Nursing bottle caries in infants

1. NURSING BOTTLE
CARIES
Submitted by:
Chhaya Dev
Roll no-106
BDS 4th year

2. Dental caries:-
Dental caries is a microbial disease of the mineralized tissues of the
teeth, characterized by the demineralization of the inorganic portion
and destruction of the organic substances of the tooth.
Nursing caries :-
Nursing caries is a unique pattern of dental caries seen in very young
children due to prolonged and improper feeding habits.

3. Synonyms:
Nursing caries- Winter(1966)
Tooth clearing neglect- Moss(1996)
Infant and early childhood dental decay- Horowitz(1998)
Early childhood caries- Davies(1998)
MDSMD- Maternally derived streptococcus mutans disease.

4. Etiologic agents in nursing
bottle caries:
1.Food products
■ Bovine milk
■ Human breast milk
■ Honey
■ Fruit juice
■ Sweetened beverages
■ Milk or water with added sugar

5. 2. Pathogenic Microorganism:
“Streptococcus Mutans “
It is transmitted to the infants mouth primarily through mother
It colonizes the teeth
It produces large amount of acid
It provides large amount of extracellular polysaccharides

6. 3. Substrate
“ Fermentable carbohydrate”
Main sources are:
-Bovine milk or milk formulas
-Human milk (breast feeding at will or on demand)
-Fruit juices & other sweet liquid
-Sweet syrups like vitamin preparations
-Honey or sugar solution
-Chocolates or other sweets

7. 4.Time
Time is an important factor that determines caries activity.
More the time child sleeps with the bottle in the mouth the higher is
the risk of caries.
During sleep salivary flow is diminished & swallowing reflex is absent.
Hence milk cannot be eliminated from the oral cavity & it pools
around the tooth surfaces, providing more time for accumulation of
carbohydrates in the mouth which are acted upon by microorganisms
to produce acid, leading to caries.

8. 5. Host
-Teeth act as hosts for microorganisms
-Hypomineralization or hypoplasia of teeth increases caries-
susceptibility of the child
-Thin enamel in primary teeth is one of the reasons for early spread
of lesions
-Developmental grooves also may act as plaque retentive areas

9. Other etiologic risk factors :
-Feeding at night always poses a serious threat especially if the teeth
are not cleaned after feeding.
-Feeding beyond the weaning age i.e. Beyond 12 to 15 months
-Single parent households.
-Child neglect could also be one of the major reasons for nursing
caries to occur as the parent is too busy.
-Financial stress and responsibilities.
-Immunocompromised children are at higher risk due to decreased
salivary flow.

10. -High socio-economic status as it has been seen that some mother
avoid breast feeding.The children are left to the mercy of the
domestic help who think it their duty to continuously force a bottle in
to the child’s mouth.
-Low socio-economic status as both the parents if working, leave the
children to be looked after by the young siblings and the resultant
neglect leads to tooth decay
-Children who present sleep disorders are found to be affected by
nursing caries.

11. Classification:
Type I ( Mild to moderate):
-Carious lesions involving the molars & incisors
-Seen in 2-to-5 year-old children
-Cause is usually a combination of cariogenic semisolid
or solid food & lack of oral hygiene
-Number of affected teeth usually increases as the
cariogenic challenger persists

12. Type II (Moderate to severe):
-Labiolingual carious lesion affecting the maxillary incisors with
or without molar caries, depending on age
-Seen soon after the first tooth erupts
-Mandibular incisors are unaffected
-Cause is usually inappropriate use of feeding bottle or at will
breast feeding or combination of both with poor oral hygiene
-Unless controlled, it may proceed to an advanced stage.

13. Type III (Severe):
-Carious lesions involve almost all the teeth, including
mandibular incisors
-Usually seen at 3 to 5 years of age
-Cause is a combination of factors & poor oral hygiene
-Rampant in nature & involves immune tooth surfaces

14. Clinical features:
The intra-oral decay pattern of nursing caries affects the
primary teeth in the following sequence:
-Primary maxillary incisors are first to get affected.
A) Maxillary central incisors: facial, lingual, mesial & distal surfaces
b) Maxillary lateral incisors: facial, lingual, mesial & distal surfaces
c) Maxillary first molars: facial, lingual and occlusal, prominent surfaces.
D) Maxillary canine and second molars facial, lingual and proximal surfaces.
E) Mandibular molars: At later stage

15. -The Mandibular incisors are usually spared because of:
✓They are protected by the mechanical cleansing action of the tongue
✓ Cleansing action of saliva due to presence of the orifice of the duct of the
sublingual glands very close to lower incisors

16. Developmental stages:

19. Management:
Divided in to three visits:-
FirstVisit-This phase of treatment constitutes treatment of the lesion identification of
the cause for counseling parent
-All lesions should be excavated and restored.
-Indirect pulp capping or pulp therapy procedures can be evaluated by further
investigation.
-If the abscess is present it can be treated through drainage.
-X-rays are advised to assess the condition of the succedaneous teeth.
-Collection of saliva for determining the salivary flow and viscosity.
-Also, the application of fluoride topically.

20. Parent Counseling:
-The Parent should be questioned about the child ‘s feeding habits,
specially regarding the use of nocturnal bottles, demand the breast
feeding, pacifiers dipped in sweetening agents
-The parents should be asked to try weaning the child from using the bottle
as a pacifier while in bed
-In case of considerable emotional dependence on the bottle suggest the
use of plain or fluoridated water
-The parents should be instructed to clean the child’s teeth after every feed
and advised to maintain a direct record of the child’s teeth after every feed
-Parents are advised to maintain a diet record of the child for one week
which include the time, amount of food given to the child, the type of food
and the number of sugar exposure

21. SECONDVISIT-It Should be scheduled one week after the first visit.
-Analysis of diet chart and explanation of the disease process of the child’s
teeth should be undertaken by a simple question.
-Isolate the sugar factors from the diet chart and control sugar exposure by
intelligent use.
-Caries activity tests can be started and repeated at monthly intervals to
monitor the success of treatment

22. Third and subsequent visits-Restoring all grossly decayed teeth.
-Endodontic treatment
-In case of unrestorable teeth extractions can be done followed by space
maintenance
-Crowns can be given for grossly decayed or endodontically treated teeth.
-Review and recall after every 3 months.

23. Complications:
✓ Nursing caries is a severely disabling condition. It can result in a severely
painful, unaesthetic appearance. Due to loss of tooth structure, the child
may not be able to chew food properly and subsequent malnutrition may
occur. Hence these children may show retarded growth as compared to
normal children
✓ Prolonged bottle feeding often displaces other components of staple
diet hence this can result in nutritional deficiencies for e.g. Anemia, etc.
The child who has nursing caries has an increased risk of developing caries
in the permanent dentition
✓ Rapid destruction of teeth may affect a child psychologically when he
compares himself to other children
✓ Early extraction of maxillary incisors can create speech problems
✓ Loss of primary teeth can cause space problems, which may result in
malocclusion

24. PREVENTION:
✓The main strategies for the prevention of nursing caries should be to
create awareness and alert prospective parents and new parents about the
condition and its causes
✓ Information on nursing caries can be distributed to new parents through
obstetricians or gynecologist, pediatricians, paramedical staff, health
workers and maternal and child health care centers
✓ Sealing of all caries free pits and fissures
✓ Professional fluoride programs
✓ Use of antimicrobial therapy topically
✓Systemic fluoride program if there is sub-optimal fluoride concentration
in drinking water

25. Thank
you