Early childhood caries (ECC) affect the teeth of children under the age of six years. 

Today we are going to discuss what you need to know about ECC cavities in kids, including common causes, treatment options, and prevention tips.

According to the Global Burden of Disease Study in 2017, more than 530 million children globally have dental caries in (baby) primary teeth. 

By age 5, about 60 percent of U.S. children will have experienced tooth decay, in one or more teeth.

You might shrug it off thinking your child will eventually lose these teeth anyway. So why does it matter? But you shouldn’t ignore a cavity even in a baby tooth.

ECC is a  disease that affects primary (baby) teeth as well as permanent teeth and is a contributing factor in overall health and quality of life across a child’s entire life. ECC links with other frequent diseases of childhood, primarily due to risk factors including a high sugar intake, acidic foods, mouth breathing, and dental disease is tied to other health conditions such as obesity. 

Dental cavities can lead to toothaches and cause abscesses, which can have an impact on the ability to eat, sleep and participate in activities. Severe dental caries are associated with poor growth and development. 

Fortunately, ECC is preventable, with almost all of the risk factors being modifiable. ECC differs from dental cavities in older children and adults in its rapid development, diversity of risk factors, and the control of the disease. Both cause and prevention are strongly determined by economic, environmental, and societal factors. 

The decay in baby teeth spread much faster and does not always cause pain until the abscess. The habit we are taught by our parents plays a big role in how we take care of our teeth. When I grew up there was not much thought given to our teeth. We know we can prevent many diseases if we start caring for our mouths as soon as we are born.

The first primary teeth erupt in infancy, at about age 6 months, Yet they start to form before we are born. The primary dentition consists of a set of  20 teeth that is complete by about 3 years of age. In many children, these teeth stay healthy, until we lose them all between the ages of 12-14, adding to a child’s health and well-being. But for an unacceptably large percentage of children, these teeth do not stay sound but are ravaged and sometimes totally destroyed by dental decay. 

Dental caries (tooth decay) is a disease that may affect the teeth of people of all ages, including young children. Even though it is  100 % preventable It is the most common Noncommunicable disease among children around the globe. The disease affects primary teeth (milk teeth) and permanent teeth. Cavitation occurs due to the loss of tooth structure (enamel and dentin) formed by bacteria in dental plaque, which accumulates on the surface of the teeth and creates acid and then a hole. 

This process is due to the bacterial metabolism of sugars. Meaning the bacteria feed on the food and sugars we eat. Tooth decay is the destruction of the tooth, which is made from calcified tissue. Under normal circumstances, the loss of calcium (demineralization) is compensated by the uptake of calcium (remineralization)  of the tooth’s microbiome. 

The process of demineralization and remineralization takes place more or less continually and equally in a favorable environment in the mouth. In an unfavorable environment, the remineralization rate does not sufficiently neutralize the rate of demineralization, and a cavity occurs. The early stages of dental caries are often without symptoms, while advanced stages of dental caries may lead to pain, infections, and abscesses, or even sepsis. 

Advanced stages often result in tooth extraction (the tooth is pulled out). The development of caries is influenced by the susceptibility of the tooth, bacterial profile, quantity and quality of the saliva, level of fluoride, and amount and frequency of intake of sugars, and how you breathe Dental caries influence general health and quality of life. 

Dental caries is linked with several frequent diseases of childhood, primarily due to common risk factors. For instance, dental caries can co-occur with obesity, as both diseases are related to diet and nutrition.  Across the world, dental caries is particularly frequent or severe among underprivileged and disadvantaged groups of children. Socioeconomic factors also play a crucial role in oral health care.

Caries lesions progress faster in primary teeth than in permanent teeth, So early detection is key to managing ECC and preventing problems associated with their existence, they are also likely to be painless and less expensive. Especially for children under six years of age. 

 An oral health professional (dentist, dental therapist, or pedodontist) will be able to diagnose ECC. Suspicious white spot lesions may indicate the early process of caries in teeth should be detected carefully. A mouth mirror and satisfactory lighting of the mouth are required for careful examination of all teeth present. X-ray Images of the teeth may also help the identification of carious lesions. 

