Prevalence of Early Childhood Caries (ECC)


Iqura Khan1                      BDS
Raza Javed2                      BDS
Rizwan Mahmood3        BDS
Faiza Awa3                        BDS, MPhil
Ayyaz Ali Khan3              BDS, MSc, PhD



The presentation of children with ECC seems to be common in local setting. This study adds to the evidence of existing knowledge of risk factors leading to ECC.


To determine the frequency of ECC and its contributing factors in children of age 6-36 months.


This cross-sectional survey was conducted over 06 months from May 2015 to October 2015, in the Pediatrics Department of Shaikh Zayed Medical Complex, Lahore. 400 children of age 6-36 months were included in the study. Using an interviewer administered questionnaire mothers were asked about their age, literacy level and oral hygiene practices including the child’s feeding method and pattern, teeth cleaning aids and sugar consumption. The oral hygiene (deft and DMFT) of the mothers and their children was examined by three dental surgeons. Chi square test of associations was used for statistical analysis on SPSS software version 21.0.


The frequency of ECC in our study was 26.5%. Data was compared for different risk factors. Child’s feeding method and pattern, oral hygiene aids, sugar consumption and mother’s education was found to be significantly associated with Early Childhood Caries (p<0.05), while gender did not play any significant role in the prevalence of ECC.


Frequency of ECC in patients presenting to the Pediatrics Department of Sheikh Zayed Medical Complex was found to be 26.5%. Dietary habits and mother’s education level was found to have a significant association with frequency of dental caries.


Children, deft, DMFT, Early Childhood Caries, Oral Hygiene.

HOW TO CITE: Khan I, Javed R, Mahmood R, Awais F, Khan AA. Frequency of Early Childhood Caries (ECC). J Pak Dent Assoc 2016; 25(2): 69-73

Received: 12 April 2016, Accepted: 29 June 2016


The American Dental Association defines early childhood caries (ECC) “presence of black lesion (cavitated or non-cavitated) in any primary tooth of a preschooler, 0-71 months old.”1, 2 It is also known as ‘baby  bottle’ or ‘nursing bottle’ caries. Mostly, it occurs on labial surfaces of maxillary anterior teeth but any other tooth can be affected as well. It is an infectious, chronic disease caused by a number of factors which affects 1-17% children in developed and 70% children in under-developed countries.3 The triad for caries to occur includes tooth surface, cariogenic bacteria and fermentable carbohydrates.4 Several behavioral factors and demographics appear to be determinants of ECC which include limited access to care, finances and oral health education. In addition, the value that parents place on primary teeth and views on prolonged bottle-feeding have also been identified as predictors of caries-risk.2

It is the most prevalent unmet health need especially among children in the developing countries. Left untreated, ECC impacts the quality of life to an extent similar to other systemic diseases and may lead to excruciating dental pain and infection.5

Highest prevalence of early childhood caries is reported from Africa and South-East Asia.6 In India, prevalence of this disease among children between 8–48 months was reported as 44%.7. One study in Sri Lanka reported the incidence of ECC to be 23% in children of age 1-2 years.8 While in North America the prevalence of ECC ranges from 11-72%.9 In Pakistan difference studies stated the prevalence of ECC from 27.9% to 51%10 11.

A valuable tool can be prepared by knowing the frequency and prevalence of ECC and its contributing factors, which will help in planning and implementing health care programmes. Such data is rarely found especially when it comes to a developing country like Pakistan. Aimed at focusing 6-36 months old children, this study is meant to assess the frequency of ECC on the basis of various risk factors.


This cross-sectional survey was conducted at Outpatient Department (OPD) of Pediatrics, Shaikh Zayed Medical Complex Lahore, for 06 months. A total of 400 children from 6-36 months of age with no physical or mental illness were included in the study. Verbal consent from parents was obtained prior to including children in the study and an interviewer administered questionnaire asked mother’s education, oral hygiene aids, feeding method and pattern and sugar consumption by the child. After explaining the aim of study, oral cavity of children and their mothers was examined under good light using disposable wooden spatulas. The deft and DMFT was calculated after examination. Data collection and examination was done by three dental surgeons to facilitate the process.

