Early Childhood Caries (ECC) is a common multifactorial disease in children under six years old and is associated with considerable adverse effects on oral health, growth, development, and quality of life. Early detection of ECC is challenging because initial lesions are often subclinical and difficult to identify using conventional diagnostic methods. This study aimed to review and synthesize current evidence on the role of digital technology, particularly artificial intelligence (AI), in supporting the early diagnosis and prevention of ECC. A literature review was conducted using international databases, including Pubmed, Scopus, ScienceDirect and ResearchGate focusing on peer-reviewed English-language articles published within the last five years. Studies involving children under six years of age that applied AI-based technologies for ECC diagnosis or risk prediction were included. The analysis of ten selected articles demonstrated that machine learning and deep learning models, such as convolutional neural networks, vision transformers, and ensemble learning methods, achieved high accuracy, sensitivity, and specificity in detecting advanced carious lesions and predicting ECC risk based on clinical, behavioral, socioeconomic, salivary, and genetic data. However, limitations were consistently observed in the detection of early non-cavitated lesions. Overall, the findings indicate that AI-based digital technologies serve as effective clinical decision support tools that enhance diagnostic accuracy, risk stratification, and preventive planning for ECC. Although AI cannot replace conventional clinical examination, its integration into pediatric dental care holds strong potential to support earlier, more targeted, and personalized prevention strategies for treating dental caries in young children.

Impacts of early childhood caries on the mental development.

Background: Early Childhood Caries (ECC) is a global public health concern. This study aimed to assess parental perception and practice regarding ECC among patients attending Pedodontics departments of selected tertiary hospitals. Materials and methods: This cross-sectional study involved 233 parent-child pairs visiting Pedodontics Departments at Chattagram International Dental College Hospital and Chittagong Medical College Hospital. The study included parents having children under 6 years of age. Data were collected through a pre-tested semi- structured questionnaire, and face-to-face interviews were conducted. The sampling technique used was purposive. Ethical clearance was obtained from the Institutional Review Board of Chattagram International Dental College. Results: In this study, 75% of children had a self-brushing habit, parental supervision during brushing was irregular in about 50% of cases. More than 50% of parents were unaware that long-term bottle-feeding can contribute to the development of tooth decay. In this study, 75.5% of children had decayed teeth. About 80% of parents frequently missed to clean their child’s teeth. There was a significant relationship between the presence of decayed teeth in the child and the perception of parents regarding prolonged bottle feeding can help to develop caries (p<.009). Conclusion: This study reveals inadequate parental perception and practice concerning early childhood oral health. It emphasizes the necessity for parental education through oral health promotional programs. JCMCTA 2025 ; 36 (1) : 159-163

Background The Bangkok Declaration and the Developmental Origins of Health and Disease (DOHaD) concept can guide paediatric dentists in promoting oral health during the first 1,000 days of life. Teledentistry can help translate these guidelines into practice, facilitating education for parents.Aim To evaluate the impact of a teledentistry service as an innovative approach to adopting healthy habits to prevent early childhood caries (ECC).Design In total, 64 parents of children aged 0-5 received teleconsultations from 118 supervised undergraduate students. The students, working in pairs under a lecturer's supervision, collected caries risk information and educated parents. Fisher's exact test and Wilcoxon rank-sum test assessed associations, while multivariate analysis identified factors influencing habit changes.Results The parents of 55 children (86%) participated in at least two teleconsultations, with the majority of children (78.2%) aged up to three years. Positive changes in habits were noted, particularly among children with employed and more educated mothers (p = 0.007 and p = 0.019, respectively). Significant improvements included increased use of fluoride toothpaste (p = 0.02), higher brushing frequency (p = 0.0004), and reduced sugar consumption frequency (p = 0.025).Conclusion Teledentistry can be an important tool for implementing healthy habits in the first years of life, increasing oral hygiene and reducing sugar consumption, thus preventing ECC and chronic non-communicable diseases.

Background/Objectives: Although the relationship between prolonged breastfeeding and early childhood caries remains unclear, dentists must manage children’s oral health while respecting mothers’ chosen feeding practices and providing information on maintaining oral health as long as possible. This longitudinal study was performed to investigate the occurrence of dental caries and identify associated factors, with particular attention to maternal condition and oral-health-related support in long-term breastfed children. Methods: Of 6746 children aged 42 months in Toyonaka City, Japan, 1210 who had been breastfed for at least the first 18 months were enrolled. Participants underwent oral examinations and anthropometric measurements at 18 and 42 months of age. In addition, a self-administered questionnaire was distributed to families when the child was 18 months old. Logistic regression analysis was used to evaluate risk factors for dental caries, with caries occurrence at 42 months as the dependent variable. Results: Overall, 24.3% of the children had experienced dental caries at 42 months. Logistic regression analysis identified several significant factors associated with caries occurrence: birth order (p < 0.001), snacking frequency (p = 0.038), Cariostat® caries-risk test results (p < 0.001), and wake-up time (p = 0.015) among child factors, and parental exhaustion (p = 0.041) and participation in postnatal oral health classes (p = 0.005) among maternal factors. Conclusions: Waking habits in early childhood, maternal psychological condition, and participation in postnatal oral health instruction were significantly associated with dental caries occurrence over time among long-term breastfed children.

