When sweetness sours teeth

Nursing caries (previously known as Baby Bottle Syndrome or Baby Bottle Caries) are fast becoming one of the most common paediatric dental problems.

The main symptom of this syndrome is the rotting of the top four primary (baby) teeth. This happens because the baby or toddler who at this stage has teeth goes to sleep with a bottle of milk, fruit juice or sugar-containing liquid (for example tea with sugar) or falls asleep at the breast or with a sweetened dummy.

Plaque bacteria produce acid when sugar is ingested. While the child is sleeping, the flow of saliva and the frequency of swallowing diminish, allowing the fluid in the bottle to accumulate around the teeth.

The plaque bacteria on the teeth then utilises the sugar as a form of energy, and during this process acid is produced as a by-product. It is this acid that will decalcify the teeth, and not the sugar itself.

As the decalsification progresses, cavities are formed. The milk also sours in the mouth and this further contributes to the development of caries.

When your baby drinks, the fluid is sucked through the front teeth. These top four teeth are most vulnerable to decay (the back and bottom teeth are protected by the tongue). The eye teeth (canines) and top molars can also be affected in severe cases.

When a child has nursing caries, the primary tooth has to be restored under general anaesthetic. If it is not detected timeously, the caries will worsen and the primary tooth might have to be removed.

This could have implications for the development of permanent teeth – milk teeth are important because they guard the space for permanent teeth. Loss of this space can result in orthodontic problems. Feeding and speech development could also be affected.

 The good news is that nursing caries can be prevented. Follow these steps:

• Let the baby finish drinking before you lay him/her down to sleep. If the baby insists on a bottle, only give clean water.
• Do not add sugar or honey to the liquid.
• Avoid fluids that contain acid, such as fruit juice. If your baby already goes to sleep with a bottle of juice, wean the baby by gradually diluting the juice with water.
• Try to switch your baby from a bottle to a cup before the age of one. Do not use a cup with a spout or bottles with nozzles (such as Energade bottles) as these have the same effect as a bottle.
• Do not dip dummies in sweetened substances – this will also cause decay.
• Always clean the baby's teeth before bedtime by using a moist cloth and wiping the teeth. Plaque is a soft, sticky substance that can be rubbed off easily. As the baby gets older, introduce the use of a special baby toothbrush.

 (Dentist Dr Ilona Visser, December 2009)