Baby Bottle Tooth Decay (BBTD) is a rampant form of caries affecting the maxillary incisors, and frequently the molars, that occurs before the age of 2 years and is of growing concern. BBTD is a nutritional disorder whose outcome is carious teeth. Treatment involves extensive and expensive restoration of teeth or extraction of teeth associated with physical restraint, sedation, or general anesthesia in a hospital. This review of several issues regarding BBTD includes description, etiology and pathogenesis, prevalence, background factors, treatment, timing for intervention, existing strategies, and research opportunities. The disease is of significance to the nutritionist because it is totally preventable and occurs at an age when many children have seen a nutritionist (e.g., in a WIC program) but may not have seen a dentist. The dietetic practitioner can identify children at risk, determine awareness by the parent, and establish a behavioral contract with the parent. The practitioner needs to succeed for only a brief time to prevent BBTD.