Early Childhood Caries (ECC) is a common oral health problem that negatively affects their quality of life and everyday function. The Early Childhood Oral Health Impact Scale (ECOHIS) is a validated tool for measuring Oral Health-Related Quality of Life (OHRQoL) in preschoolers. Although the Persian version of ECOHIS exists, the relationship between dental caries and OHRQoL has not been sufficiently investigated in Iranian preschool populations. This study aimed to examine the association between ECC and OHRQoL in children aged 2 to 6 years within the PERSIAN birth cohort in Isfahan, Iran. A cross-sectional study was conducted between April and October 2023 on a subset of the PERSIAN birth cohort-Isfahan. A total of 350 children aged 2-6 years were initially recruited, of whom 347 were included in the final analysis. Clinical examinations were performed to record decayed, missing, and filled primary teeth (dmft) and parents completed the ECOHIS questionnaire. Children received oral health education and fluoride varnish. The association between dmft and OHRQoL was analyzed using chi-square tests, independent t-tests, and multivariate logistic regression, with adjustments made for confounding variables. Higher dmft scores were significantly associated with lower OHRQoL in both child and parent sections of the ECOHIS questionnaire (p < .001). According to multivariate logistic regression, each unit increase in dmft was associated with greater odds of low child OHRQoL (OR = 1.23, 95% CI: 1.16-1.31), low parent OHRQoL (OR = 1.32, 95% CI: 1.23-1.41), and lower parental satisfaction (OR = 1.35, 95% CI: 1.26-1.45). Household income was significantly associated with parent-reported OHRQoL (OR = 0.27, 95% CI: 0.12-0.61). Dental caries were associated with lower OHRQoL of preschool children and their families. These findings emphasize the need for early detection, preventive strategies, and targeted oral health education, especially among low-income households. However, the results should be interpreted with caution due to the limited sample size, particularly within the moderate-income subgroup. Enhancement of public health initiatives and considering oral health in early childhood care programs may help reduce the burden of ECC and improve quality of life in this vulnerable population.

Maternal vitamin D level during pregnancy has been repeatedly reported to be associated with early childhood caries (ECCs) in offspring, yet the conclusions remain inconsistent. To evaluate the association between maternal vitamin D status in different trimesters during pregnancy and offspring dental caries. This prospective cohort study was based on the Zhoushan Pregnant Women Cohort, which enrolled pregnant women between August 2011 to May 2021, and followed up on their offspring until November 2022, at Zhoushan Maternal and Child Health Hospital in Zhoushan, Zhejiang Province, China. Data were analyzed from October 2024 to April 2025. Maternal plasma 25-hydroxyvitamin D (25[OH]D) levels measured in the first, second, and third trimesters and vitamin D deficiency (VDD). The primary outcome was offspring ECCs. Secondary outcomes included the decayed, missing, or filled teeth (dmft, with lowercase term denoting primary, instead of permanent, dentition) index and caries rate (the ratio of dmft to number of erupted teeth). The cohort included 4109 mother-offspring pairs (maternal median [IQR] age, 29.0 [27.0-32.0] years; offspring gestational age at birth, 39.0 [38.0-40.0] weeks; 2121 males [51.6%]), of whom 960 children had ECCs and 3149 did not. Higher maternal 25(OH)D levels were associated with reduced odds of ECCs in offspring (first trimester odds ratio [OR], 0.98 [95% CI, 0.97-0.99], false discovery rate [FDR]-adjusted P = .009; second trimester OR, 0.98 [95% CI, 0.97-0.99], FDR-adjusted P = .001; third trimester OR, 0.99 [95% CI, 0.98-1.00], FDR-adjusted P = .009), while Cox proportional hazards regression models showed protective benefits of 25(OH)D levels against ECC risk throughout all trimesters. Categorical analyses suggested elevated odds of ECCs in offspring of mothers with vitamin D insufficiency, VDD, or severe VDD compared with the vitamin D sufficiency group, although the statistical significance of some associations was attenuated after FDR correction. Moreover, higher maternal 25(OH)D levels (μg/mL) were associated with lower dmft scores (third trimester: β [SE] = -9.97 [3.97]; P = .01) and caries rate (third trimester: β [SE] = -50.87 [19.78]; P = .01). Generalized estimation equation models also confirmed the inverse associations. In this cohort study, maternal 25(OH)D levels throughout pregnancy were inversely associated with odds of offspring ECCs. These findings support the potential benefit of vitamin D supplementation before or during pregnancy in reducing the risk and severity of childhood dental caries.

