Early childhood caries

Early childhood caries is a chronic dental caries affecting infants and preschoolers. It is defined as the presence of one or more missing, decayed or filled teeth in less than 5-year-old children.

ECC is also known as Nursing bottle caries or Baby bottle caries, though other than nursing habits there are many other causes.

Risk factors

1.Mutans streptococci bacteria

The acid produced by this bacteria reduces oral pH leading to tooth decay. Mechanism of transmission of this bacteria is not clear but factors like from caregiver  sharing food and utensils, poor oral hygiene may contribute

  1. Poor feeding habits

Inappropriate feeding habits are one of the major cause of ECC. Bottle feeding during bedtime makes the liquid stay in the child’s mouth for a long time creating a perfect environment for bacteria. Infants feeding habits like frequent snacking, sweetened drinks during bedtime and bad dietary habits can lead to ECC.

  1. Environmental factors

Research says that a child is never born with bacteria causing decay, but are infected with it at an early age. If a primary caregiver has a cavity then there is a risk of transferring the bacteria to the child. Hence it is required to visit the dentist and get the treatment done.


The decay is first seen on four maxillary anterior teeth. A white spot like lesion appears on the tooth surface and if not arrested it continues to form cavitation. If left untreated it progresses to complete destruction of crown leading to root stumps. Further, in moderate cases, caries spread to maxillary and mandibular molars.  The child will suffer from considerable pain, leading to difficulty in eating and talking. Later it may result in a delay in physical development due to poor nutrition.

Stages of Early Childhood Caries

Mild to moderateA white spot or carious lesions involving incisors and molars.
Moderate to severeLabiolingual lesions affecting maxillary incisors with or without molars
SevereCarious lesions affecting almost all teeth including mandibular incisors.


It is very important to maintain primary dentition in healthy condition. Primary dentition helps in space maintenance, aesthetics, and proper mastication.

The first step towards management includes finding the underlying causative factor or factors. Prevention of progression of caries is done by restoring and treating present caries. Treatment depends on the progression of the disease, the child's age, medical and behavioral history of the patient. Sometimes there may be a need for surgical removal of carious teeth. Fluoride application is also very effective in preventing dental caries, which includes water fluoridation, fluoride toothpaste, and topical fluoride application.

Another way of treating in young children is Atraumatic Restorative Treatment (ART). In this procedure, the carious lesion is removed using a hand instrument and restored with an adhesive restorative material. This helps in reducing pain and trauma in young patients.

Parents should be educated about nursing habits and child's brushing techniques. Weaning of the child from using the bottle at night and if there is emotional dependence then plain water should be given.

Preventive measures

Preventive measures begin with educating parents. Parents should be educated to avoid improper feeding practices. Parents should start brushing their children’s teeth as soon as the first tooth erupts.

Some of the other prevention methods include;

  • Dietary changes, avoid giving sugary snacks or drinks to your child.

  • Use a soft cloth or baby brush to clean your baby’s gums and teeth. For a child under two years, pea size amount of toothpaste can be used.

  • Teach your baby to drink with a cup as early as possible preferably by one year. The American Academy of Pediatrics says, “Children who use a bottle after 15 months of age or have sweets or starchy snacks more than three times a day are at higher risk of getting ECC.”

  • Taking the child to a pediatric dentist after completion of one year is advised. A dentist can only check and advise if there is any risk of dental caries in the best way.


ECC is an infectious chronic disease affecting children all over the world. It is a multifactorial disease but can be prevented by following some preventive measures. It can affect a child's normal development and quality of life. Early diagnosis and prompt treatment of children with signs of ECC can help to improve the oral health of children.

Contact Details: Dr. Rashmi Byakodi,

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