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Young Children and Decayed Teeth

Often, the pattern of cavity development in the teeth of very young children leads dentists to label them as having ‘nursing caries’ or ‘bottle decay.’ These unfortunate terms refer to a typical pattern of dental decay among multiple teeth seen when juice, formula, or breastmilk sit in the mouth frequently for extended periods.


The making of a cavity

What causes dental decay? Sugars in the diet feed undesirable bacteria in the mouth. As they eat, these bacteria create acids that damage the teeth. Once a small hole is created in a tooth by bacterial acids, cavity-causing bacteria can then live in (infect) the hole, gobbling sugars and creating more acids, causing the cavity to grow. Acids from highly acidic foods, such as lemon juice, can also weaken teeth, making them more vulnerable to decay.


Where do these sugars come from?

Of course, sweetened foods are the main source of harmful dietary sugars. The longer sugars are in contact with the teeth, the more bacteria they will feed. This causes sticky foods like raisins to be problematic. When breads and cereals stick to the teeth, they can break down to sugars in the mouth. Juice is the most common source of damaging sugar in young children, with the acidic properties of juices contributing to decay. Babies receiving juice bottles exhibit the most bottle decay by far (but if they also breastfeed, it’s very possible that their dentist will choose the term ‘nursing caries’).

Breastmilk, cow milk, and some infant formulas contain the natural milk-sugar lactose, which does not feed dental bacteria as quickly as simpler sugars, but it can feed them. All other infant formulas contain other sugars that are more cavity-causing than lactose.


But breastmilk?

It doesn’t make sense that the food meant for human babies to live on, that humans survived on throughout millennia, would cause such harm. Human milk is found in laboratory studies to inhibit, not encourage cavities, due to its many bacterial-fighting factors, so how does a baby become diagnosed with nursing caries? Whereas bottle or nursing patterns of decay are sometimes recognized in infants and children receiving breastmilk, you will be hard-pressed to find such decay in a child who receives no other foods besides breastmilk, whether from bottle or breast. Cavities are found more often in formula-fed than breastfed babies, but it turns out that if there is other sugar in a breastfed child’s diet, cavities can happen.

There are mixed findings but common concerns about comfort nursing at the breast for long periods during the night after teeth have developed. I’ve yet to hear of caries in a baby who has never received anything but breastmilk. Still, caries in a breastfed baby who also consumes juice, cereals, or sweets gets blamed on the healthiest part of the child’s diet, the breastmilk, even though studies show that, among breastfed infants who develop nursing caries, most are those who have frequent snacking and sugary foods or juices in their diets.


The real culprit

Nighttime feeds can be highly cavity causing in a bacteria-laden mouth because saliva is not very mobile during sleep, leaving baby without its rinsing and antibacterial protection. Although decay may occur chiefly while baby milk is sitting against teeth during nighttime comfort nursing at the breast, or with a bottle in bed, it’s most bound to occur in a mouth full of bacteria. It is other sugars in the diet, including any non-lactose sugars in infant formulas, that initiate bacterial growth and cause the vulnerability to decay in children’s mouths. Sugar feeds the growth of cavity-causing bacteria in a child’s mouth. Sugar also creates an acid environment that weakens the teeth and makes them more prone to decay. Now, when milk sits undisturbed in a child’s mouth at night due to comfort nursing or nighttime bottles, cavities can form in a fashion that’s labelled as nursing caries or bottle decay, depending upon the child’s source of milk.


Nighttime challenge

Babies are designed to fall asleep nursing, and bottle nursing is importantly comforting too. Both breastfed and bottle-fed infants have a natural need for comfort nursing. Besides pacifier use, the means by which bottle-fed infants find this comfort is to “nurse” their bottles very slowly when allowed to lie and hold their own bottle, causing milk or formula to sit against their teeth for long periods. Caries are known to be more common in formula-fed babies who have nighttime bottles at older ages. Some studies point their fingers at older breastfeeders. Certainly these findings are because older children typically have more other sugars and starches in their diets than do babies.



Although Streptococcus mutans bacteria are thought to be the chief cause of dental decay, the candida yeast that builds up on pacifiers has been found to promote cavity formation as well. Because of this candida and the occasional incidence of caries linked to bottles or nighttime breastfeeding, dentists and pediatricians commonly recommend throwing out bottles and pacifiers at 12 months of age and weaning breastfed infants prematurely. Of course, the common suggestion that one must switch from tailor-made human milk, to cow milk, i.e. “wean,” makes no sense at all. Targeting the least cavity-causing and most healthy food in a breastfed child’s diet just doesn’t make sense. And, taking away the comfort derived from bottles and pacifiers is not an affectionate move.


Consider the whole child

Babies naturally experience hunger and emotionally thrive on comforting during the night. Withholding response to these needs can possibly be more harmful to a child than any risk of damage to temporary teeth, although your dentist may feel that baby teeth are the primary concern. Certainly, the known health benefits of extended breastfeeding outweigh any potential challenges to temporary teeth. While dental treatments on infants are traumatic, warranting preventive measures, the mere possibility of infant caries (about a 14% chance) is not enough of a worry that I would withhold or withdraw important feeding and comforting from any infant, especially before any dental symptoms have occurred. Feeding and comforting practices can be modified when needed to protect teeth, without blunt, drastic weaning measures.


