early childhood cavities

Learn more about the #1 chronic disease among kids in the world.


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Dive right in and explore these common Early Childhood Cavities (ECC) FAQs to help guide you in the right direction.

What is Early Childhood Cavities (ECC)?

Early Childhood Cavities (ECC) is an infectious dental disease affecting millions of children across the world. It is so widespread that it is often considered the #1 chronic disease among kids in the world.

The American Dental Association (ADA) recognizes Early Childhood Caries as a significant public health problem among preschool-age children.

A child fits the definition of ECC if:
  • they are between 0-6 years of age
  • they have one or more decayed, missing, or filled tooth surfaces in any primary tooth (also known as a “baby” tooth or “milk” tooth)

Severe early childhood caries are usually defined as having six or more decayed, missing, and filled primary tooth surfaces.


Why is ECC a serious health problem?

If untreated, tooth decay and dental caries can lead to serious, painful, and even life-threatening conditions such as massive infections, a compromised airway and blood clots. Infections from decay in the teeth and gums can spread to other parts of the body and harm the digestive, circulatory, nervous and respiratory systems.

What’s the difference between Cavities, Caries, and Tooth Decay?

Cavities, caries, and tooth decay all refer to the same basic issue and are often used interchangeably.

  • Cavities are small holes that form on the surface of the tooth. These pitted holes are caused by caries (tooth decay).
  • Tooth decay is caused by a buildup of bacteria and acid on the tooth. This acid is produced as a result of excess sugars and starches leftover in the mouth after you eat or drink.

Learn more about Early Childhood Caries here.

What causes cavities?

In order to understand why we get cavities, we must first understand the epic battle that is waged in your mouth every single day.

The battlefield is your oral cavity, which includes your gums, oral walls, teeth, and tongue. On one side are harmful bacteria that eagerly consume sugars. On the other side, defending your teeth from acid attack, is your tongue and your saliva. As long as your saliva has enough of the right minerals from the food you eat, it will faithfully and continuously deposit calcium, phosphate, and fluoride in your mouth to remineralize your teeth.


How tooth decay works

  1. Every time you eat, tiny particles of food stick around and ferment on the surface of your teeth.
  2. When exposed to enzymes in the saliva, carbohydrates break down into sugars, which feed the bacteria.
  3. The bacteria begin to feast on these sugars, producing acid as a byproduct.
  4. If it isn’t neutralized in time, this acid begins to eat away at the surface of your tooth, causing holes known as cavities or dental caries.

Cavities reflect systemic disparities

Cavities affect the general population, but they disproportionately affect low-income, Latino, and African American children. According to the Center for Disease Control and Prevention (CDC), in the United States, children from low-income families are twice as likely to have cavities than children from higher-income households.

ECC is a growing problem globally, as cheap processed foods and soft drinks replace the healthier whole foods found in traditional diets

Read more about Early Childhood Caries (and how to prevent it) here.

My child may have ECC. What do I need to know?

It is common knowledge that when kids eat lots of sweets and don’t brush their teeth, they are more likely to get cavities. Too much sugar and poor oral hygiene create the perfect environment for tooth decay.

But what if you avoid feeding your child sweets and are proactive about oral hygiene, and your child STILL gets frequent cavities?


Beyond brushing, flossing & fluoride

Oral hygiene achieved by brushing and flossing is extremely important for healthy teeth and gums. Fluoride, added to mouthwash, toothpaste, or drinking water, is also widely touted as a preventative measure to ward off tooth decay by strengthening the tooth enamel. In pediatric dentistry, it is common to apply plastic sealants to the tops of children’s teeth (especially the back teeth) to protect them from dental caries.

But there are other factors impacting children’s dental health to look into that aren’t as widely talked about, including:

  • Epigenetics
  • Nutrition
  • Oral restrictions
  • Mouth breathing 


Most of us are familiar with the nature vs. nurture debate. Rather than an “either/or” scenario, science is revealing that your health is shaped by BOTH nature (genes) AND nurture (environment). In a nutshell, epigenetics is the study of the complex interplay between your genes and your environment.

