Early Childhood Caries: Prevalence, Risk Factors, and Prevention

Preventive Measures
Early childhood caries preventive strategies should begin with 
prenatal education of expectant parent(s), progress through 
the perinatal period, and continue with the mother and infant 
(Figure 2). Adequate dental treatment and oral hygiene meas-
ures during pregnancy can reduce or delay ECC in infants 
(
85
). Parents also should be advised to maintain optimal dental 
health during pre- and postnatal periods (
86
, 
87
). Measures 
should be taken in educating parent/caregiver about the etiol-
ogy and prevention of ECC (
88
). Nurses are also in a position 
to carry out prevention efforts for infants, toddlers, and their 
families and can provide counseling and support for children 
who suffer from ECC (
86
). A recently published multilevel 
conceptual model, incorporating influences of ECC exerted at 
the individual, family, and community level suggests that both 
social and behavioral change is important in the prevention 
of this oral disease (
89
). Use of probiotics chewable tables or 
TAbLe 1 | Classification based on the severity of ECC and etiology (
73
).
Type I (mild to 
moderate)
The existence of ‘isolated carious lesion(s)’ involving 
incisors and/or molars. The most common causes are 
usually a combination of semisolid or solid food and 
lack of oral hygiene.
Type II (moderate to 
severe)
ECC was described as ‘labiolingual lesions’ affecting 
maxillary incisors, with or without molar caries, 
depending on the age of the child and stage of 
the disease. Typically, the mandibular incisors are 
unaffected. The cause is usually inappropriate use of a 
feeding bottle or at-will breast-feeding or a combination 
of both, with or without poor oral hygiene.
Type III (severe)
ECC was described as carious lesions affecting 
almost all teeth including the mandibular incisors. A 
combination of cariogenic food substances and poor 
oral hygiene is the cause of this type of ECC.
TAbLe 2 | Classification based on the pattern of ECC presentation (
27
).
Type 1
Lesions associated with developmental defects (pit and fissure defects 
and hypoplasia)
Type 2
Smooth surface lesions (labial-lingual lesions, approximal molar lesions)
Type 3
Rampant caries—having caries in 14 out of 20 primary teeth, including 
at least one mandibular incisor