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Pediatric Dentist

Infants & Toddlers

Nursing Bottle Decay

Nursing bottle decay usually occurs when infants or young children are put to bed with a bottle which contains milk, juice, coke, or something else that contains some type of sugar. The sugar remains on the teeth for 8 to 12 hours. It decays the upper teeth much more than the lower teeth. Nursing bottle decay is sneaky. It starts around the back of the teeth, then progresses around the sides. By the time you can see it in the front, it is well established on the back and side of the teeth. Sometimes we can save these teeth with partial root canal treatments and crowns, but other times the decay has progressed too far and the teeth must be extracted.

Nursing bottle decay develops extremely rapidly. It only takes a few months for this type of decay to cause extensive, sometimes irreparable damage to your children’s primary (“baby”) teeth. It can be present in children as young as 12 months!

Breastfeeding your child for hours each day or nursing them and putting them to bed without brushing or washing their teeth, can cause decay similar to nursing bottle decay. In addition, decay similar to nursing bottle decay can develop if your child walks around for hours each day using a bottle or sippy cup.

Tooth decay in infants can be minimized or totally prevented by not allowing sleeping infants to breast or bottle-feed. Infants that need a bottle to comfortably fall asleep should be given a water-filled bottle or a pacifier. Please let us know if you notice any signs of decay or anything unusual in your child’s mouth.


Normally the first tooth erupts between ages 6 to 12 months. Gums can be sore, tender and sometimes irritable until the age of 3. We recommend Tylenol or a generic equivalent. Tylenol is very effective and can last for hours. Avoid topical anesthetics like Oragel® or Anbesol, as these products are only effective for ten minutes or so. Frozen or chilled teething rings are also very effective, and can be used repeatedly. If your child is under 2-years of age, please check with their pediatrician before giving them Tylenol. Tylenol should only be used occasionally. If you find it necessary to give your child Tylenol more than occasionally, please speak with their pediatrician or pediatric dentist.

Oral Hygiene Measures for Young Children

Begin caring for your child’s teeth early – as soon as the first one comes in. This will establish oral hygiene as a routine, and will be much more accepted by your child than waiting until a future date when they may resist it. If your child has had teeth for some time and you have not been caring for them, start now.

We recommend you use a very soft tooth brush when your child is very young. A piece of moist gauze will work as well for the first 6 or 8 teeth. This action is more of a gentle massage than an aggressive brushing. The most important time to brush your child’s teeth is just before bed time. The next most important time is after breakfast. Of course, it would be best to brush after every meal or snack.

The chewing surfaces of back teeth, the areas between teeth where adjacent teeth touch one another, and along the gum line, are more difficult to clean.

Use a children’s toothpaste that has been approved by the American Dental Association. Apply a very small amount to the brush – the amount that would stick to your finger if you just touched the toothpaste.


Fluoride toothpaste contains quite a bit of fluoride: about 1000 times that contained in fluoridated water. It is not intended to be swallowed. Excessive swallowed fluoride have no affect on primary teeth, but can lead to stained permanent teeth. So, please do not brush your child’s teeth with fluoridated toothpaste more than twice each day.

Children who are not yet 7 years old should not use any fluoride rinsing products, such as ACT. They may swallow some of the rinse even if they don’t intend to.

Fluoride helps teeth become stronger and resistant to decay. Regularly drinking water treated with fluoride and brushing with a fluoride toothpaste approved by the American Dental Association (ADA) regularly can result in significantly fewer cavities.

Facts about fluoride:

  • The correct amount of swallowed fluoride ingested from birth to age 7 can prevent 50% of decay for life.
  • All community water systems in this part of Georgia are fluoridated.
  • If your child drinks fluoridated water, he/she is receiving all the swallowed fluoride that is necessary.

Sucking Habits

Sucking is a natural reflex that relaxes and comforts babies and toddlers. Excessive sucking habits can cause the bone into which the upper teeth are anchored to be constricted and elongated; the upper front teeth are pushed forward and the lower front teeth are pushed backward. This results in a space between the upper and lower front teeth with the upper jaw too far forward and the lower jaw too far back. This is not a normal bite for a young child and, if not corrected may produce a “buck teeth” appearance.

If recognized and stopped early enough (prior to age 3), much, if not all, of the damage done to the jaw and teeth will self correct with no treatment. If allowed to continue, sucking habits can cause damage that can only be corrected by orthodontic or surgical means.

Pacifiers generally, cause less damage than a thumb sucking habit. In addition, it is much easier to get rid of a pacifier. It’s a little bit difficult to lose a thumb or a couple of fingers. If, as a parent, you must decide between your child using a pacifier or sucking his/her thumb, choose the pacifier.

Other reminders

Make sure your child does not have access to alcohol-containing mouthwashes. Some mouthwashes have a high percentage of alcohol that could be dangerous and possibly even fatal to a young child. Young children have been known to drink all sorts of things that can hurt them, so mouthwash should be considered medicine and kept out of the reach of children.

Dry cereal, especially when eaten over hours, is not a good snack. Dry cereal sticks to the teeth and contains the second favorite food of bacteria: starch. Starch is made up of a series of sugars. When starch is broken down by enzymes in the mouth it simply becomes sugar.

Liquid medication taken on a regular basis. Some children must take medications on a regular basis for any number of situations. If your child takes liquid medication on a regular basis (over a number of months or years) you should determine if it contains sugar. Many medications intended for children do. If it does contain sugar, special oral hygiene methods possibly coupled with special fluoride use may be recommended. Some medications can contain as much as 80% sugar. We recommend that your child rinse thoroughly with water after taking the medication.