Q My 17-month-old has what my dentist calls 'baby-bottle mouth'. She has lost most of the enamel from one tooth and has cavities in three others. The dentist says it's due to nighttime feeding (she is breastfed). I've heard similar claims about sharing saliva - for instance, if we chew something up and give it to her. Neither seems plausible. - Karen Cramer, via e-mail
A Breastmilk, unlike formula, is not cavity-causing, though once erosion has begun, it may be contributory. Sharing saliva, however, may be significant.
The terms 'baby-bottle mouth' and 'bottlerot' are very outdated. In 1994, the US Centers for Disease Control suggested discarding them as they inaccurately imply that bottle- or breastfeeding is the cause of tooth erosion.
Today, the syndrome is called 'ECC' - early childhood caries. It affects up to 11 per cent of infants in the industrialised countries (J Public Health Dent, 1996; 56: 38-50).
The cause of ECC - indeed, most tooth decay - is Streptococcus mutans. Infants acquire these bacteria from parents or other caretakers through kissing or using the same eating utensils (J Dent Res, 1993; 72: 37-45). Once in the mouth, S. mutans multiplies quickly, feeding on sugar and excreting enamel-etching acid. Children with ECC tend to have concentrations of S. mutans up to 100 times greater than normal (Arch Oral Biol, 1996; 41: 167-73). Breastfeeding may contribute because the lactobacilli in breastmilk form their own acid, encouraging more decay.
What makes some children ECC-susceptible is not clear. Risk factors include the mother's diet and oral hygiene, pregnancy complications (like preeclampsia), or a traumatic, caesarean or premature birth. Others are maternal diabetes, kidney disease, viral/bacterial infections, Rh incompatibility, allergies and gastroenteritis. So, susceptibility involves multiple factors.
Doctors recommend topical fluoride to remineralise the eroded teeth, but this tends to work only if caught early, before the white spots turn brown, and fluoride should be used sparingly on young teeth.
You may also wish to consider using calcium-containing mouthwashes (for remineralising adult teeth) perhaps by wiping the liquid onto your child's teeth. Sadly, once cavities have become serious, there are few options except surgery to repair or remove the teeth.
To prevent further erosion and decay, make sure you brush your daughter's teeth several times a day, rinsing toothbrushes thoroughly and renewing them regularly to avoid bacterial build-up. And don't chew food for her. You may also wish to visit your own dentist to have your mouth checked out. Chewing xylitol-containing gum can lower your own levels of S. mutans.
As S. mutans thrives in a low-pH (acid) environment, keeping your mouth more alkaline can help control its growth (J Am Dental Assoc, 1999; 130: 1787-92). Avoid formula milks (including soya) and offer your child water instead of juice. Fresh crunchy fruits such as apples are preferable to sticky raisins or candy. Brush as soon as possible after meals and snacks. In addition:
* Make bedtime brushing a ritual, and nurse your baby before this time
* Consider whether nighttime feeds are a habit rather than necessity, in which case, don't offer your breast unless it's emphatically asked for
* If the erosion is on one side of the mouth, switch sides at night to avoid further damage to that side
* Ditch that dummy, as it can increase levels of lactobacilli and Candida, both risk factors for ECC (Acta Odontol Scand, 1997; 55: 9-13)
* Introduce more fortified dairy and vitamin D-rich oily fish into her diet
* Watch out for hidden salt in children's foods, as this may contribute to ECC
* Encourage a fondness for peppermint tea. Mint should not be given to very young babies, but toddlers can handle small amounts and this may help kill off S. mutans
* Find a dentist who is less disapproving of prolonged breastfeeding - the benefits far outweigh the risks to teeth.