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 between birth and 71 months 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
  • 37% of children ages 2-8 years
  • 35% of 3-year-olds from low income families
  • Untreated dental caries in primary teeth among children aged 2-8 is 2x the rate for Hispanic and non-Hispanic black children compared with non-Hispanic white children


  • 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


Tinanoff N, Reisine S. Update on early childhood caries since the Surgeon General's Report.AcadPediatr.2009; 9(6):396-403.

American Academy of Pediatric Dentistry. Policy on Early Childhood Caries (ECC): Classifications, Consequences, and Preventive Strategies. 2011. Reference Manual 33(6): 47-49.

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