Early Childhood Caries: Prevalence, Risk Factors, and Prevention

environmental Factors
Lack of good oral hygiene practices promotes the development 
of ECC. Children should begin receiving oral hygiene care upon 
the eruption of the first primary tooth (
59
). Children from low 
socioeconomic status are two times more likely to have dental 
caries than from higher income strata (
60
). Caregivers’ social 
status, poverty, ethnicity, deprivation, number of years of edu-
cation, and dental insurance coverage are other factors which 
influence the oral hygiene habits of children and the severity of 
ECC (
28
, 
61
).
Saliva has a protective role against dental caries development 
by providing the main defense system. Saliva flow rate, antimi-
crobial properties, the buffering capacity, and clearance of foods 
from the oral cavity are factors that are important in reducing 
the development of caries (
62
). Feeding of high sugar containing 
food at night may increase the caries risk for infants and toddlers 
due to the low salivary flow rate (
63
). Studies have shown the 
presence of enamel hypoplastic defects with prenatal conditions 
such as premature birth and low birth weight, as well as with 
malnutrition and illness (
64
, 
65
). In a case–control study, enamel 
hypoplasia was reported in 67% of low birth weight children in 
comparison to 10% among normal birth weight children (
66
). 
Although enamel hypoplasia has been confirmed as an inde-
pendent risk factor for caries, the causal relationship with dental 
caries has not been established. Low socioeconomic status, poor 
parental education, and life style factors have significant influence 
on ECC (
67
). Leroy et al. (
68
) reported a significant relationship 
between parental smoking habit and caries experience children.