Response to Tinanoff and Palmer:
: Joanna M. Douglass, BDS, DDS
Sugar, notably suaose, is the undisputed
dietary etioIogic agent of caries.
What remains less apparent is the
form and method of consumption that
places a preschool child at increased
risk of developing early chidhood caries
(ECC). As suggested by Tinanoff
and Palmer (l), the traditional cause of
ECC-inappropriate use of the baby
bottle-can no longer be considered
the sole etiology. Only half of the papers
that examine the relationship between
bedtime bottle use and ECC
show a significant relationship (2).
However, to eIiminate the baby bottle
as a cause, or at least a risk marker, for
early childhood canes would be premature.
In fact, little is known about
the behaviors assodated with bottle
use that might make it a signrfrcant
etiologic factor. Most studies have
only asked the question, "Did your
child ever go to bed with the bottle?"
Few studies have investigated related
behaviors, such as whether the child
quickly finishes the bottle, whether the
child uses the bottle ad lib during the
day, or what foodstuff is in the bottIe.
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