Some people are born with genes that make them more susceptible to cavities. Through no fault of their own, they inherit genetic factors that make their teeth more prone to tooth decay. Your genetics can affect oral restrictions, tooth shape, enamel formation, immune response, and oral microbiome, among many other things. These, in turn, can affect how prone you or your children are to dental caries. Epigenetics gives us hope because it means that there is a lot you can do to improve your oral health, even if you have genes that make you more susceptible to dental cavities.


Find out how epigenetics relates to dental cavities here.


If you have cavities, reducing your intake of sugary foods and processed nutrient-poor carbohydrates is very important. But removing harmful foods and drinks is just ONE part of the equation. The other part is learning how to eat whole foods rich in minerals, fats, and vitamins as well as natural probiotics and prebiotics that support a balanced and diverse mouth and gut microbiome.

According to a growing number of dentists and health professionals, you need chewy and fibrous foods to strengthen your jaw muscles for optimum development and airway health. By intentionally eating whole foods with enamel and bone-building vitamins and minerals, we can essentially “feed our teeth” and make them more resistant to cavities.

Learn how you can protect your kids’ teeth from cavities with better nutrition here.


Oral restrictions

Oral restrictions such as tongue tie, lip tie, and buccal tie can increase your propensity for cavities for many reasons. That’s why cavities can be a symptom to look out for if you suspect that you or your child could have an oral restriction.

Oral restrictions can inhibit important functions such as breathing, swallowing, chewing, sleeping, and self-cleaning. This impacts the body and systems in many ways.

Tongue tie, buccal tie, and lip ties can influence:
  • Tongue mobility
  • Acid reflux
  • Tooth grinding
  • Jaw development and tooth crowding
  • Mouth breathing

Find out more about how chronic cavities can be a sign of an oral restriction here.

Mouth breathing

Simply put, mouth breathing is when you bring air into your body through your mouth, instead of your nose. Ideally, we inhale and exhale exclusively through the nose with our mouths completely closed. The nose is built to filter air. It moistens and warms the air to the body’s temperature. It reduces the amount of bacteria that enter the body with each breath. It is also designed to help the body safely release carbon dioxide with each exhale.

Many cases of mouth breathing are caused by a problem with a tiny cord under your tongue. This is because an oral restriction can obstruct your airway, making healthy nasal breathing difficult or nearly impossible.

Mouth breathing is enmeshed within a complicated web of issues including:

  • oral restrictions
  • tooth decay and gum disease
  • improper jaw development
  • crooked teeth
  • facial deformities
  • sleep apnea and snoring
  • throat infection
  • heart problems
  • asthma

Click here to read more about the connection between mouth breathing and dental cavities.

Proper care for “baby teeth”

Although it is true that “baby” teeth (known by dentists as primary teeth) are replaced by permanent “adult” teeth, those so-called “baby” teeth really matter!

Primary teeth are important for many reasons. They help children speak clearly and chew naturally. Plus, they help form a path that permanent teeth can follow when they are ready to come in.


Are cavities a big deal?

Because early childhood cavities are so common, it’s easy to take a cavalier attitude towards them. We justify cavities thinking, “it’s not the end of the world if my kids get cavities, as long as they take better care of their permanent teeth in the future. After all, my child’s baby teeth are going to fall out eventually, so aren’t they essentially ‘disposable’ teeth?”

The truth is, your baby’s first teeth are extremely important in shaping their health and future well-being. The first six years of life lay the foundation for your child’s development in so many ways. Starting at birth (and even in the womb) babies and children establish patterns that influence:

  • breathing
  • swallowing
  • chewing
  • talking

Not only do these patterns affect the quality of their sleep, growth, digestion and communication, they actually shape the development of their muscles and bones!


When are cavities “normal” or something to worry about?

It is important to avoid confusing “prevalent” with “normal.” Although cavities have become very widespread, they are certainly a cause for concern. Even one cavity can cause pain and infection for your child.

