2 International Journal of Dentistry Heavy infection of mutans streptococci Inappropriate feeding practices Risk factors Environment + Acids Caries balance Fluoride Demineralization Remineralization Early childhood caries Treatment Caries management and prevention Community care Early detection Professional care Education Fluoride Figure 1: Brief overview of early childhood caries. Home care Feeding Toothbrushing Fluoride toothpaste CPP-ACP tooth mousse 2. Prevalence ECC is a public health problem that continues to aﬀect infants and preschool children worldwide. A comprehen- sive review of the epidemiology of ECC showed that its prevalence varies from population to population; however, disadvantaged children, regardless of race, ethnicity, or culture, are most vulnerable. In the United States, the Centers for Disease Control and Prevention (CDC) reported that the prevalence of dental caries among the nation’s youngest children, aged 2–5 years, was 24.2% in the National Health and Nutrition Examination Survey (NHANES) III between 1988 and 1994 and 27.9% in NHANES 1999–2004 [10, 11]. Among children aged 2–11 years during 1999–2004, Mexican-American children had higher caries levels (55.4%) than black (43.4%) or non-Hispanic white children (38.6%). Children from families with incomes 200% of the federal poverty level (FPL) had a lower caries experience (32.3%) compared to those in lower income groups (48.8% for those with family incomes of 100–199% of the FPL and 54.3% for those with family incomes <100% of the FPL) [10]. In developing countries, the prevalence of ECC diﬀers according to the group examined, and a prevalence of up to 85% has been reported for disadvantaged groups [12, 13]. In the Western world, the prevalence at 3 years of age was 19.9%, and strong associations were found with socioeconomic status and ethnicity [14]. In a Japanese national survey in 2007, the experience of ECC was 2.8% among 18-month-old children and 25.9% among 3-year-old children [15]. 3. Process The presence of a fermentable carbohydrate (e.g., sucrose, glucose, fructose, cooked starch) and bioﬁlms on the teeth support the metabolism of acidogenic microorganisms, resulting in acidic substances, the hydrogen ions of which dissolve the carbonated hydroxyapatite crystal lattice of enamel, cementum, and dentin. Continued demineralization results in cavitation of the tooth enamel surface [16]. It is more diﬃcult to remove bioﬁlms from rough, cavitated surfaces, thus potentiating rapid bacterial replication and subsequent growth of bacterial colonies. In the primary