Mother too

Nursing mothers may be prone to cavities related to nursing (maybe these are the true “nursing caries”). Especially during the first months of breastfeeding, nursing mothers often find a need for midnight snacks. This food sitting against the teeth in the sleeping mom may cause some cavities in her teeth, which have mildly reduced calcium content (no matter how much calcium is supplemented) until after the end of lactation. Preventive measures should be taken in a cavity-prone mom. When mom and dad have more bacteria in their mouths, so does baby.


If cavities are found
There are times when a parent chooses “watchful waiting” over immediate repair of small dental insults in a very young child who appears quite traumatized by dental procedures; hoping the repair will be simpler and less harrowing when the child is some months older or that the parent can get the problem under control with diligent efforts.


Like all other bones of the body, teeth have a potential to heal themselves, when attacks are very small, but this will only occur with conscientious efforts and even then, only occasionally. A small brown spot may be left even after the bacterial assault in a tooth has stopped, because the enamel coating does not heal. One must remember that if early efforts are not effective, the decay can “spread,” creating a larger problem. Below are some efforts that can be tried during “watchful waiting,” and even better, before cavities are ever present.


Cavity prevention and care
In cavity-prone families, or when any evidence of decay has been detected in an infant, night nursing and bottle practices can be gently reduced (not necessarily eliminated) once several teeth are present. A squirt of water into the mouth or stirring the child enough to cause some extra swallowing after nursing or bottle feeding will help to clear the mouth of milk. Juice bottles should never be given at night (or ever, really). Good dental hygiene in the parents’ mouths will reduce baby’s risk of developing cavities. Still, genetic tendencies, imbalanced flora, and other unknown factors make some children susceptible to bacterial presence and destruction in their mouths, seemingly no matter what measures are taken.


Although damage to baby teeth does not affect adult teeth, a strong tendency for decay will likely carry over to adult teeth. Caries in baby teeth can serve as a warning that good preventive measures must be taken with permanent teeth.


Cavity-fighting foods

Xylitol and sorbitol are natural fruit sugars found in varying levels in different fruits. These sugars actually reduce bad bacterial growth and promote dental healing. These can be found in special chewing gums for children who are old enough for gum. Studies show xylitol to be probably more effective than fluoride. Avocado, carrot, raspberry, strawberry, apricot, and plum have all been found to contain anti-cavity ingredients, such as these special sugars. Likely many other dark-colored fruits and vegetables will be discovered to have anti-cavity qualities as well. Juices from these fruits lack fiber that feeds healthy bacteria, and lack the physical brushing against teeth during chewing that can be beneficial.

There are many herbs that fight caries, such as cloves, mint, thyme, and savory. In cheese, the lactose sugar is consumed by the bacteria that form the cheese. The milk protein left in cheese has been shown to be anti-cavity. Once a baby is eating solids regularly, it would be a great practice to end a meal with any of these foods or to choose them as snacks.


Other healthy treatments

Some parents have found good results in preventing and “curing” cavities with the use of calcium and phosphorous-providing ‘MI Paste’ (or a milk-free version), and xylitol-providing Spry gel. Tea tree oil is strongly antimicrobial against cavity-causing bacteria. It can be found in toothpastes in healthfood stores and some parents concoct a mouthwash with it. Like fluoride, ingestion of any significant quantities of tea tree oil can be harmful, so these both should be used in limited amounts if a child will not refrain from swallowing. Chinese medicine provides many herbs and extracts that are shown to fight cavity-causing bacteria. Ozone treatments to kill decay-causing bacteria are performed in some dental offices and have gained support from recent studies.


Probiotics, like the healthy bacteria found in yogurts, are a bit of a confusing picture when it comes to dental caries in children. The most common probiotic, the bacterium Lactobacillus acidophilus, is known to provide great gut health and overall health, and babies with the highest amounts of these bacteria in their intestines are generally found to be the healthiest. But, this bacterium is found inside many cavities and is thought to be contributing to decay. Still, studies on the consumption of various probiotic products show reduced decay and reductions in the key infective agent, Streptococcus mutans. There’s clearly more to this picture than is understood today. Personally, for dental cavity purposes, I would select products with multiple assorted strains of bacteria while not being concerned as to whether Lactobacillus acidophilus were one of these or not. Twice-daily probiotic drops or other probiotic products can help to battle undesirable bacteria and maintain a less cavity-causing flora in the mouth. Consider concocting a yogurt snack from unsweetened yogurt, berries, plums, or apricots, and possibly some sorbitol or xylitol for sweetening. A nursing mother can also take probiotics to increase the amounts of good flora that are passed along in her milk.


Good brushing (not just wiping with a cloth), twice-daily flossing if the decay is between teeth, and some occasional scraping with a dental tool at home are highly valuable efforts, removing the plaque that bacteria thrive in. If caries are a challenge for your family, do not allow food or drink (besides water) to sit in your child’s mouth at night. Again, when needed, one can encourage some swallowing after nighttime breastfeeding by disturbing the child a bit before she falls back to sleep or by providing a sip of water. The same can be performed after a bedtime bottle feeding.




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Written by Linda F. Palmer, DC

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