Medical Questions » Teeth Questions » Question No. 983
| Question: | My two year old is still bottle fed but has white spots on his teeth and bleeding gums. He often cries when feeding. Should he see a dentist at this early age? |
| Answer: | This case describes the typical presentation and outcome of ' nursing bottle decay' or ' bottle caries' , which is seen in young children who are not yet weaned from the bottle.
Bottle caries is caused by frequent feeding of sweetened liquids from a bottle, especially before the child goes to sleep. Sugar in the liquid mixes with bacteria in the dental plaque to form acids that attack tooth enamel. Each time a sweet liquid is taken, acids attack the teeth for at least 20 minutes.
When children are awake, the saliva is able to remove some of the liquid. However, during sleep, the saliva flow decreases and the sweet liquids collect around the teeth for prolonged periods, bathing the teeth in acids.
The earliest appearance of decay is the enamel turning a chalky white colour, usually around the gum line. Then as more calcium is lost from the tooth, a hole finally appears. In severe cases of bottle caries, the cavities can ringbark the teeth and cause them to break off.
At the early stages, the cavities do not cause pain, but as they enlarge, increasing discomfort may be experienced, and dental abscesses may result.
Bottle caries may be treated by fillings or extractions, but because most children are not cooperative at such a young age, they usually need to be sedated. Very often, general anaesthetics have to be given.
The best form of treatment for nursing bottle decay is prevention. Children should not be allowed to sleep with a bottle of sweet liquid. If a child needs a bottle for comfort before falling asleep, fill the bottle with plain water, milk or formula, and remove the bottle as soon as the child is asleep. Dummies should never be dipped in honey.
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