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Tooth decay - early childhood


Tooth decay is a serious problem for some children. Decay in the upper and lower front teeth are the most common problems.

Alternative Names

Bottle mouth; Bottle carries; Baby bottle tooth decay; Early childhood caries (ECC)

Keeping teeth healthy

Your child needs strong, healthy baby teeth to chew food and to talk. Baby teeth also make space in children's jaws for their adult teeth to grow in straight.

Foods and drinks with sugar that sit in your child's mouth cause tooth decay. Milk, formula, and juice all have sugar in them. A lot of snacks children eat also have sugar in them.

  • When children drink or eat sugary things, sugar coats their teeth.
  • Sleeping or walking around with a bottle or sippy cup with milk or juice keeps sugar in your child's mouth.
  • Sugar causes bacteria to grow in your child's mouth.
  • Bacteria make acid.
  • Acid causes tooth decay.

Preventing tooth decay

To prevent tooth decay, consider breastfeeding your baby. Breast milk by itself is the best food for your baby. It keeps the inside of your baby's mouth healthy and prevents tooth decay.

If you are bottle-feeding your baby:

  • Give babies, ages newborn to 12 months, only formula to drink in bottles.
  • Remove the bottle from your child's mouth or hands when your child falls asleep.
  • Put your child to bed with a bottle of water only. Do not put your baby to bed with a bottle of juice, milk, or other sweet drinks.
  • Teach your baby to drink from a cup at 6 months of age. Stop using a bottle for your babies when they are 12 to 14 months old.
  • Do not fill your child's bottle with drinks that are high in sugar, such as punch or soft drinks.
  • Do not let your child walk around with a bottle of juice or milk.
  • Do not let your baby suck on a pacifier all the time. Do not dip your child's pacifier in honey, sugar, or syrup.

Caring for your child's teeth

Check your child's teeth regularly.

  • After each feeding, gently wipe your baby's teeth and gums with a clean washcloth or gauze to remove plaque.
  • Begin brushing as soon as your child has teeth.
  • Create a routine. For instance, brush your teeth together at bedtime.

If you have infants or toddlers, use a pea-size amount of non-fluoridated toothpaste on a washcloth to gently rub their teeth. When your children are older and can spit out all of the toothpaste after brushing, use a pea-size amount of fluoridated toothpaste on their toothbrushes with soft, nylon bristles to clean their teeth.

Floss your child's teeth when all of their baby teeth come in. This is usually by the time they are 2 ½ years old.

If your baby is 6 months or older, they need fluoride to keep their teeth healthy.

  • Use fluoridated water from the tap.
  • Give your baby a fluoride supplement if you drink well water or water without fluoride.
  • Make sure any bottled water you use has fluoride.

Feed your children foods that contain minerals to strengthen their teeth.

Take your children to the dentist when all their baby teeth have come in or at age 2 or 3, whichever comes first.


Douglass JM, Douglass AB, Silk HJ. A practical guide to infant oral health. Am Fam Physician. 2004;70:2113-2120.

Tianoff N. Dental caries. In: Kliegman RM, Stanton BF, St. Geme III JW, Schor NF, et al. eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 304.

Ribeiro NM, Ribeiro MA. Breastfeeding and early childhood caries: a critical review. J Pediatr (Rio J). 2004;80:S199-S210.

Sexton S, Natale R. Risks and benefits of pacifiers. Am Fam Physician. 2009;79:681-685.

Touger-Decker RJ. Position of the American Dietetic Association: oral health and nutrition. J Am Diet Assoc. 2007;107:1418-1428.

Review Date: 4/16/2014
Reviewed By: Ilona Fotek, DMD, MS, Palm Beach Prosthodontics Dental Associates, West Palm Beach, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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