Nursing Bottle Syndrome

Nursing bottle syndrome primarily affects babies and young children. Because caries can already occur in infancy and several or even all milk teeth are affected by caries.

Nursing Bottle Syndrome

What is Nursing Bottle Syndrome?

Nursing bottle syndrome is also known colloquially as baby bottle caries or bottle caries. It is a form of early childhood caries that can develop with the first milk tooth. Improper nutrition in the form of drinks that are too rich in carbohydrates, sugar and fruit acid, which are drunk with a bottle and insufficient oral hygiene causes bottle caries. The molars and incisors are most commonly affected. See aviationopedia for CA Explanations.


Caries is triggered by drinks that are too sweet and high in carbohydrates, such as fruit juices, sweetened teas and milk, which children drink in a bottle or sippy cup. The children suck on the bottle for a long time and so the sweetened drink stays in the mouth longer.

The risk of tooth decay increases, especially at night, when a child falls asleep with the feeding bottle in its mouth. During this time, the production of saliva, which naturally protects the teeth by neutralizing the acid, is reduced.

Symptoms, Ailments & Signs

The upper incisors are the first to be affected by this form of tooth decay. Because the tongue protects the lower incisors, it is rare for them to be affected. The first sign of tooth decay is brown discoloration of the teeth.

Teeth are sensitive to sweets and cold when carious destruction begins. The first signs are when the child complains of pain when drinking or eating, if it can already express it. Children often refuse to drink or eat when they are already in pain. If there is no change in drinking behavior, tooth decay can spread to the entire child’s teeth.

Diagnosis & course of disease

If parents discover the first signs of caries in early childhood, a trip to the pediatrician or dentist is unavoidable. The doctor can make the diagnosis with just one look inside the mouth. This also includes the analysis with the parents about the usual drinking and eating behavior of the child. Initially, only the enamel (outermost layer of the teeth) is affected.

However, if the caries progresses further, it can penetrate into the dental nerve (pulp). This leads to severe pain and, in particularly severe and persistent cases, can lead to an abscess (suppuration) in the bone. This can damage the germ of the underlying tooth. Nursing bottle syndrome can progress to the point where teeth do not extend past gum level.

If the second, permanent teeth break through when there is still untreated caries in the mouth, there is a high risk that the new teeth will be attacked by caries more quickly. For children, this type of oral disease can also lead to secondary diseases.

The absence of teeth can lead to a later speech disorder. Above all, the absence of the incisors is of great importance in language development in order to be able to pronounce the s-sound correctly. The bite also loses an important placeholder for the following second teeth. A misaligned tooth can be the result.


Due to the nursing bottle syndrome, the small babies or children suffer from tooth decay. This affects the milk teeth, with the incisors of the patient being particularly affected. Furthermore, the teeth turn brown or black and there is pain when taking liquids or food. The children can scream constantly if the pain cannot be assuaged.

Cold and hot food can also cause pain and have a significantly negative effect on the quality of life of the child and the parents. Refusal to eat can also occur if the pain is too severe due to Nursing Bottle Syndrome. This leads to malnutrition and various deficiency symptoms.

If left untreated, nursing bottle syndrome can spread to other teeth. As a rule, the treatment of nursing bottle syndrome is carried out with the help of a dentist. The procedure is carried out without complications and the complaints are completely removed. The life expectancy of the child is also not affected due to the nursing bottle syndrome. In severe cases, some teeth may need to be removed.

When should you go to the doctor?

Nursing bottle syndrome is an urgent case for an experienced dentist. Even the pediatrician can tell that it is caries, but he cannot offer any treatment. What is important when choosing the right dentist is his suitability for young patients. This is not due to the way in which the nursing bottle syndrome is treated with the possible damage to the permanent teeth that is already present. From a purely medical point of view, any dentist can treat caries even in a (small) child. Rather, it is important that the treatment does not make the child afraid of going to the dentist.

The treatment of caries is unpleasant and depending on the extent and progress of tooth decay, it may be necessary to drill holes, insert fillings or even remove destroyed milk teeth so that the permanent teeth underneath suffer as little damage as possible. A dentist who has experience with children works in such a way that the little patients take as little pain and unpleasant memories with them as possible.

Otherwise, it can lead to anxiety problems when visiting the dentist, which still have consequences in adulthood, such as the complete avoidance of the necessary check-ups. Many dental practices have now specialized in the treatment of children or anxious patients, so that nursing bottle syndrome is possible without unpleasant experiences and pain. Parents should address this openly when making the appointment.

