Early Childhood Caries: Prevalence, Risk Factors, and Prevention

particularly for children who are refugees or migrants, or whose 
parents are refugees or migrants from third world countries (
10
, 
11
). This could be related to low socioeconomic status, social 
exclusion, and sociocultural differences in oral health beliefs and 
practices (
12
). ECC is a serious oral health problem, especially in 
disadvantaged communities in both developing and industrial-
ized countries in which undernutrition is very common (
13
).
ePiDeMiOLOgY OF eCC
Despite the decline in the prevalence of dental caries in children 
in western countries, caries in preschool children remains a 
major problem in both developed and developing countries 
(
13
). Prevalence of ECC also varies widely with several factors 
like race, culture, and ethnicity; socioeconomic status, life style, 
dietary pattern, and oral hygiene practices and also according 
to the various factors from country to country and from area to 
area. A review of the literature suggests that in most developed 
countries the prevalence rate of ECC is between 1 and 12% (
14
). 
In less developed countries and among the disadvantaged groups 
in the developed countries, the prevalence has been reported to 
be as high as 70%. ECC has been found to be more prevalent in 
low socioeconomic groups (
15
, 
16
). The prevalence ranged from 
11.4% in Sweden to 7–19.0% in Italy (
17
, 
18
). A high prevalence 
of ECC has been reported in some Middle Eastern countries, 
such as Palestine (76%) and the United Arab Emirates (83%)
(
19
, 
20
). The national surveys from some countries, such as 
Greece (36%), Brazil (45.8%), India (51.9%), and Israel (64.7%), 
showed inconsistent prevalence of ECC (
21
–
24
). In a systematic 
review, Ismail and Sohn (
25
) found that the prevalence varied 
from 2.1% in Sweden to 85.5% in rural Chinese children. The 
national prevalence of ECC in the USA can be estimated between 
3 and 6%, which is consistent with the prevalence in other western 
countries (
26
, 
27
). According to a study, the highest prevalence 
of ECC is found in the 3- to 4-year-old age group and that boys 
are significantly more affected than girls, aged between 8 months 
and 7 years (
28
). Epidemiological studies from Europe showed 
significant percentages of the preschool children are affected by 
ECC, confirming the widespread prevalence of the disease. ECC 
is randomly dispersed in the population, with the disease affect-
ing disproportionately among deprived families (
29
).