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Policy on Early Childhood Caries (ECC): Consequences and Preventive Strategies

Policy statement

The AAPD recognizes ECC as a significant chronic disease resulting from an imbalance of multiple risk and protective factors over time. The AAPD encourages the following evidence-based preventive measures to decrease the risk of developing ECC and to promote optimal oral health for infants and children:

  • establishment of a dental home within 6 months of eruption of the first tooth and no later than 12 months of age to conduct caries-risk assessment and parental education.
  • at the initial dental visit and periodic dental appointments, delivery of anticipatory guidance including home oral hygiene instructions (eg, parental brushing with an age-appropriate toothbrush and volume of fluoridated toothpaste) and dietary counseling that emphasizes:
    • avoidance of on-demand or nocturnal baby bottle- and breastfeeding beyond 12 months of age.
    • encouragement for children between 6 and 12 months old to drink 4 to 8 ounces of water per day and to abstain from all juice consumption.
    • avoidance of foods and drink with added sugars in children under 2 years of age and restriction of 100% fresh or reconstituted juice to no more than 4 ounces a day for children between the ages of 1 and 3 years.
    • avoidance of frequent consumption of sugar-containing liquids and/or solid foods.
  • professional application of fluoride varnish for children at risk for ECC.

Additionally, AAPD supports interprofessional education and public health efforts to promote oral prevention, including:

  • working with medical health care professionals to ensure all infants and toddlers have access to dental screenings, counseling, and preventive procedures with a consistent, unified message.
  • supporting CWF as a primary prevention for dental caries to reach underserved and vulnerable communities.
  • educating legislators, policy makers, and third-party payors regarding the consequences of and preventive strategies for ECC, emphasizing the importance of access to care for all.
  • advocating for reimbursement systems to allow access for all children and educational reforms that emphasize evidence-based preventive and comprehensive management of ECC.