Infant feeding

Feeding practices and diet in young children have immediate and long-lasting effects on child oral and general health. It is recommended that infants are exclusively breastfed up to six months of age, after which breastfeeding should continue alongside complementary feeding up to two years of age or beyond because of the many health benefits of breastfeeding, including oral health.

While Breastfeeding is recommended for overall health and oral development, not all women can breastfeed. Due to the inability for the infant to latch and thrive or the mother just does not produce enough milk. 

Breastfeeding should not hurt the Mother if it does that is a sign something is not right. Your infant could have a lip or a tongue-tie or it could be something different altogether. Not everyone can nurse and it is ok. How you feed your child is a very personal choice and as a Mom, you should not let it make you feel like a failure. You are not a failure, you are not failing your child. Every child is different; you may be able to nurse with one and not another. People will judge you no matter what throughout your parenthood journey at almost every stage. You do what works for you and your baby. 

I breastfed my daughter for 13 months then pumped and breastfed a baby we adopted. My daughter could not keep down the formula of any kind. Once she turned thirteen months I mixed cereal with breastmilk. Fortunately, I was able to produce enough milk to feed them both. But again everyone is different and every child is different. If you are having difficulty I recommend a lactation consultant. They are very helpful at troubleshooting and helping you find solutions that work for both you and your baby. Please do not take on Mom’s guilt if nursing is not a good fit for you. There are plenty of women who are not able to breastfeed. All will be ok. I had a friend who could not nurse. It was just too painful. Your mental health is just as important for your baby to grow and thrive. Even though I talk about breastfeeding being better for facial development I understand and support Moms who are just not able to nurse for whatever reason. 

 What we choose to feed our kids as they grow has a major effect on ECC. The World Health Organization Global Guidance on Ending the Inappropriate Promotion of Foods for Infants and Young Children states explicitly that commercial complementary foods should not be advertised for infants aged under six months. Evidence suggests that infants who are breastfed in the first year of life have lower levels of dental caries than those fed infant formulae. Breast milk has a relatively higher concentration of lactose and a relatively lower content of protective factors such as calcium and phosphorus compared with cow’s milk and other milk This has raised concerns among the oral health profession about the risk breastfeeding poses to dental caries. 

One systematic review suggested a higher risk of ECC when breastfeeding extends beyond one year of age, but the data analysis did not adequately control for important confounders such as intake of sugars from other sources.  A systematic review including more recent data has shown that infants who are breastfed two years of age do not have a greater risk of ECC than those breastfed up to one year of age.

Feeding practices and dietary habits in the early years of life may modify the risk posed by exposure to dietary free sugars. It is well established that the amount of sugars consumed is the primary causative factor for dental caries and the number of sugars should be no more than 5%.

Free sugars include all mono and disaccharides added to foods and drinks by manufacturers, plus the sugars that are naturally present in honey, syrups, fruit juice, and fruit juice concentrates.

Free sugars do not include sugars naturally present in milk and milk products or in whole fresh fruits and vegetables 

Studies show that consumption of liquids containing free sugars from an infant feeding bottle is independently associated with the risk of ECC.

Children should be encouraged to eat a combination of different foods to help them obtain the right amounts of essential nutrients and avoid a diet high in sugars. 

A good combination of different foods includes: 

  •  staple foods, such as cereals (e.g. wheat, barley, rye, maize, rice) 
  •  starchy tubers or roots (e.g. potato, yam, taro, cassava);
  •  legumes (e.g. lentils, beans); 
  •  vegetables and fruits; 
  •  foods from animal sources (e.g. meat, fish, eggs, milk)


Although an intake of sugars, poor oral hygiene, and inadequate use of fluoride are given as the primary risk factors, the reasons for these unfavorable behaviors need to be understood if preventive strategies are to be successful. Awareness of oral health and attentiveness to ECC prevention among parents can be raised through health communication and by providing them with sound information about the disease, prevention, and intervention. In addition to parents, caregivers such as kindergarten staff are vital in young children’s health learning, and they may be instrumental in the development of viable health practices. They may carry out accompanying ECC preventive actions, particularly by providing a healthy diet, regular tooth brushing with children at school, facilitating fluoride administration, and contributing to early detection of dental caries with wellness checks.

