Early Childhood Caries: Prevalence, Risk Factors, and Prevention

Keywords: dental caries, early childhood caries, dietary habits, oral health, pediatric oral health, sociodemographic 
factors, infant feeding
iNTRODUCTiON
Early childhood caries (ECC) has been on the increase in many countries and has become a 
significant health problem especially in socially disadvantaged populations. ECC is defined as 
the presence of one or more decayed, missing, or filled tooth surfaces in any primary tooth in a 
child at 71 months of age or younger. It has several unique characteristics in clinical appearance 
such as rapid development of caries, which affects a number of teeth soon after they emerge in 
oral cavity. These lesions involve tooth surfaces that are less prone to caries development. Several 
terminologies were used to describe the condition such as, nursing bottle caries, nursing caries, 
rampant caries, baby bottle caries, baby bottle tooth decay, milk bottle syndrome, and prolonged 
nursing habit caries. ECC is a multifactorial disease that results from the interaction of factors that 
include cariogenic microorganisms, exposure to fermentable carbohydrates through inappropriate 
feeding practices, and a range of social variables. ECC is a severe health condition found among 
children living in socially disadvantaged communities in which malnutrition is a social and health 
disparity (
1
, 
2
). ECC is associated with other health problems, ranging from local pain, infections, 
abscesses, leading to difficulty in chewing, malnutrition, gastrointestinal disorders, and difficulty 
in sleeping (
3
).

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FigURe 1 | The influence of host–microbe–diet interactions in the etiology and pathogenesis of early childhood caries.
2
Anil and Anand
Early Childhood Caries
Frontiers in Pediatrics | www.frontiersin.org
July 2017 | Volume 5 | Article 157
The etiology of ECC is multifactorial and is mainly attributed 
to a time-specific interaction of microorganisms with sugars on a 
tooth surface (Figure 1) (
4
). Diet and feeding practices also play 
an important role in acquisition of the infection and development 
of caries (
5
, 
6
). Factors such as high sugar intake, lack of oral 
hygiene, lack of fluoride exposure, and enamel defects are some 
of the major factors responsible for the development of ECC 
(
7
–
9
). ECC is higher among the more socially disadvantaged and