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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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Year : 2019  |  Volume : 37  |  Issue : 4  |  Page : 405-408

Does the position of a bottle during infant feeding influence the jaw's postural position?

1 Department of Restorative Dentistry, Rutgers School of Dental Medicine, Newark, New Jersey, USA
2 Undergraduate Student, Brown University, Providence, RI, USA
3 Department of Pediatric Dentistry, Rutgers School of Dental Medicine, Newark, New Jersey, USA

Date of Web Publication7-Nov-2019

Correspondence Address:
Dr. Hua Zhu
Clinical Assistant Professor, Department of Restorative Dentistry, Rutgers School of Dental Medicine, 110 Bergen Street, Newark, NJ 07101-1709
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JISPPD.JISPPD_91_18

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Early correction of anterior crossbite in the primary dentition can encourage proper growth and development of the maxilla and mandible, reducing the need for future orthodontic therapy. Correction is typically initiated after the age of 3 when a fixed or removable appliance can be fabricated and worn. This case study describes an instance of exceptionally early intervention without the use of an appliance. A bottle-fed 10-month-old boy presented with anterior crossbite, and a contributing factor may have been the position of the bottle's nipple during feeding. Correction of the anterior crossbite was achieved in 5 months by changing the bottle position to a counterbalancing angle. Although this technique warrants further investigation, it has the potential to reduce the need for and length of future procedures.

Keywords: Anterior crossbite, bottle-feeding, early correction, malocclusion

How to cite this article:
Zhu H, Zhang B, Rosivack R G. Does the position of a bottle during infant feeding influence the jaw's postural position?. J Indian Soc Pedod Prev Dent 2019;37:405-8

How to cite this URL:
Zhu H, Zhang B, Rosivack R G. Does the position of a bottle during infant feeding influence the jaw's postural position?. J Indian Soc Pedod Prev Dent [serial online] 2019 [cited 2023 Feb 4];37:405-8. Available from: http://www.jisppd.com/text.asp?2019/37/4/405/270485

   Introduction Top

Anterior crossbite is a condition in which maxillary anterior teeth are positioned palatally in relationship to mandibular anterior teeth. It often transfers from primary dentition to permanent dentition and may stimulate the growth of mandibular condyle.[1],[2] Early treatment provides a more favorable position for jaw development and reduces the need for eventual costly orthodontic treatment. Currently, early treatment includes tongue blade therapy and a variety of fixed or removable appliances, performed on children of at least 3 years of age.[1],[3] This case report describes the successful correction of anterior crossbite in an infant, without the need for an appliance.

   Case Report Top

A 10-month-old Asian American male presented to a private dental office for evaluation. The patient's medical history was unremarkable. At that time, the patient's two mandibular primary central incisors, left mandibular primary lateral incisor, two maxillary primary central incisors, and two maxillary lateral incisors had erupted. No other primary teeth had yet erupted. On clinical examination, the patient's postural position was such that his incisors presented in an anterior crossbite [Figure 1]a. The patient's parents were questioned regarding the patient's day-to-day posture of his dentition, and the parents confirmed that he consistently positioned the mandibular incisors anterior to the maxillary incisors. To evaluate a possible genetic component to the patient's occlusion, the occlusion of both parents was evaluated. Both parents presented with a Class I occlusion, and they denied having previous orthodontic treatment.
Figure 1: Clinical pictures before and after changing the bottle angle ([a] anterior crossbite of a 10-month-old infant before treatment. [b] anterior crossbite corrected 5 months after treatment. [c] anterior teeth 2 years after treatment. [d] facial profile 2 years after treatment)

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Next, the parents were questioned about the patient's feeding habits. They revealed that he had been breastfed and bottle-fed for the first 2 months after birth. This was followed by exclusive bottle-feeding for the next 8 months. The type of bottle used was a traditional bottle [Figure 2].
Figure 2: Current bottles in the market

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The traditional bottle's overall structure allows the bottle-feeding position to easily vary between positions A, B, and C, in [Figure 3]. It was determined that the patient's parents had fed the child mainly in position B attempting to reduce air intake when the patient was feeding. A recommendation was made to shift the position of the bottle downward to position C without changing the baby's head position while feeding. The parents switched to this feeding position and routinely followed this instruction until the patient returned.
Figure 3: The three bottle-feeding positions ([a] position A: bottle held perpendicular to the mouth, [b] position B: bottle tilted at an upward angle, [c] position C: bottle tilted at a downward angle)

