What is ECC?

Early Childhood Caries (ECC) is a chronic disease that destroys tooth structure leading to loss of chewing function, pain, and infection in children through five years of age. Defined as > 1 decayed, missing, or filled primary tooth surface in children less than 6 years of age.

  • ECC was once called "nursing caries" or "baby bottle tooth decay."
  • Now the disease is called ECC as a variety of feeding habits are implicated.
  • Other known variables include socioeconomic status, access to dental care, fluoride exposure, and family caries experience.


  • 23% of children ages 2-5 years
  • 17% of permanent teeth ages 6-11
  • 57% adolescents ages 12-19
  • Higher Prevalence among Mexican American, Non-Hispanic Black and children of lower socioeconomic status


  • Upper front teeth that are least protected by saliva are affected first.
  • Disease moves posteriorly as teeth emerge.

Severe Early Childhood Caries

Joanna Douglass, BDS, DDS
Joanna Douglass, BDS, DDS
Joanna Douglass, BDS, DDS


Centers for Disease Control and Prevention. Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999–2004 to 2011–2016. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2019. www.cdc.gov/oralhealth/publications/OHSR-2019-dental-caries-permanent-teeth.html

US Department of Health and Human Services. Oral health in America. A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.

NCHS Data Brief, Number 191, March 2015, Dental Caries and Sealant Prevalence in Children and Adolescents in the United States, 2011-2012.