Dr Khalida Mustafa
17/1/2025
Nursing Bottle Caries: Nursing bottle caries, also known as baby bottle tooth decay or
nursing caries, refers to dental decay caused by prolonged exposure to sugary liquids, such
as milk, formula, or fruit juice, in a bottle or sippy cup. This condition is seen in the 0-3-year-
old age group and typically affects the upper front teeth and can involve the back teeth
without affecting the lower front teeth. It is commonly associated with bedtime feeding
without cleaning the child’s teeth afterward.
Early Childhood Caries (ECC): Early childhood caries is a widespread form of dental decay
affecting children under six. It is caused by frequent consumption of sugary foods or drinks,
poor oral hygiene, and transmission of cavity-causing bacteria from mothers/ caregivers.
ECC can progress rapidly, leading to pain, infection, and difficulty eating or speaking if
untreated. Prevention includes proper oral hygiene, regular dental visits, and limiting sugary
snacks, juices and beverages.
Management of caries in (0-5 years)
Younger children are often uncooperative in the dental chair, which is challenging for
dentists and necessitates preventative approaches.
Parents' education, particularly mothers, about diet is the cornerstone of caries management
in young children.
Mothers must supervise oral hygiene practices and manage diet. Parents should brush their
child’s teeth at least once a day until 6 years of age and supervise until 8 years of age.
Fluoride toothpaste is safe for children in the community where the water fluoride is below
the optimum level (.7ppm/l )
Late-night drinks, except water and milk, should be discouraged.
Fruit juices and sweetened liquids in the bottle should be discouraged after 1 year to avoid
prolonged acid in the mouth.
Mothers should clean their babies' teeth after feeding at night and after every meal with a
wet cloth to avoid nursing caries.
Black stains, commonly seen as a line in young children's cervical third of the teeth, are not
a risk factor for caries. They are extrinsic stains due to the presence of chromogenic
bacteria. Iron supplements can also be the cause. History taking plays a key role. These
stubborn stains can be reduced by advising mothers to brush their babies' teeth twice daily,
especially at night.
Management by Caries Risk:
Low Risk:
No signs of decay or white spots.
Educating mothers and reinforcing good hygiene and dietary practices are important.
Any regular toothpaste/or 500ppm fluoride toothpaste is acceptable.
Moderate Risk:
No visible decay but at risk due to frequent snacking and drinks between meals and
inadequate oral hygiene concerns.
Healthy snacks like popcorn, cheese, and whole fruits are preferred. Milk and water are
healthy drinks.
Fluoride toothpaste 500ppm twice a day is recommended under the supervision of the
mother
A small toothbrush with soft bristles is preferred, and grain-size toothpaste for 0-2 years and
pea-sized for 3-6 years is appropriate.
Mothers should encourage children to spit fluoride toothpaste to avoid swallowing to prevent
fluorosis.
Educate parents to check the fluoride content in toothpaste.
High Risk:
Multiple decayed teeth or white spots are present with more risk factors
Children with Mothers/siblings with current decay are at high risk for caries
The guidelines recommend 1000ppm fluoride more effective for 3-6 yrs in high-risk patients.
Toothpaste with calcium and phosphate and less fluoride concentration should be prescribed
to children whose parents are concerned about fluoride toxicity.
Educate parents to limit snacks and maintain regular meal times. Fruit juices and favourite
sweets should be given only at mealtime.
Fluoride mouthwash is not advised for young children
Flouride varnish is not recommended in early age group
Intervention in the clinic for high-risk children
Drops of Silver Diamine Fluoride (SDF) should be applied to arrest caries in uncooperative
children without pulp involvement. Inform parents about staining, and parents' consent is
crucial. SDF has less fluoride than 5% fluoride varnish and is safe in children.
SDF followed by glass-ionomer restorations can defer the patients for treatment under
general anesthesia
Fissure sealants like glass ionomer in uncooperative and composite sealants in patients
where moisture can be controlled
Temporary stainless-steel crowns are ideal in large cavities that are without pulp involved.
They have longer longevity than glass ionomer and composite restorations. They are easy to
place, do not need cutting except proximal clearance, and can be sealed with glass ionomer.
Glass ionomers are ideal for uncooperative children and are called atraumatic restorations.
Compomers (resin-modified glass ionomers) Composites in cooperative patients where
moisture can be controlled
Additional Notes for Dentists:
Dentists are responsible for educating parents during clinic visits or through awareness
programs.
Spend time discussing dietary habits and hygiene practices with mothers and encourage
them to follow-up visits to review their compliance.
Monitor fluoride concentration in local water; prescribe fluoride toothpaste accordingly.
Here is a simple explanation of tooth decay that you can discuss with the patients
(Featherstone)