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At the patient's next visit at the age of 15 months, the patient's eight maxillary and mandibular incisors, four primary canines, and four first primary molars had erupted. On examination, the patient was found to be positioned in a Class I occlusion. The anterior teeth no longer presented in crossbite, and there was 1.5 mm of overbite and 1.5 mm of overjet present [Figure 1]b. The parents were then instructed to switch the feeding position of the bottle to that shown in [Figure 3]a.

Two years later, at the age 3, the patient presented for reevaluation. At this time, all primary teeth had erupted. The patient again presented with all teeth in a Class I occlusion with an overbite of 2 mm and an overjet of 1.5 mm [Figure 1]c and [Figure 1]d.

   Discussion Top

Previous studies evaluating the primary dentition suggest that malocclusions, including anterior crossbite, are associated more with bottle-feeding than breastfeeding. Most studies, however, cannot link bottle-feeding with any specific increase in malocclusion.[4],[5] Some researchers believe that the tongue position and facial muscles used in bottle-feeding cause malocclusions;[6],[7] others believe the shape and texture of the bottle's nipple cause malocclusions.[8] None of the previous articles have related the cause of malocclusions to bottle or nipple angle.

Hypothesis and rationale

Differential pressures on the teeth and jaw influence the development of the maxilla–mandible relationship in the sagittal plane. Because infants grow rapidly and their bones are pliable, even a small force, if repeated frequently, may change the jaw, teeth, and condyle position and affect facial development.

Currently, no standardized bottle-feeding angle recommendations have been found among local hospitals, pediatric offices, maternity care books, printed literature, or Internet searches.[9],[10] This paper hypothesizes that of the three bottle-feeding positions, the perpendicular position A [Figure 4]a is likely the best option to prevent malocclusions because it puts balanced pressure on the maxilla and mandible, encouraging normal jaw and teeth development in the sagittal plane.
Figure 4: Force diagrams of the three bottle-feeding positions ([a] position A: bottle held perpendicular to the mouth, [b] position B: bottle tilted at an upward angle, [c] position C: bottle tilted at a downward angle)

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Position B may contribute to anterior crossbite by retroclining the maxillary incisors and proclining the mandibular incisors or encouraging a forward posturing of the mandible through the pressure of the nipple [Figure 4]b. Position C, on the other hand, may procline the maxillary incisors and retrocline the mandibular incisors through the pressure of the nipple [Figure 4]c. Since positions B and C have opposing effects, they may be used to correct already existing malocclusions through counterbalancing forces (i.e., B can correct excessive anterior overjet; C can correct anterior crossbite).

The recommendation given to the parents in this case study was based on the aforementioned theory. Once the parents had changed from feeding position B (which may have contributed to the anterior crossbite) to position C, the crossbite was corrected in 5 months. The subsequent use of position A maintained the patient's normal overjet.

The parents in this case study fed the baby with the traditional bottle, which is most commonly used because it is the least expensive bottle type. Since the traditional bottle has a straight bottle shape and a tall, narrow nipple with a funnel-shaped base, it can be shifted to various positions easily. In an attempt to eliminate the infant sucking in air, the parents fed the baby at position B. Several other types of bottles are available for retail purchase which have modifications proposing to be an improvement over the traditional bottle [Figure 2]. Some of these newer styles of bottles and nipples may make holding the bottle in an incorrect position less likely. For example, the bottle with the wide nipple base design cannot be incorrectly positioned at B or C as easily as the traditional bottle. Alternatively, the tilted nipple and the angled bottle designs reduce the need to wrongly tilt the bottle to position B, which was often necessary with traditional bottles to prevent the infant from sucking in air as the bottle depletes. Adding a liner to the bottle would also prevent the infant from sucking in air and reduce the need to tilt the bottle upward. Regarding different nipple shapes, Corrêa Cde et al. in their systematic review stated that they were unable to conclude if conventional nipples and orthodontic nipples affect the occlusion differently.[11]

The private practice where the above case was treated had a second case, very similar to the one presented here. It documented a healthy 10-month-old Asian American male with no family history of anterior crossbite, who had 2 months of mixed feeding followed exclusively by bottle-feeding from a traditional bottle in position B. At the initial visit, the patient's four mandibular and four maxillary incisors had erupted into crossbite, and after the bottle position was switched to position C, the anterior crossbite was corrected in 4 months. As no good quality pretreatment photographs of this patient are available, this has not been presented as an independent case.

