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Baby Bottle Tooth Decay (BBTD). The Journal of Dietetic Association defines this as a widespread form of caries (We call these cavities) that affect the incisors and molars. This usually occurs between ages 0 and 2 years old. It can also occur with any child that is still on bottle feeding or is given a bottle to sleep at night. It is considered a nutritional problem as it can be eliminated easily if parents stop giving the child a bottle to soothe the child to sleep at naptime or bedtime at night.

This problem is highly preventable and occurs at every socioeconomic level in our nation. I remember studying this at Northwestern when I did my pediatric rotation in school. This problem is based on culture and family practices. I remember being a little girl and watching my aunts put my cousins to bed with a bottle and it was the most natural thing to do. No baby in my family went to bed bottle-less!!!!  As far as I remember, there was a formula in their bottles. Breast feeding, although promoted by some people, was certainly not promoted in many families. It seemed as if the only people who breast fed were immigrants from other countries. We now know that babies that are breast fed are the healthiest and develop the most antibodies against disease. Even a small amount of breastfeeding is beneficial to the baby’s immune system.

I want to stress that there will be pressure for you to do what your parents did when you were a baby. They will say that I put you to bed with a bottle, and you turned out just fine.  That is true, however there have been many advances in dentistry.  It could be helpful for you, as the parent, to invite the baby’s grandma to the dentist where there can be a patient education conversation.  Oftentimes, the grandma will have gone totally to the other side and correct you if you slip a bottle in the baby’s mouth without wiping the baby’s gums.  If you MUST put a bottle in your baby’s mouth when sleeping, NO JUICE, NO FORMULA, NO SODA, only PLAIN NURSERY WATER.

According to an article labeled “Early Childhood Caries”,

Studies have found that early childhood caries are more frequent in children who consume juice between meals and sweetened solid food. Salivary flow reduces while sleeping; therefore, combining low salivary flow and a child who falls asleep with a bottle filled with a sweet liquid, including formula, significantly increases the risk of early childhood caries.

Fruit juice should be avoided in children younger than 12 months of age, limiting it to 120 ml up to 3 years of age and 120 to 180 ml in 4- to 6-year-olds. Appropriate breast- and bottle-feeding practices must be emphasized: avoiding regular sipping of sweet drinks, putting the child to sleep with a bottle of formula, or falling asleep with the breast nipple in their mouth at night.

In addition, health care workers such as Family Practice Physicians, Pediatricians, Nurse Practitioners, and nurses should stress the importance of parents brushing their child’s teeth. It is a good idea to wipe a child’s gums after nursing or taking a bottle. Then, when the first tooth emerges, take an exceptionally soft toothbrush, using water and brushing the baby’s tooth. By practicing this way to prevent tooth decay, will have the child develop good habits in brushing their teeth. No one should go to bed without brushing their teeth. Parents can purchase little stools to elevate the child so that they may use the sink for this purpose. It also helps the child feel like they are a big boy or girl and are developing independence.

I will caution you that those who are directed to give their baby liquid vitamins or liquid iron preparation should take special precautions in discoloration of the teeth. I knew about Baby Bottle Syndrome, so when I was directed to give my son an iron supplement, I could not get the stain off his teeth. I called a pediatric dentist for a consultation and cleaning. He was quiet as I walked in with my little one. After sitting on the lounge chair with me holding my son, I noted that every single person who worked there came into the room. The dentist was trying to make a teachable moment as he thought my son was a victim of Baby Bottle Syndrome. As he examined Christopher’s teeth and scraped a little on his baby teeth, he noted that it was easy to have the teeth come clean. He asked me about vitamins and iron, and I was forthright and told him about the iron preparation. Everyone in the room breathed a sigh of relief as each of them left the room. The Dentist was especially delighted when he announced that Baby Bottle Syndrome was not the culprit.

According to the American Association of Pediatric Dentists, it’s recommended that kids go in for their first oral health checkup when their baby teeth first begin to emerge or by the time their first birthday comes around. This provides a foundation for their dental care. This dental visit allows parents to address their child’s oral health in several areas:

The first is the management of oral habits such as finger and thumb sucking. If your child uses a pacifier, this can also be explored through questions and dialogue with your pediatric dentist.

The second area is Teething. It is a wonderful time to ask questions such as “How do I alleviate the pain of teething for my baby.”  Oftentimes, health care workers will advocate putting a teething ring in the freezer. Babies normally experience an abundance of drool which drips out of their mouths. Asking the dentist if a pain reliever, such as liquid Tylenol is appropriate for your child is appropriate.

If the teeth are in, the dentist will do an assessment of his or her first teeth. The dentist will give you a summary of the health of your baby’s teeth, letting you know if they see more teeth coming when they examine baby’s gums, and having you avoid sweet drinks such as juice. The best way to give juice is to dilute it with tap water by 50%. The dentist will stress the connection between diet and oral health

The dentist will be able to see and assess the Development of gums and baby’s jawline. My son had a cross bite when he was a toddler, and the lower jaw was bigger than the upper jaw. I was concerned, but the dentist assured me that Christopher would outgrow it, which he did!

The dentist will tell you how to care for an infant’s or toddler’s teeth appropriately. As you can see, your baby’s first dental visit is the foundation for life-long dental health. Make sure you write down any important questions you have for the pediatric dentist and follow up about the next appointment.

If everything looks OK from the dentist’s perspective, you don’t need to have your baby see the dentist until age 4. After your baby’s first dental visit at age 1, you should not have to see the dentist again for about 3 years, unless there is a problem or a dental emergency. Age 4 is a critical age for a child to correct bad oral habits,such as finger or thumb sucking or chewing on fingers and thumbs or sucking on a pacifier. And with an age 4 dental visit, dentists can reinforce strategies to help a child overcome these unhealthy habits quickly and effectively.  Here is where you as a parent get to ask those pressing and individualized questions regarding those habits.  Every child is different, therefore your dentist should be a wizard at problem solving with you to have a positive outcome.

This dental visit is a bridge between going to the dentist at age 1 and when a child should see the orthodontist, which is 7 years old. Many companies offer dental insurance to offset the cost of braces and other dental appliances that can correct teeth and jaws.  Remember, seeing an orthodontist is not for cosmetic purposes, but rather for mouth and jaw function.  It is a necessary procedure to eliminate speech problems, and function.  Many an orthodontist has eliminated bullying and self-esteem issues, as well.


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