Advances in detecting early childhood caries (ECC)—from improved diagnostics to emerging AI tools—promise earlier intervention and expanded treatment options. Yet ECC is more than a microbial condition. For many children, especially in marginalized communities, it is a visible marker of systemic inequity.
The view from the dental chair
Oral health professionals see health disparities in stark, clinical terms—inside the mouth. In some remote Indigenous communities in Canada, ECC affects up to 85–90% of preschool-aged children. Among First Nations children living off-reserve (ages 1–5), 24% have experienced ECC; for Inuit children, the rate is 42%. These numbers reflect more than oral hygiene habits—they mirror patterns of historical injustice, intergenerational trauma, and structural barriers to care.
One case illustrates the reality
In a northern community, a single mother of three young children—all under five years of age—arrived at a nursing station after nights of inconsolable crying by the three children. Initially suspecting ear infections, she learned all three had extensive ECC, each requiring emergency transfer for full-mouth extractions under general anesthesia. This was the family’s first contact with oral health services—not from neglect, but because no acute emergency had arisen before. The circumstances were complex. The mother, raising her children alone after domestic violence led to the father’s removal, lived on social assistance without access to social work or lactation support. Her own mother, already caring for seven grandchildren, was her only help. Night-time bottles of milk or juice were the only way she could comfort her children—an act of survival, not indifference.
Related: Effective toothbrushing: Why, when, and how to teach it
Understanding the roots
In such settings, ECC is less about bacterial presence and more about the environment in which it thrives—conditions shaped by overcrowded housing, food insecurity, limited access to clean water, fragile social supports, and fragmented preventive health care.
Our professional responsibility
Our role goes beyond prevention and restoration. As frontline providers, we have both a vantage point and a responsibility to inform public health and policy, ensuring that every Canadian—regardless of geography or income—has the opportunity for positive oral health outcomes.
As technology advances, the most powerful tools we bring to ECC prevention remain empathy, cultural humility, and advocacy. If we address the systemic roots alongside the clinical ones, ECC can truly become a disease of the past.
References
- Schroth RJ, et al. Prevalence and risk factors of early childhood caries in four Manitoba communities. J Can Dent Assoc. 2005;71(8):567.
- Schroth RJ, et al. Prevalence of dental caries among preschool-aged children in a northern Manitoba community. Can J Public Health. 2013;104(7):e493–e497.
- Statistics Canada. First Nations, Métis and Inuit children’s oral health. Government of Canada. 2024.
About the author
Myrtle Wong is retired from private dental practice after 25 years—presently on personal learning journey as an independent dental hygienist in remote northern communities.