The completed questionnaires were collected and total responses for each item were tabulated. Data was entered and analyzed by using statistical software, Statistical Package for Social Sciences (SPSS) version 21.0. Chi square test was applied as test of significance. For all analysis p value ≤0.5 was taken as significant.


The prevalence of ECC in our study was 26.5% in all children of age 6-36 months with mean deft value of 0.60± 1.13 and mean DMFT value of 1.60±1.88 (see Table 1).

Table 1. Clinical assessment of children and mothers regarding caries (n=400).
Prevalence of ECC in children

The comparative analysis showed that in age >12 months, the frequency of ECC was significantly high (P<0.05) (see Table 3), however there was no difference in both genders for ECC (P>0.05). While feeding method and pattern, sugar addition to bottle milk, dietary habits and mothers’ education (P>0.05) had significant impact on frequency of ECC (p<0.05) (see Table 2).


ECC is a major public health problem that continues to affect toddlers and small children worldwide with prevalence varying among populations. Many studies on ECC have been conducted to identify the etiology, prevalence, risk factors and treatment of this disease over the past 40 years12.

Table 2. Comparison of both genders for different characteristics related to caries.

This study also adds to the evidence of existing knowledge. The study was conducted in the Outpatient Department of Pediatrics, Sheikh Zayed Medical Complex Lahore, among 400 children of age between 6-36 months. The study determined that almost one fourth, 26.5% of children had ECC. This shows a slight variation from a few previous studies done in Pakistan. In a study conducted at Tertiary Care Hospital, Karachi in 2010, the reported prevalence was 50.1% in children attending dental OPD.13 While a research by Sufia et al., calculated the dental caries prevalence about 40.1% among the children of 3-5 years.14 Both of these were community based holistic studies which would explain the difference in result from our study.

The present study reported that statistically significant (82.5%) children with ECC were either bottle fed or taking both. This is supported by a similar study conducted in the department of Child Dental Health at University Teaching Hospital Lagos, Nigeria which showed that children who were solely bottle-fed had a caries prevalence of 33% greater than those who were solely breastfed (15.7%) or taking both (25.3%)15.

Table 3. Comparison of mean deft in children of different age groups.

It was also apparent in our study that in the age >12 months, the prevalence of ECC was significantly high (P<0.05), contrary to a study conducted in Karachi where age had no significant impact on ECC.16 However, other studies conducted in Peshawar10 and Sri Lanka17 showed higher frequency of dental caries with age.

Gender had no significant role in the development of ECC. These findings are in agreement with other studies conducted in Peshawar10 and Karachi.18.

In our study, mother’s education which appeared to be directly influencing the child’s dietary habits and oral hygiene aids was found to be indirectly proportional to the prevalence on ECC. This is supported by the analysis of another study conducted in India19 where the children of less educated and illiterate mothers had more dental caries.


Frequency of ECC in patients presenting to Pediatrics Department of Sheikh Zayed Medical Complex. Medical Complex was found to be 26.5%. Feeding habits and mother’s education was found to have a significant association with frequency of dental caries.


Pediatrics Department of Shaikh Zayed Medical Complex. Miss Iqra Waheed, Consultant Biostatistician.


Dr. Iqura Khan Assisted in data collection and write up.
Dr. Raza Javed Assisted in data collection.
Dr. Rizwan Mahmood Assisted in data collection.
Dr. Faiza Awais Assisted in write up.


NONE declared.


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1 & 2. Senior House Officer, Shaikh Zayed Medical Complex, Lahore, Pakistan
2. PG candidate for Oral Pathology, University Sains Malaysia, Kelantan, Malaysia.
3. Dental Surgeon, Ghurki Trust Teaching Hospital, Lahore, Pakistan.
4. Head of Department of Oral Health Sciences, Shaikh Zayed Medical Complex, Lahore, Pakistan.
Corresponding author: “Dr. Iqura Khan” < >