your child to sleep with a bottle.

This can be a difficult conversation for some parents as we understand that children can be unpredictable. We know that some nights, the only way a restless child might fall asleep is if they have a bottle. If this is the case, try to switch the milk bottle with a bottle of water towards the end. If this doesn’t work, you can try to wipe your child’s mouth with a soft wet cloth after feeding.

3. Avoid dipping dummies in liquids such as honey, to soothe the child.

Sugars left in the mouth will create the perfect environment for decay to start.

4. If required, bottle/breast feed immediately after a meal

After eating a meal, the mouth goes through an acid attack. Milk feeding immediately after eating reduces the mouth to one single, combined acid attack. Conversely, if your child eats and isn’t given the bottle until 30+mins later, the mouth which at this stage is in recovery mode, will go through an additional acid attack. Too many acid attacks and you can end up with decay!

5. Ensure your child has regular dental visits from 12 months of age

Decay doesn’t start off as an immediate hole (cavity) in the tooth. Usually a white lesion will appear first. Prevention is always desired over treatment and this can also come down to early detection. If your child’s dentist can spot the white lesions before they breakdown into cavities, they can give you advice on how to maintain the teeth.

A dentist will also ask you a number of questions to assess your child’s caries risk level. This can be dependent on medications, health conditions, genetics, developmental defects, diet and the ability to clean the teeth. With this information, they will give you a personalised plan on how to prevent ECC.

Why it is important to avoid

Although we should be trying to avoid dental decay at any given age, here are a few additional reasons that should encourage parents to avoid ECC for their children.

1. There are less treatment methods available.

Toddlers and infants are rarely able to tolerate treatment in the chair. This means there are limited options when it comes to treating their teeth. At PDSWA, we are not only treating the decay, we are treating the person as a whole. Preserving good mental health and trying to avoid contributing to a fear of the dentist is important to us. We will always provide an option which can include restorative treatment - however at a young age, these options are limited and could end up resulting in additional hospital and anaesthetic bills.

BEFORE: Early childhood caries in patient.

AFTER: Restorative treatment by Dr John Camacho.

2. ECC can take longer to detect

When ECC occurs in an infant, they are unable to talk to us and tell us if they are in pain. Infants may cry which will alert parents however it can sometimes take months of investigating before figuring out the reason behind their cries or lack of eating/feeding. This can mean months of restless nights for both the child and parent.

In summary

If you suspect your child has ECC, it is advised to see your paediatric dentist to seek treatment and further prevention.