Though it is common to lay the blame for ECC on inappropriate feeding practices - particularly the use of baby bottles with a sugar-containing liquid - the condition results from a complicated combination of factors including the transmission of the infectious microbes and the age of the infant or child (discussed earlier), diet and nutrition, mucosal immunity, the relative susceptibility of the incisors and molars, and the early detection of these caries.

With bottle feeding, the sugar-containing beverage in the bottle bathes the teeth in sugars and increases the risk of caries when the bottle is given to a child overnight or during naps.

When bottle feeding, the nipple effectively blocks the access of saliva to the upper incisors, while the lower incisors are close to the major salivary glands and are protected from the contents of the bottle by the nipple and the tongue. This is a contributing harmful factor for ECC. You'll recall from an earlier discussion that saliva can help to buffer and neutralize the acid produced by plaque bacteria, and it can also facilitate the clearance of food from the oral cavity.