What Are Nursing Bottle Caries In Children

Good oral health is an integral component of good general health. Child’s teeth are at risk as soon as they erupt. Many children have inadequate oral health because of uncontrolled dental caries.  As soon as the first tooth erupts in the oral cavity, it is more conducive to the process of demineralization. Nursing caries is a unique pattern of dental caries in very young children due to prolonged and improper feeding habits.

Children when put to bed, either for the night or for a nap, with a nursing bottle of milk or a sugar containing beverage which they drink while lying down can lead to nursing bottle caries.

It is a serious socio-behavioral and dental problem that afflicts infants and toddlers.

Classification Of Early Childhood or Nursing Bottle Caries

     Type 1 ECC – Mild to Moderate

       1.   Carious lesion(s) involving molars and incisors.

       2.   Seen in 2-5years of age.


Type 2 ECC - Moderate to Severe

       1.   Labiolingual carious lesions affecting maxillary incisors, with or without molar caries depending on the age of the child and stage of the disease.

       2.   Seen soon after the first tooth erupts.

Type 3 ECC - Severe

       1.   Carious lesion affecting almost all the teeth including the lower incisor.

       2.   Involves immature tooth surfaces.

       3.   Seen in 3-5years of age.

What are Causes of Nursing Bottle Caries

Dental caries is an infectious and transmissible disease. Caries is the result of an ecological imbalance in the oral cavity. The basic process is that cariogenic microorganism act on fermentable carbohydrate to produce acids, which act on susceptible tooth surface causing demineralization that is the decay of the tooth.


Microorganism can be present in infant’s mouth shortly after the eruption of their first baby teeth. Microorganism responsible for dental caries can be transmitted from one individual to another. Streptococcus mutans is principal microorganism responsible for caries in humans. It colonizes the teeth and produces large amount of acid.

The transmission of S.Mutans to human infants is usually from their mothers. A mother with high numbers of S.Mutans in her saliva is a source for infection. If she uses her own spoon to feed the child, she may introduce each time several colonies of bacteria into the mouth of the child.


Carbohydrates component of the diet is utilized by oral microorganisms, especially S.Mutans that enables the microorganisms to adhere to the teeth. Sucrose the most widely used sugar is considered important in dental caries as it is essential for bacterial adherence. It causes pH drop and demineralization of enamel.


In infants and toddlers, the main sources of fermentable carbohydrates are:

       1.   Bovine milk.
       2.   Human milk.
       3.   Acid fruit drinks.
       4.   Milk formulas
       5.   Pacifiers dipped in honey.
       6.   Chocolates or other sweets.

Salivary Factors for Nursing Bottle Caries

Human saliva not only lubricates the oral tissues, but also protects teeth and oral mucosal surfaces. The most important caries preventive function of saliva is the flushing and neutralizing effects. In general, higher the flow rate, faster the clearance and higher the buffering capacity. Reduced salivary flow rate may cause severe caries and mucosal inflammations. Dental caries is probably the most common consequence of hypo salivation.

Tooth Factor for Baby Bottle Caries

Teeth act as the host of microorganisms. Thin enamel is the reason for early spread of caries in primary teeth. Thus in many infants, a combination of recently erupted immature tooth in an environment of cariogenic flora with frequent intake of fermentable carbohydrate would render teeth particularly susceptible to caries.

Time Factor

Time is important in nursing caries in relation to frequency and amount of exposure of the liquid. Time is also important in relation to the duration of the deleterious habit. Duration should affect both the severity of lesion and number of teeth involved.

Clinical Appearance of Nursing Bottle Caries

Characterized as first affecting the upper front baby teeth , followed by involvement of baby molars and canines.

Lower front teeth are probably more resistant to caries because of their close proximity to secretions of submandibular salivary glands as well as the cleansing action of the tongue.

Distinct Pattern In Nursing Bottle Caries

  1. Upper front baby teeth: facial, lingual, distal and mesial surface
  2. Upper first baby molar : facial, lingual, occlusal, proximal surfaces.
  3. Upper baby canine and second molar: facial, lingual &proximal surfaces
  4. Lower baby molar: at later stages.
  5. Lower baby front teeth: usually not involved


How to prevent Nursing Bottle Caries in Children

During the last 50 years there has been a major reduction in the extent and severity of dental caries affecting population living in the Western (Mainly because of improved preventive programs). This reality has bought a sense of confidence to some dental researchers who felt content after having substantially contributed to lowering the incidence of this oral disease.

While on the other hand children from developing countries and the minority groups of the developed countries still experience a severe form of dental caries affecting their primary dentition.

There are three general approaches that have been used to prevent nursing bottle caries. The first is a community-based strategy that relies on education of mothers in the hope of influencing their dietary habit as well as those of their infants. This approach also includes fluoridating the water source and personal and community preventive programs in high-risk communities.

The second approach is based on the provision of examination and preventive care in dental clinics.

The third involves development of appropriate dietary and self care habits at home.

Use of topical antimicrobial therapy can also be recommended. Sealing of all caries free pits and fissures. The main strategies for the prevention of nursing caries should be to create awareness and alert prospective parents and new parents about the condition and its causes.

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