Baby bottles predispose to ECC because their nipple
blocks the access of saliva to the upper incisors, whereas
lower incisors are close to the main salivary glands and
are protected from liquid contents by the bottle nipple and
the tongue.11 The use of baby bottles during the night is
associated with the reduction in salivary flow and in the
capacity of salivary neutralization, which would cause
food stagnation in the teeth and prolonged exposure to
fermentable carbohydrates.9,30 Additionally, it has been
demonstrated that infants with ECC sleep less at night,
wake up more frequently, and receive more bottle-feedings
as a way to manage their sleep problems.48