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  • We recently shared a story from our archive about nursing bottle syndrome (NBS). It was an article that defined NBS and how it can happen to babies and toddlers. We wrote there that NBS was the decay of baby teeth due to prolong exposure to sweetened liquids or natural sugars. For prevention, we added that it was advisable for "kids not to go to bed while drinking formula milk or while breastfeeding."

    On our Facebook, one mom wanted us to verify the facts of our story because she said "[NBS] wasn't true with breastfeeding." She also added we might cause moms to worry needlessly.

    We took her concern seriously, so we checked if we needed to revise or update the facts of our story. Our story back in 2015 was fairly accurate after we got in touch with two pediatric dentists. 

    In the previous article, we said moms need to refrain from letting their child fall asleep with a bottle in her mouth. It could lead to unswallowed milk to remain in the baby's mouth. Because less saliva is produced when a child sleeps, the bacteria in the mouth would thrive instead on the sugar from the milk and produce acids that attack the teeth, causing tooth decay.

    According to Dr. Carina De los Reyes, former president of the Philippine Pediatric Dental Society Inc. (PPDSI), if your child is asleep for eight hours every night with milk residue in her mouth, her teeth are exposed to damage night after night. It’s typical that the upper front teeth are the first decay. “The lower front teeth are protected from contact with the milk as the tongue covers and protects them during bottle feeding,” adds the pediatric dentist.

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    Dr. Georgina Remulla, director of the PPDSI, agrees with Dr. De los Reyes. She explained that any liquid containing fermentable carbohydrate (sugar, in other words) could cause cavities if left undisturbed for long periods. 

    Baby bottle tooth decay (BBTD) is actually the most common way for tooth decay to develop via exposure, says the American Academy of Pediatrics (AAP). “BBTD results from teeth being coated in almost any liquid other than water for long periods, and occurs most commonly among babies who are put to bed with a bottle of formula or juice.”

    But can breast milk cause BBTD? “Previously, research has shown that human milk, unlike cow's milk, doesn't cause cavities. However, some newer studies say that the sugar from breast milk may also cause decalcification,” explains Dr. De los Reyes. 

    So it is not impossible for baby bottle tooth decay to happen especially if there is unswallowed breast milk in a baby's mouth. As AAP points out, “Breastfeeding infants who fall asleep while nursing with unswallowed milk in their mouths are also vulnerable to tooth decay.”  

    Nursing moms may find this a cause for concern because we know extended and on-demand breastfeeding is the goal for our babies for 2 years old and over. AAP and local dentists, however, tell breastfeeding moms not to overly worry. There is little evidence that breast milk alone can be a cause for cavity. Other foods can be a major problem as well, and there are kids who are at a higher risk for tooth decay.

    Experts' advice: make it a point to remove your breast from your child’s mouth once she has fallen asleep. It lessens the chances of milk pooling in her mouth overnight. You may also wipe your child’s teeth with a damp cloth after feeding and before bedtime. 

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    Apart from that, Dr. De los Reyes stresses the importance of that first visit to the dentist. This is for “parental education on proper tooth brushing with fluoridated toothpaste,” says Dr. De los Reyes. “Fluoridated toothpaste should be used as soon as the first tooth erupts. Fluoride is the best protection against dental cavities.” Find the PPDSI guide on how to pick the right toothpaste for your child here.

    Aside from not putting a child to bed with a bottle, the AAP also advises parents not to use a bottle filled with milk, juice or any other sweetened liquid as a pacifier.

    And, teach your child to drink from a cup as soon as possible, around 12 to 15 months of age. “Drinking from a cup is less likely to cause liquid to collect around the teeth. Also, a cup cannot be taken to bed,” says the AAP. Sweetened beverages, like fruit and instant juice, is not recommended for children below 2 years old. 

    According to the AAP, tooth decay is the most common chronic infectious disease of childhood, which is why dentists everywhere are encouraging parents to schedule an appointment once the first tooth pops up. It's a crucial first visit; dentists make their initial assessment, and parents are taught how to take proper care of your child's teeth. 

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