What are baby bottle cavities?

Baby bottle cavities are a term used for cavities that start at an early age. They usually occur in children under 3 years old. The cavities are typically found on the upper front teeth. Parents may notice them as white or brown spots.

The conventional term for baby bottle cavities is “early childhood caries”.

What causes baby bottle cavities?

These cavities are often caused by milk left in the mouth overnight, but they can also result from any source of sugar. They were previously called “nursing caries” or “baby bottle rot” because they were commonly seen in children who were exclusively nursed or given bottled milk overnight without regular oral hygiene. The milk would stay in the child’s mouth overnight and can quickly lead to cavities.

The rapid progression of these cavities is due to several factors: the teeth are less mineralized (aka they are softer) when they first erupt, lack of fluoride exposure and limited oral hygiene.

Baby bottle cavities can also occur without nighttime milk feeding. Any instance where food or sugary liquids remain in the mouth for extended periods without being removed can lead to similar cavities.

What foods can cause cavities?

The benefits of breastfeeding are clear: milk (breast milk, cows milk or formula) is the ideal source of nutrition after feeding. However, night time milk exposure-with a bottle can increase the risk of cavities, especially if there are other carbohydrates remaining in the mouth.

Breast milk alone is not shown to increase the risk of cavities before 12 months of age. Other sources of milk have been shown to have higher sugar content than breast milk.

Exposure to juice, sugar sweetened beverages or flavored drinks from a bottle over night increases risk for baby bottle cavities. Frequent sugary snacking between meals is also a risk factor.

How do I prevent baby bottle caries?

1. Regular dental visits (exam, cleaning, fluoride)
   • the first dental visit should be 6 months after first tooth eruption or by 12 months of age. Whichever is earlier
2. Oral hygiene
   1. Mouth wiping with a clean wash cloth or gause after meals. Brushing once teeth erupt with a soft toothbrush
   1. Fluoridated toothpaste (smear amount if < 3yo)
3. Diet
   1. Minimize sugar exposure to sugary beverages or juice

How can you treat baby bottle caries?

This varies based on the size of the cavities and the risk of your child.

• Minor cavities: fluoride treatments, improve oral hygiene, reduce sugar exposure
• Moderate cavities: dental fillings or crowns
• Severe cavities: extractions

The final word

Baby bottle cavities (aka early chidlhood caries) is caused by milk exposure to erupting baby teeth over long periods of time. The most common way it occurs is by over-night use of bottled milk. The result is rapid progression of cavities in children. The best way to prevent this is by improving brushing with fluoridated toothpaste after feeding and to see a dentist early!

References:
American Academy of Pediatric Dentistry. Policy on early childhood caries (ECC): Consequences and preventive strategies. The Reference Manual of Pediatric Dentistry. Chicago, IL: American Academy of Pediatric Dentistry; 2025:96-100.

American Academy of Pediatric Dentistry. Policy on dietary recommendations for infants, children, and adolescents. The Reference Manual of Pediatric Dentistry. Chicago, IL: American Academy of Pediatric Dentistry; 2025:118-22.

Dean, J. A., Jones, J. E., Sanders, B., Walker Vinson, L. A., & Yepes, J. (2022). Chapter 23: Dental Caries in the Child and Adolescent. In McDonald and Avery’s Dentistry for the Child and Adolescent (11th ed.). essay, Elsevier.