Treatment & Therapy

The treatment of the little ones often proves to be difficult. Due to the fact that severe pain is the result of a treatment and the children are afraid, this is usually carried out under general anesthesia. If the destruction caused by caries is rather superficial and has not yet penetrated deep into the tooth, these teeth are drilled out and provided with a filling. The dentist tries to avoid pulling teeth as much as possible, otherwise an important signpost for the following teeth will be missing.

A root canal treatment is necessary when the caries has already progressed to the tooth nerve. In this way, an attempt is made to keep the tooth for as long as possible without having to pull it out. It is possible to fill the tooth afterwards to prevent further infection. This must be done in consultation with the parents, because if no dental care is carried out, this method is useless. In addition, the milk tooth root must be almost completely intact again. In many cases, however, it is unavoidable to remove the teeth.


In order to avoid the occurrence of the nursing bottle syndrome, special attention is required on the part of the parents and the pediatrician. Since at this age no examination at the dentist is common, the pediatrician should issue a referral to the dentist at the first inconspicuousness. In order to protect your child from early childhood tooth decay, care should be taken that the children do not suck on the bottle continuously.

Take the bottle out of the mouth before going to sleep and after the first year of life the bottle should be discontinued. No sweetened liquids are offered, only water or unsweetened tea. Daily tooth cleaning (morning and evening) with a brush after the first tooth erupts is an important preventive measure to counteract tooth decay.

The pediatrician recommends giving fluoride tablets or later brushing with a toothpaste containing fluoride. Parents should be well informed about prophylaxis and encouraged to carry it out.


In most cases, those affected with nursing bottle syndrome only have limited follow-up measures available. In the case of this disease, a quick and early diagnosis of the disease is primarily necessary so that there are no further complications or other symptoms. The sooner a doctor is contacted, the better the further course of the disease will usually be.

In most cases, the affected children are dependent on an operation on the mouth, in which the teeth are removed. As a rule, there are no particular complications or other symptoms, so this procedure generally proceeds without difficulties and the symptoms are completely relieved.

After such an operation, regular check-ups and examinations by a dentist are very important in order to avoid inflammation and infections. Further follow-up measures are usually no longer necessary in the case of nursing bottle syndrome. In general, parents should take care of their children’s teeth properly and intensively in order to avoid the occurrence of nursing bottle syndrome. The life expectancy of the children is unaffected.

Outlook & Forecast

The prognosis of nursing bottle syndrome is favorable under optimal conditions. If a doctor is consulted at regular intervals, the first irregularities can be noticed quickly. Treatment is then immediately initiated to alleviate the symptoms. Infants and young children are affected by this disease. Therefore, for a good prognosis, parents should visit a doctor with their offspring at regular intervals. If these time intervals are too long or if a visit to the dentist is avoided, irreversible damage to the teeth can occur. The germs present in the mouth destroy the tooth enamel, lead to suppuration or damage teeth and gums.

In an advanced stage of the disease, a denture must be used, otherwise there is a risk of losing the teeth or progressing the disease. With an unfavorable course of the disease, the formation of pus in the mouth can lead to blood poisoning. This is a potential threat to human life. In acute cases, working with an emergency team is therefore particularly important to ensure the child’s survival.

For an improved course, the diet should be changed and optimized. Parents are responsible for the food the child eats. You can therefore have an immediate influence and should make optimizations for long-term improvements.

You can do that yourself

Wenn das Nursing-Bottle-Syndrom diagnostiziert wurde, muss in erster Linie die Ernährung des Kindes angepasst werden. Zunächst gilt es, Zucker, Fruchtzucker und Kohlenhydrate zu streichen. Der Kinderarzt kann, falls notwendig, geeignete Nahrungsergänzungsmittel verschreiben. Das Trinkverhalten muss ebenfalls angepasst werden. Das Kind muss ausreichend Mineralwasser aufnehmen (mindestens ein bis zwei Liter pro Tag) und sollte zudem ausreichend Tee, Milch und Schorlen trinken.

After the diagnosis, the children are no longer allowed to eat anything that is too sweet or cold, as their teeth are sensitive to these stimuli. Depending on how far the damage has progressed, either medicinal or surgical measures must be initiated. In the case of minor damage, a light pain medication is sufficient, since the damaged milk teeth will loosen by themselves after a few years.

In the case of severe damage that may have already spread to the roots of the tooth, surgical intervention is necessary. After such an operation, it is essential to follow the doctor’s instructions regarding dietary measures and oral hygiene. Parents should ensure that this does not scratch the wounds excessively so that they can heal properly. If, despite all the measures, there is an increase in caries, a visit to the pediatrician is recommended.