Bottle-feeding may lead to severe tooth decay in babies: Experts

By Dr. Ananya Mandal, MDFeb 7 2011

Dental experts have urged parents to stop bottle-feeding their babies because of rising rates of severe tooth decay in infants as young as 12 months. In the warning from Children’s Hospital at Westmead, Sydney, experts say that prolonged feeding with bottles of breast milk and infant formula are linked to the problem, especially at night, when children suck on bottles in their cots for extended periods.

According to the hospital’s head of dental services, Associate Professor Richard Widmer, lactose sugar is present in both breast milk and formula. When combined with plaque in a baby’s mouth, it could erode the enamel of primary teeth. Professor Widmer said, “Ideally, children should go straight from breast to cup, avoiding bottles altogether.”

There have been earlier warnings hat babies should not be put to bed with juice, cordial or other sweet drinks for fear of teeth damage, but this warning regarding milk including breast milk is new.

Professor Widmer revealed that his team has been removing teeth, under general anaesthetic, from babies as young as 12 months due to bottle-feeding infants at bedtime. The decay mainly occurs in the back of the upper front teeth, indicating the cause was drink from a bottle that had been held between the child’s tongue and teeth for prolonged periods.

Professor Widmer said, “We see more kids with decay, and we’re struggling to get them all done… Some of the ‘littlies’ are in pain. It is difficult some days.” The waiting time for dental surgeries under general anaesthetic is between nine and 12 months he added. Of early 100 five year olds, as many as one-third would have some form of tooth decay and as many as nine per cent severe decay he said. Of the 600 children he treated in emergency each year, as many as 15 per cent had presented with severe tooth decay.

Experts add that damage to primary teeth can be harmful. These milk teeth helped children chew food properly, develop proper speech and guide permanent teeth into the right place. Professor Widmer said good oral hygiene habits should be developed even before teeth erupt. A child should not become accustomed to sucking on a bottle at night.

Trends also revealed that bottle linked tooth decay was more prevalent in the Aboriginal and Torres Strait Islander community, among people from lower socio-economic or non-English-speaking backgrounds, and in rural areas that suffered from a lack of services, he said. Professor Widmer continued, “The biggest fears for me as a clinician are the bottle-feeding and the honey on the dummy.”

His message to parents says, “The golden message is two minutes brushing twice a day with fluoride… I understand parents are busy, but that’s the gold standard - brushing before school and before bed.” He advises taking children to the dentist from the age of one and no later than two, and brushing as their first teeth appear.

According to Angus Cameron, the head of paediatric dentistry at Sydney University and Westmead Hospital, some children had it so bad that every one of their primary teeth had to be removed. Australian Dental Association Victorian branch president Dr Anne Stewart also added, “The aim is to try to get into a routine where you aim eventually to not feed the baby to sleep… To help minimise those problems, don’t leave a bottle with anything, whether it’s breast milk or formula, in the baby’s mouth when it falls asleep… The reason we don’t want that pool of milk left in the mouth is that the normal bacteria we have on our mouths uses the milk to produce acids, which is how tooth decay starts.”

Dietician Susie Burrell said there was also a strong link between the consumption of sweet drinks and weight issues later in life. She said, “Ideally, water should be the drink of choice for everyone… If reduced-fat milk is chosen, it should be consumed with meals and out of a cup.”