A 2 year old boy was seen by a general practitioner for an upper respiratory infection. While doing the physical examination, the doctor noticed poor dental hygiene and dental caries. The picture is shown above.
What could be the most likely cause?
Milk Bottle Dental Caries
Case Discussion :
It is milk bottle dental caries. It is also known as baby bottle tooth decay (BBTD). It occurs because usually the baby is fed milk with bottle and the infant often goes to sleep with bottle. Thus, milk remains in contact with the teeth during sleep for long duration that precipitates the caries in upper and lower incisors of the child especially. Dental caries development depends on the inter-relationship between the tooth surface, dietary carbohydrates and specific oral bacteria. Dietary carbohydrates are fermented by oral bacteria especially mutans streptococci. It results in production of organic acids that reduce the pH of dental plaque adjacent to the tooth to a point that demineralization occurs. Initially carious lesion appears as an opaque white spot on the enamel but with progressive demineralization cavity formation occurs in the tooth. Sucrose is the most cariogenic sugar because a byproduct glucan is produced on its bacterial metabolism. Glucan is a polymer which enables the bacteria to adhere more readily to tooth surface and cause damage. Bottle feeding in sleep is very likely to cause dental caries because of greater duration of contact of sweetened milk being supplied to bacteria for causing dental caries. It has great cariogenic potential. It often results in severe caries of upper and lower incisor teeth in such children. Therefore, it is often advised that children should never be given feeds by bottle and that especially in night or before sleeping. Sucrose that is present in candies and chocolates is more cariogenic than other sugar containing substances that are likely to come in contact with teeth for a shorter duration. Candies and chocolates are usually retained much longer. Many times, they stick over teeth thus provide the substrate (carbohydrate) to bacteria for production of organic acids that destroys teeth. It is best for children to avoid candies and chocolates altogether. Even if they occasionally eat it, then it is best to brush and gargle thoroughly after it to clean the teeth of its remnants.
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