Nursing caries, formerly known as baby bottle syndrome, is the destruction of the hard tissues of primary teeth caused by frequent and continuous milk consumption throughout the day and, above all, during the night.
It is usually seen in children aged 2–4. It is often severe and can affect all 20 teeth in the mouth. Its severity ranges from early decay — white marks at the base of the tooth near the gums — to the tooth being completely “eaten away”, appearing black and very often worn down to gum level, as well as abscesses.
What causes it?
It can be caused by either breast milk or cow’s milk when these are given very frequently, particularly during the night. We know that tooth decay is caused by the gradual dissolution of enamel by the acids released by bacteria when they come into contact with sugar.
What is not widely known, however, is that all carbohydrates are converted into sugar in the mouth through the action of enzymes. In the same way, the milk in which primary teeth “bathe” throughout the night — when children breastfeed or wake up asking for a bottle — is converted into a sugary solution.
This solution cannot be rinsed away by saliva because saliva flow decreases during sleep. It therefore provides ideal conditions for bacteria to act rapidly and undisturbed, quickly “drilling” into the teeth with the abundant acids they produce.
The solution and prevention
The only solution, apart from teaching your child not to wake during the night to feed, is to brush their teeth properly after every feed and rinse their mouth with water.
Even if your child has fallen asleep, you can clean their teeth with a wet toothbrush while holding them in your arms in the very convenient feeding position.
Risk of orthodontic problems
In addition to nursing caries, children are also at risk of orthodontic problems affecting facial development, speech and breathing.
This is because, during breastfeeding or bottle-feeding, the tongue remains in its forward infant position between the upper and lower jaws. This position is gradually abandoned as the child grows and begins to eat solid foods: the tongue moves further back and down, into the position in which an adult tongue rests and functions.
In some children, however, the tongue remains in its infant position even after they have stopped using a bottle, and a gap appears between the front teeth, known as an open bite. In this case, the position of the tongue can be corrected with special exercises or an orthodontic appliance.
When should bottle-feeding stop?
The American Academy of Pediatric Dentistry recommends stopping bottle use around a child’s first birthday and transitioning to a regular cup through the use of special training cups with a spout.
