Nursing-bottle syndrome (NBS) – colloquially known as teat-bottle caries – is the occurrence of caries, up to and including extensive destruction of deciduous teeth in infants and young children, resulting from frequent or continuous administration of beverages containing sugar, carbohydrates or fruit acids with a teat bottle. The use of sippy cups or sippy cups can also lead to the development of sippy bottle caries.
Symptoms – complaints
Teat bottle caries usually starts on the upper incisors. The lower incisors are very rarely affected because the tongue lies protectively over them when drinking. The carious destruction makes the teeth sensitive to sweet and cold. The children complain – if they are already able to do so – of pain when eating or drinking. If nothing is changed in the drinking behavior, the painful destruction of the teeth can spread to the entire dentition.If the caries goes so deep that the pulp (tooth nerve) is already affected, this causes severe pain in the affected children up to abscesses (suppurations) in the bone.
Pathogenesis (disease development) – etiology (causes)
The cause of early carious destruction of milk teeth is the excessive administration of sugary or acidic drinks. These are given to affected children in teat bottles or sippy cups several times a day between main meals, but also to calm them down or put them to sleep. The children drink in this way for several hours a day, and dental hygiene is often neglected or not carried out at all. The constant wetting of the maxillary anterior teeth with sweet or acidic drinks causes massive carious damage. Initially, only the enamel is affected. If the NBS progresses, the teeth can be destroyed to such an extent that they barely rise above the gingival level (gum level). Normally, saliva is able to neutralize acid attacks. However, this function fails when fluids are continuously administered by bottle. Furthermore, less saliva is produced at night, which additionally reduces the cleansing effect as well as the buffering effect against acids when carbohydrate-containing bottle feeds are administered at night. Various studies have shown [including 4] that children from socially deprived backgrounds are particularly affected by NBS.
Follow-up
Sometimes severely destroyed deciduous teeth have to be removed. This represents a major impairment for the children. On the one hand, speech development – especially S-sound formation – is negatively affected when the upper incisors are missing. On the other hand, their important placeholder and guide function for the subsequent permanent teeth is lost. Premature eruption and an unfavorable malocclusion of the permanent teeth may result. Furthermore, abscesses (suppurations) of the milk teeth in the bone can occur and consequently germ damage to the underlying permanent tooth. If permanent teeth break through in the presence of a severely decayed primary dentition, caries can also attack these teeth at an early stage and thus permanently damage the permanent dentition.
Diagnostics
Due to the characteristic clinical appearance, a simple dental examination is usually sufficient to detect NBS. It is important to take a detailed history regarding the child’s drinking behavior with the parents so that they can be specifically counseled during and after treatment on how to avoid such serious dental damage in the future.
Therapy
Because the affected children are usually infants, in many cases treatment must be performed under general anesthesia due to – understandably – a lack of cooperation on the part of the young child. Teeth worthy of preservation whose destruction has not yet progressed too far are treated with fillings. If the caries has already reached the pulp (tooth nerve), endodontic treatment (root canal treatment) can sometimes be performed to preserve the tooth for as long as possible. In this case, it must always be weighed up how good the prognosis of the affected tooth is, whether there is a willingness to cooperate on the part of the young patient and whether it is possible to subsequently treat the tooth with an adequate filling in order to avoid reinfection of the root canal. Furthermore, the deciduous tooth root should be resorbed to a maximum of one third.Often, however, the anterior teeth in the upper jaw are already so severely destroyed when the diagnosis is made that extraction (removal) of the teeth is unavoidable. Counseling of the parents is of great importance. Only if the parents change the child’s drinking behavior and practice adequate dental hygiene can a recurrence of massive carious destruction be prevented. Therefore, special emphasis should always be placed on providing parents with detailed, comprehensible advice.
Prophylaxis
The primary teeth are important placeholders for the permanent teeth and should be cared for and preserved under all circumstances.To prevent the development of Nursing-Bottle syndrome, parents should follow these tips:
- Do not leave the bottle or sippy cup for your child to suck continuously.
- Give your child only unsweetened tea or water from the beginning.
- Teat bottles or sippy cups should not be given to fall asleep or to soothe, as there is a habituation effect.
- Sippy bottles and sippy cups should only be used for a short time as a transition to a cup. Between the 10th and 12th month of life, drinking from a cup should be learned.
- From the eruption of the first tooth, the milk teeth should be brushed in the morning and evening with fluoride-containing toothpaste for children for two minutes each. A Nachbürzen by the parents is thereby urgently required until the children are eight to ten years old.
- After brushing teeth and before bedtime, do not give milk, tea or fruit juice. If the child is thirsty, give him some water, which is still the best thirst quencher.
If you follow these rules, you can successfully avoid the occurrence of painful tooth decay in your child.
