Germs (strep mutans) feed on fermentable carbohydrates or sugar in any form. The occurrence of decay in susceptible or genetically predisposed children infected with strep mutans is directly related to sugar exposures.
The key factor will be how many times a day the teeth are exposed to fermentable carbohydrates or sugar. Almost all foods, unless marked “sugar-free,” contain sugar. This includes fruits, breads, milk, juices and vegetables, in addition to candies, cookies and other sweets. It is not how much sugar you eat; it is how many times per day you feed the germs. When we take in foods or drinks containing even small or dilute amounts of sugar in any form, the germs produce acid on the tooth surfaces. The more minutes the acid burns into the tooth surface, the more destruction or decay occurs.
Dentists often see “baby bottle syndrome” or “severe early childhood caries” in children two years old and younger. The intent of many well-meaning parents is to pacify and hydrate their child using a bottle or sippy cup. However, if the liquid in the bottle or cup contains sugar, especially juices or chocolate milk, the result is often very rapid tooth decay.