Retraction: Investigating the association between Candida albicans and early childhood dental caries: A comprehensive systematic review and meta-analysis

Impact of early caries intervention on dental treatment in Indigenous Australian children: a randomised controlled trial.

Characterizing human microbiota in host-dominated samples is crucial for understanding host-microbe interactions, yet is challenged by the high host DNA context (HoC). Current depletion strategies are limited by DNA loss and require immediate processing. In this paper, we introduce 2bRAD-M, a reduced metagenomic sequencing method that enables efficient host-microbe analysis without prior host depletion. Validated on mock samples with >90% human DNA, 2bRAD-M achieved over 93% in AUPR and L2 similarity. In both saliva and oral cancer samples, 2bRAD-M closely matched WMS profiles; in the former, it captured diurnal and host-specific patterns with only 5–10% of the sequencing effort. In an early childhood caries (ECC) study, 2bRAD-M identified key bacterial indicators and distinguished ECC from healthy subjects (AUC = 0.92). By providing high-resolution microbial profiles without host depletion, 2bRAD-M offers a practical and efficient solution for HoC-challenged microbiome research.

Young children are a high-risk group for dental caries. Understanding the prevalence, characteristics of severe early childhood caries (S-ECC), and its associated complications (e.g., pulpitis and periapical periodontitis) is crucial for guiding the prevention, diagnosis, and treatment of these conditions. A retrospective analysis was conducted on the dental records of children with S-ECC who received treatment at Jinan Stomatological Hospital from 2018 to 2023. Cases were excluded if they did not meet the S-ECC diagnostic criteria, had intellectual impairment, had other severe systemic diseases with unstable conditions, were duplicate records, or had missing critical data. Data processing was conducted using Python software. Among the 2,357 included 0–5-year-olds with a total of 26,215 primary teeth, 2–3-year-olds were the largest group (34.0%). Primary caries distribution: maxillary molars > mandibular molars > maxillary incisors > maxillary canines > mandibular canines > mandibular incisors. Notably, maxillary incisors had significantly higher rates of deep caries, pulpitis, and periapical periodontitis than other teeth (p < 0.05), showing faster disease progression. This study elucidates the epidemiological characteristics of S-ECC, laying a foundation for targeted prevention and clinical management in high-risk pediatric populations.

Early childhood caries (ECC) is a global public health crisis affecting large populations of children, although the prevalence in suburban Nigeria is low. The role of dietary diversity in this context for ECC prevention remains unexplored. This study aimed to assess the associations between dietary diversity, food groups, and the prevalence and severity of ECC in Ile-Ife, Nigeria. This was a school-based cross-sectional survey of children aged 36-71 months conducted in Ile-Ife, Nigeria, from September 2021 to September 2022, with participants randomly recruited from public and private nursery and primary schools. Information was collected on the independent variables (dietary intake and diversity assessed using a 24-hour recall and food frequency questionnaire), the dependent variables (dmft score), and the confounding variables (oral hygiene status, age, sex, and socio-economic status). Multivariable logistic regression was used to identify associations between the dependent and independent variables after adjusting for confounders. The study recruited 430 children, of whom 61 (14.2%) had ECC and 19 (4.4%) had severe ECC. The mean dmft was 0.42 ± 1.3SD. High dietary consumptions were fats and oils (100%), beverages, spices, and condiments (100%), vegetables (96.3%), cereals (92.8%), and sweets/snacks (92.3%), while low-consumption items were eggs (37.2%), meat (50.5%), fish (54.7%), and dairy products (54.9%). Frequent consumption of fruits was associated with a significantly lower risk of ECC (AOR: 0.484; 95% CI: 0.261-0.900; p = 0.022). No significant associations were found between the overall dietary diversity score and ECC severity. Promoting fruit consumption in early childhood diets may have a protective role against ECC and should be integrated into oral health education for parents.

