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A mother brings her 18-month-old son to the physician's clinic for his well-child examination. He is almost weaned from his bottle, but still drinks from a bottle to go to sleep. During the day, he uses a sippy cup to drink everything—from milk to soda. His mother has started giving him apple juice in the bottle instead of milk because he tends to get constipated. On performing an oral examination, the physician notices that several of his teeth have "white spots" (Figure 46-1). The physician discusses dental hygiene and treats him with topical fluoride gel.


Demineralization at gingival margins characterized by whitish discolorations. (Reproduced with permission from Gerald Ferretti, DMD.)


Dental caries continues to be the most prevalent chronic disease problem facing infants and children. The American Academy of Pediatric Dentistry, American Academy of Pediatrics, and American Dental Association recommend that a child's first visit to a dentist should occur 6 months after the eruption of the first tooth or at 1 year of age. Providing a dental home by age 1 year allows the health provider to complete a risk assessment, provide an introduction to dentistry, and provide anticipatory guidance. It is important to be able to recognize disease and to provide prevention strategies early on to the parents/caregivers.


Nursing bottle caries, baby bottles caries.


  • Early childhood caries (ECC; tooth decay) is the single most common chronic childhood disease. It is 5 times more common than asthma and 7 times more common than hay fever among children 5 to 7 years of age.1

  • Approximately 37% of children ages 2–8 years had experienced dental caries in primary teeth in 2011–2012.2

  • Disparities in oral health exist. In 2011, 27% of Hispanic children had dental caries in permanent teeth compared to 18% of non-Hispanic children.2

  • ECC is defined as "the presence of one or more decayed (noncavitated or cavitated lesions), missing (as a consequence of caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger" (Figures 46-2, 46-3, 46-4).3

  • Consequences of ECC include poor self-esteem, diminished physical development, decreased ability to learn, higher risk of new caries, and added cost.3


Central maxillary incisors with severe tooth decay, and bilateral maxillary lateral incisors with demineralized area near gingival line (yellow-brownish discolorations). The upper incisors are often the first teeth involved in nursing-bottle caries. (Reproduced with permission from Gerald Ferretti, DMD.)


Severe ECC in a 4-year-old with severe decay of all four maxillary incisors. (Reproduced with permission from Richard ...

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