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Ask Dr. Sears: Nighttime Bottles and Tooth Decay

Q. My husband and I recently adopted a baby, and he's been exclusively bottle-fed. He always feeds at night from a bottle, and I've been hearing that he will develop cavities from this. He doesn't take the bottle to bed; rather he has his bedtime bottle and we put him down to sleep right afterwards. Is this indeed dangerous for his teeth?

Indeed, it is, as the milk sugars in formula can cause tooth decay. Even natural milk sugars present in breast milk can occasionally cause tooth decay from night nursing. The reason for the night feeding-tooth decay correlation is that when you fall asleep, saliva production drastically slows and you lose the natural rinsing action that saliva provides. This allows the milk sugars to settle on the teeth and stay there throughout the night, possibly causing decay. It's a true dilemma, because one of the time-tested ways of putting babies to sleep is feeding them. Instead, try these tricks:

Watering down. To give your baby a sugar-free feeding at night, dilute the formula with water, increasing the amount of water to formula gradually, so that over a few months' time your baby will get used to going to bed with a bottle of water. Under the age of one year, however, this will be unrealistic since infants require a before-bed feeding to give them enough nourishment to last through the night. If you notice that he wakes up more often after you've diluted the formula, then you'll know he needs the full-strength formula to carry him through the night.

Give him a chaser. After you've given him his usual bottle of formula, let him drift off to sleep with a bottle of water. Sucking on the bottle of water can help remove some of the formula that may still be present in his mouth.

Brush his teeth twice a day. After his nighttime bottle, wrap a piece of wet gauze around your index finger. Using your finger as a tooth brush, wipe away the formula from his teeth. (Try to do this before he's completely asleep.) Be sure to brush his teeth as soon as he wakes up in the morning or after his first feeding. This will remove any formula that has stuck to the teeth during the night. For babies who absolutely must continue night feedings, a morning tooth brushing is a must.

Tooth decay from nighttime bottles is seldom a problem under a year of age when baby only has a few teeth (approximately eight teeth appear between six and twelve months, four upper front teeth and four lower front teeth, which are the easiest to brush).

Most of the tooth decay from night feedings  -- dubbed "bottle mouth"  -- occurs in toddlers between one and two years of age who refuse to give up their nighttime bottle. It's also the age when you need to be extra vigilant about dental hygiene. By two years of age, your baby will have approximately 18 teeth and his full set of 24 teeth usually by two and a half years.