How Dentists can Help Reduce Early Childhood Caries


The Canadian Dental Association (CDA) recommends a child’s first visit take place within 6 months of the first tooth erupting and no later than 12 months of age as a dental best practice to help prevent early childhood caries (ECC).

A child’s first visit by 12 months of age is critical for the early diagnosis and prevention of tooth decay, to educate parents and caregivers about dietary habits, daily oral hygiene, and the importance of regular professional dental care.  

Maintaining good oral health during the early childhood period is an important investment to ensure good dental and overall health. 

The Consequences of Early Childhood Caries

The consequences of untreated early childhood caries can be significant. Pain, difficulty eating and sleeping, speech difficulties and poor self-esteem may occur. Untreated ECC can affect growth and the ability to learn, communicate and socialize. Canadian evidence also suggests that children with severe early childhood caries are more likely to be anemic, iron deficient, and vitamin D deficient. According to a report from the Canadian Institute for Health Information (CIHI), hospital outpatient dental surgery for early childhood caries constituted 31% of all day surgery for children age 1 to 4, making it the leading cause of day surgery for children in this age group. The quality of life of our youngest and often most vulnerable members of society can be seriously compromised and yet ECC is totally preventable.


Community water fluoridation is an important investment for all age groups, particularly children. Scientific evidence continues to support the health promoting effects of fluoridating drinking water which is a cost-effective population-health method of preventing tooth decay.

CDA uses a risk-based approach to determining whether fluoridated toothpaste should be used for children younger than 36 months of age. For children younger than 36 months who are at increased risk for ECC, it is recommended that parents use a grain of rice sized amount of fluoridated toothpaste to brush their child’s teeth. For children not at risk for ECC, parents can simply moisten the toothbrush bristles with water and then brush their child’s teeth. The CDA considers that any one or more of the following conditions place a child at risk for ECC:

  • living in a community with non-fluoridated water supply or low natural fluoride levels (< 0.3 ppm);
  • enamel defects, early signs of tooth decay (i.e. white chalky spots), or cavities;
  • frequent intake of sugary snacks/drinks between meals (including bottle or sippy cup containing liquids other than water and sweetened medications);
  • persons with special health care needs that limit cooperation with brushing and oral hygiene;
  • teeth are not brushed at least twice daily;
  • premature birth and low birth weight children;
  • parent or primary caregiver has tooth decay;
  • visible plaque on teeth.

Considering that ECC is a multifactorial disease, there are numerous other risk factors not appearing above that would justify recommendations to use a grain of rice sized amount of fluoridated toothpaste with infants and toddlers. 


First Visit continuing education teaching kit

The First Visit, First Tooth teaching kit is an invaluable resource for those who are committed to seeing children reach their full dental potential to prevent the burden of illness associated with early childhood caries. This kit is designed for dentists and other members of the oral health care team, family physicians and pediatricians, nurses, nurse practitioners and public health officials. This CDA sponsored interactive course incorporates both knowledge transfer and experiential learning. It can be modified to suit the presenter’s own material, presentation style, time constraints, audience and geographic realities. The interactive component includes sim-lab experience on a knee to knee exam, use of a risk assessment tool, fluoride varnish application and appropriate use of toothpaste for an infant.

This resource has been developed by Dr. Ross Anderson, Chief of Dentistry, IWK Health Centre and Head, Division of Paediatric Dentistry, Dalhousie University. 

Kit includes supplies meant for demonstration, including: 

•    Comprehensive presentation
•    Modified examination doll
•    Toothbrushes
•    Fluoride varnish
•    Disposable dental mirror
•    Penlight

Need more information? Download the fact sheet. 

To order the kit, please 1-800-267-6354 or complete an online request form

To find a course in your area, please email

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