If your child has cavity symptoms, take them to the pediatric dentist for treatment. Then double-down on prevention at home by improving nutrition and oral hygiene for optimal dental health. If your child has chronic cavities, find a healthcare provider who can screen for an underlying issue such as an oral restriction and help you get treatment.


How often should I take my child to the dentist (and when should I start)?

Take your baby to the dentist before their first birthday and every 6 months from then on. Your baby’s first dental visit is important to make sure their development and oral and dental health is the best that it can be. Find a pediatric dentist who is good with kids and is well-versed in screening for issues such as oral restrictions that can also increase the risk of cavities.


Does breastfeeding cause cavities?

Even with recent studies into prolonged breastfeeding (past 24 months) and cavities, the research still weighs in favor of the adage that “the breast is best.”

Leading healthcare professionals continue to advocate on behalf of breastfeeding. Research shows that breastfeeding is more effective at preventing dental caries in early childhood than bottle-feeding with formula.


The perfect food for your baby

Breast milk has multiple, stacking benefits for your baby’s oral health and for breastfeeding mothers too!

Breast milk has been shown to:
  • Boost the immune system with antibodies, which protect from infection
  • Promote healthier, straighter teeth
  • Establish a balanced oral and gut microbiome
  • Strengthen oro-facial muscles for healthy jaw and skull development
  • Deliver vital nutrients and minerals for healthy bones and teeth
  • Contain Lactoferrin, a protein that kills S. mutans., which is one of the main bacteria that causes tooth decay


Where did the breastfeeding-cavity misunderstanding come from?

Some very limited but highly publicized research has led to the unfortunate assumption that breastfeeding causes cavities. While there is some evidence to suggest that specific breastfeeding behaviors at a certain age can be linked to cavities, much more research is needed to find out what is actually happening.

Just like any other food, particles of breast milk that remain on the tooth surface can lead to decay. But the reality is more complex than drawing a straight line between breastfeeding and cavities.

Read more about extra precautions you can take to prevent cavities if you choose to breastfeed past 24 months.

Processed food and Early Childhood Cavities

Around the beginning of the 19th century, the U.S. and other nations saw a significant uptick in tooth decay. It is no coincidence that this came on the heels of the Industrial Revolution when cheap, processed carbohydrates and refined sugar replaced traditional diets based on whole fruits and vegetables, grains, and meats.

From spoon-fed to self-fed

When it comes to babies' first foods, many of us think of mushy cereals or pureed fruits and vegetables that we adults spoon-feed into their (sometimes reluctant) mouths. A growing number of dental professionals and parents are challenging this largely unquestioned norm in industrialized cultures.

Perhaps babies are not meant to live exclusively on mush and liquids, but rather need to exercise their growing oro-facial muscles by chewing and biting foods with their tiny teeth.

Lead by example

Parents who take care of their own oral health are more likely to have children with healthy mouths and teeth. Babies and children learn by watching you in your daily life. Modeling a healthy diet, nasal breathing, brushing and flossing is the best way to teach your children healthy habits that will serve them for the rest of their lives.


The bottom line

With a public health problem as serious and widespread as Early Childhood Cavities, “filling and drilling” is not enough.

We can turn the tide on tooth decay by radically improving nutrition, oral hygiene habits and screening for oral restrictions such as tongue tie early in life. Children around the world deserve access to preventative dental care and the opportunity to live cavity-free.

Finding help & treatment for ECC

The team at health:latch can help diagnose and determine the best treatment plan for overcoming ECC issues.

Treating early childhood cavities (ECC) requires a multi-disciplinary approach that gets to the "root cause" of its presence. If you suspect an oral restriction could be the cause of your child’s chronic cavities, surround yourself with healthcare providers who can help.

To set yourself up for success, you want a team that communicates with each other across disciplines for a holistic health approach. A custom, multi-disciplinary approach to address accompanying issues like oral restrictions, speech & language issues, and airway health & sleep will help your family have the best possible outcome.


Learn more about the health:latch clinic and how we can help with your family's specific needs here.

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