Although both cases support the derived hypothesis, the possibility still exists that the cause and resolution of the observed anterior crossbite was unrelated to bottle-feeding. The anterior crossbite could have been present due to the original position of the erupting primary incisors or could have been due to the baby's habitual posture at the time, and the resolution could have been unrelated to the feeding position. A negative control, such as the continuation of the same bottle-feeding position, would be needed to rule out the possibility of a naturally occurring self-correction. A larger sample size of infants presenting with anterior crossbite with a broader range of variables – including differences related to family background, gender, race, age, and feeding history – would be required to validate the proposed recommendations. A controlled clinical trial would be needed to confirm cause–effect relationships while creating a greater understanding of the etiology of anterior crossbite.

If the hypothesis presented above regarding bottle position during feeding is confirmed, educational programs can be established to inform and encourage parents to use proper positioning during bottle-feeding. Practitioners can provide early correction of developing occlusion, allowing patients to avoid or reduce complicated, lengthy, and painful orthodontic procedures. Finally, proper bottle positioning may improve a child's facial esthetics, thereby contributing to a healthy psychological, social, and emotional development.


The authors wish to thank Dr. Anil Ardeshna, Dr. Christopher V. Hughes, and Dr. Rob Whiteley for their help with the manuscript.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Vadiakas G, Viazis AD. Anterior crossbite correction in the early deciduous dentition. Am J Orthod Dentofacial Orthop 1992;102:160-2.  Back to cited text no. 1
Ngan P, Hu AM, Fields HW Jr. Treatment of class III problems begins with differential diagnosis of anterior crossbites. Pediatr Dent 1997;19:386-95.  Back to cited text no. 2
Borrie F, Bearn D. Early correction of anterior crossbites: A systematic review. J Orthod 2011;38:175-84.  Back to cited text no. 3
Hermont AP, Martins CC, Zina LG, Auad SM, Paiva SM, Pordeus IA, et al. Breastfeeding, bottle feeding practices and malocclusion in the primary dentition: A systematic review of cohort studies. Int J Environ Res Public Health 2015;12:3133-51.  Back to cited text no. 4
Narbutytė I, Narbutytė A, Linkevičienė L. Relationship between breastfeeding, bottle-feeding and development of malocclusion. Stomatologija 2013;15:67-72.  Back to cited text no. 5
Inoue N, Sakashita R, Kamegai T. Reduction of masseter muscle activity in bottle-fed babies. Early Hum Dev 1995;42:185-93.  Back to cited text no. 6
Gomes CF, Trezza EM, Murade EC, Padovani CR. Surface electromyography of facial muscles during natural and artificial feeding of infants. J Pediatr (Rio J) 2006;82:103-9.  Back to cited text no. 7
Nowak AJ, Smith WL, Erenberg A. Imaging evaluation of artificial nipples during bottle feeding. Arch Pediatr Adolesc Med 1994;148:40-2.  Back to cited text no. 8
Bennett R. How to Bottle Feed your Baby; 2013. Available from: http://www.kidspot.com.au/baby/feeding/bottle-feeding/how-to-bottle-feed-your-baby/news-story/219a2ad1a9675d3ccacb8de9dda5275f; http://www.webcitation.org/6sW3Opmq0. [Last accessed on 2017 Aug 06].  Back to cited text no. 9
Fredregill S, Fredregill R. Bottle feeding your baby. In: The Everything Breastfeeding Book. 2nd ed. Avon, Mass: Adams Media Corp.; 2002. p. 152-4.  Back to cited text no. 10
Corrêa Cde C, Bueno Mda R, Lauris JR, Berretin-Felix G. Interference of conventional and orthodontic nipples in system stomatognatic: Systematic review. Codas 2016;28:182-9.  Back to cited text no. 11


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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