- ECC or Early Childhood Caries is defined as “the presence of one or more decayed, missing (due to caries), or filled tooth surfaces in any milk tooth in a child under the age of six.”
- ECC is usually caused by frequent night-time bottle feeding and ad libitum breast feeding ("as desired” rather than on a schedule).
- Worldwide, ECC is one of the most prevalent health problems in infants and toddlers.
- Left untreated, tooth decay can lead to pain which impacts children’s development and quality of life.


© Dr. Enas Alkhadra, Specialist Pediatric Dentist
Here’s a case of a 3-year-old girl, a patient of our pediatric dentist Dr. Enas Alkhadra, who had Early Childhood Caries (ECC).
From birth and up until seeing Dr. Enas, the child was breastfed which also caused her to have a slight open bite.
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What treatments were made?
Dr. Enas placed short fiber posts on the front teeth to keep and cement the crowns. Some of the molars also needed root canal treatments and crowns.
These new teeth will not fall on their own and will have to be removed when she turns 6 or 7.
The treatments were done within one and a half hours under general anesthesia.
How easy was it for the parents to make a decision?
The parents took their daughter to many dentists who all suggested tooth extractions. After seeing Dr. Enas and weighing their options, the parents decided to save their child’s teeth. They did not want their daughter to be without teeth for many years – a sentiment shared by Dr. Enas.
“I see my patients as a whole and not just as a ‘tooth’. I look at the kids and see their personality, their self-esteem, and many other factors,” says Dr. Enas.

How can we avoid Early Childhood Caries?
To reduce the risk of cavities in children, the American Academy of Pediatric Dentistry recommends:
Avoiding frequent consumption of liquids and/or solid food containing sugar, in particular:
- sugar-sweetened beverages such as juices and sweetened tea in a baby bottle or no-spill training cup
- night-time bottle-feeding with formula, breastmilk, or juice
Wean your baby off the bottle by age one.
Implementing oral hygiene habits early in life. Brush your child’s teeth twice daily using a soft, age-appropriate toothbrush.
- Use a smear or rice-sized amount of fluoridated toothpaste for children under the age of three.
- Use a pea-sized amount of fluoridated toothpaste for children ages three to six.