Early childhood caries (ECC) is a multifactorial subset of caries that has influences other than diet and oral hygiene. Originally thought to be only due to extended nursing or bottle-feeding, ECC is now known to have behavioral, socioeconomic, and psychosocial factors. ECC is defined as the presence of one or more decayed (non-cavitated or cavitated lesions), missing teeth (due to caries), or filled tooth surfaces in any primary tooth in a child age six or younger. In children younger than 3 years of age, any sign of smooth-surface caries is indicative of severe early childhood caries (S-ECC). S-ECC also is defined as one or more cavitated, missing teeth (due to caries), or filled smooth surfaces in primary maxillary anterior teeth in a child ages 3 through 5, or decayed, missing, or filled score of ≥4 (age 3), ≥5 (age 4), or ≥6 (age 5).
ECC may initially affect the primary maxillary incisors of children who are routinely given a bottle or sippy-cup containing a fermentable carbohydrate throughout the day, at night or nap times, or who breastfed (at will) after teeth begin to erupt and other dietary carbohydrates have been introduced. As the child sleeps, pools of fermentable liquid collect around the teeth, especially the maxillary incisors, which exacerbates the decay process. Upper primary incisors are in a saliva-deficient area and therefore are more susceptible to acid attack. Lower anterior teeth are rarely affected unless the decay becomes rampant. If detected early, further demineralization can be minimized and may be slowed or reversed by modifying diet and oral hygiene practices and by introducing fluoride.