Motivational interviewing of parents and pregnant women by trained oral health professionals is useful for preventing and avoiding dental caries in young children.

We can prevent and reduce the number of kids that get cavities by creating awareness.

  • Supporting Feeding practices
  • Limit consumption of liquids containing free sugars, including natural unsweetened juices.
  • Encourage a combination of different foods, fruits, vegetables, and low snacks low in sugars for young children.
  • Consume more water
  • Brushing infants’ and children’s teeth 
  • Application of sealant on pits and fissures of primary molars that have deep grooves or are more susceptible to caries
  • Apply SDF in areas where there is less access to care
  • Seek early care if restoration of decayed primary teeth is required
  • Mass communication to improve oral health knowledge and practices of parents and caregivers.
  • increase efforts to ensure access to clean safe drinking water to avoid unnecessary consumption of sugar-sweetened beverages.
  • Regulate marketing of foods and drinks to children high in sugars

Management of ECC should aim to reverse the disease process and to prevent or slow down the progression of carious lesions to tooth destruction. Young children are usually apprehensive and may not cooperate fully during dental treatment. The use of non-invasive or minimally invasive treatment approaches is preferred because they are less resource-demanding, are more efficient and cost-effective, and cause less discomfort than other methods. Placement of pit-and-fissure sealants in molar teeth can reduce the development and progression of new carious lesions into dentine. Different types of sealant material have their own merits, but glass-ionomer sealants, which are less demanding on technique and moisture control, are often suitable for use in young children and in community settings. Systematic reviews have shown that regular application of 5% sodium fluoride varnish can prevent the development of new caries in primary teeth and can help remineralization of early enamel lesions. 

As a healthcare worker providing the amount of fluoride varnish the is regarded as an appropriate amount applied to the topical fluoride agent of choice. However, regular applications every three to six months are required to maintain effectiveness. Carious lesions that have progressed should be stabilized in order to preserve tooth structure and to prevent negative health consequences such as pain and infection. Annual or semi-annual application of 38% silver diamine fluoride (SDF) solution is effective in arresting the progression of cavitated carious lesions in primary teeth and in hardening these lesions. The effectiveness of SDF is greater with semi-annual applications. This can minimize discomfort and potential pulp damage, and help to keep the caries-affected primary teeth symptomless and functional until their natural exfoliation. This is a painless, simple, and low-cost treatment that can be widely promoted as an alternative to conventional invasive caries management techniques, especially in populations and areas with low accessibility to dental care services. Covering cavitated carious lesions with flowable fluoride-releasing glass ionomer cement may have outcomes similar to SDF application, but the level of skill required by dental personnel is greater. 

Daily toothbrushing with fluoride-containing toothpaste plays an essential role in arresting ECC for kids more susceptible. These techniques do not require a local anesthetic injection and, being less invasive, are more “child-friendly”. 


Cavities are the #1 Preventable childhood disease. The health of your child starts in their mouth as soon they are born. Knowing what to do and what to look for as a new parent is fundamental. Knowledge is power. We don’t know what we don’t know! There was so much I wish I knew back then. All I can do is move forward and share my experiences to help others.

Cavities aren’t only an adult problem — they can also develop in children and toddlers. So it’s important to recognize the early signs of a cavity and then speak with your child’s dentist.

Fillings can prevent tooth decay from getting worse, which helps save not only a child’s baby tooth but maybe even their permeated teeth.

Between early intervention, less sugar, breathing through their nose, and good dental hygiene, you can protect your child’s teeth, thus preventing the likelihood of future cavities.

A Healthy Mouth is a healthy body and a healthy life!

Centers for Disease Control and Prevention. Ten great public health achievements: United States, 1900–1999. MMWR Morb Mortal Wkly Rep. 1999;48:241–3.

5 keys to a healthy diet: breastfeed babies and young children. Geneva: World Health Organization (https://www. who.int/nutrition/topics/5keys_healthydiet/en/).