The relationship between prolonged breastfeeding and early childhood caries remains controversial. The present study investigated relationships between dental caries experience at 42 months of age and related risk factors, focusing on breastfeeding and the number of erupted teeth. Data from 6746 children aged 42 months were analyzed. Anthropometric measurements and oral examinations were performed, and an interview sheet was provided directly to the guardians. Logistic regression analysis was performed to clarify the risk factors related to dental caries occurrence at 42 months of age. Of the 5161 children included, 13.3% had experienced dental caries between 18 and 42 months of age. Logistic regression analysis results indicated a significant association with dental caries occurrence by 42 months of age for the following factors: 12 or fewer erupted teeth (P < 0.05), 17 or more erupted teeth (P < 0.05), breast feeding (P < 0.001), and breast and bottle feeding (P < 0.01) at 18 months of age. These results suggest that breastfeeding and the number of erupted teeth at 18 months of age are important factors for dental caries experience at 42 months of age. Dental visits and guidance on breastfeeding, diet, and oral hygiene beginning when primary teeth start to erupt may benefit oral health throughout childhood.

Background: Early childhood caries (ECC) is a prevalent public health issue affecting preschool children and impacting oral health, nutrition and overall well-being. As a multifactorial disease influenced by genetic, environmental and behavioral factors, ECC may be linked to dermatoglyphic patterns, which are genetically determined and remain unchanged throughout life. This study explores dermatoglyphics as a potential non-invasive biomarker for early risk assessment of ECC. Methods: A school-based cross-sectional study was conducted among 250 preschool children (3–6 years) in Coimbatore city. Children with special health care needs, fingertip trauma or skin disorders were excluded. Oral examination was performed to screen for ECC. Fingerprints were recorded using blue duplicating ink and analyzed under ×2 magnification to identify loops, whorls and arches. Frequencies of each pattern were compared between ECC and caries-free groups. Results: A significant association was found between dermatoglyphic patterns and ECC. Children with ECC showed a predominance of loop patterns, while caries-free children had more whorls on the left hand. Dermatoglyphics may serve as a simple, non-invasive tool for early identification of high-risk children, enabling timely preventive interventions. Conclusions: The study found a significant association between dermatoglyphic patterns and early childhood caries (ECC). Loop patterns were more common in children with ECC, while caries-free children showed more whorl patterns on the left hand. These results suggest that dermatoglyphics can serve as a simple, non-invasive and cost-effective method to predict genetic susceptibility to ECC, enabling early identification and preventive care during a child’s first dental visit.

Wu Y, Jia M, Fang Y, Duangthip D, Chu C H, Gao S S. Use machine learning to predict the treatment outcome of early childhood caries. BMC Oral Health 2025; 25: 389. This was a retrospective secondary analysis of data from a randomized controlled trial published in 2020. No new participants or patient involvement were included. This study used the available data from 880 children, contributing 4157 carious tooth surfaces assessed at 30 months. These data were drawn from an original community-based RCT in Hong Kong (baseline N = 1070) that evaluated fluoride and silver interventions for arresting ECC. Six algorithms were used and compared, including logistic regression (LR), naive Bayes (NB), support-vector machine (SVM), decision tree (DT), random forest (RF), and XGBoost. A surface-level 70:30 train: test split was used. SMOTE was applied to address class imbalance. Models were tuned and evaluated using 1000 bootstrap resamples. Performance metrics were reported as accuracy, recall, precision, F1 score, AUROC, and Brier score. Model interpretability was explored through SHAP analysis to rank variable importance and visualize feature effects. All models achieved acceptable discrimination. Metrics ranged as follows: accuracy 0.674-0.740; recall 0.731-0.809; precision 0.762-0.802; F1 0.741-0.804; AUROC 0.771-0.859 (RF and XGBoost ≈ 0.86); Brier 0.134-0.227. SHAP interpretation indicated that tooth and surface location of caries, newly developed dmfs, baseline dmfs, caregiver-assisted brushing, and visible plaque index contributed most to the model's predictions, while the fluoride and silver intervention ranked mid-to-low in importance. The original study, however, highlighted tooth and surface location of caries, newly developed dmfs, and daily snack intake as key effect modifiers influencing caries-arrest outcomes. Machine learning models, specifically ensemble tree-based methods, can discriminate which surfaces arrest by 30 months using multidomain inputs spanning clinical, behavioral, and socioeconomic features. However, participant-level splitting was not performed, allowing potential clustering leakage. External validation and detailed calibration analyses were also lacking. These methodological constraints likely inflated model performance and currently limit its generalizability and readiness for clinical implementation.

To analyze the "technology-disease burden paradox" of early childhood caries (ECC)-its rising global prevalence despite preventive advances-by examining multidimensional factors from biological mechanisms to socioecological interventions. This narrative review synthesized evidence from epidemiological, biological, behavioral, and policy studies (2010-2024) identified through systematic searches in PubMed, Web of Science, and Scopus. Inclusion criteria focused on children under 6 years of age and English-language studies reporting etiology, risk factors, or interventions. ECC prevalence exceeds 60% in many low- and middle-income countries, versus < 40% in high-income settings. Key findings include: synergistic enamel demineralization by S. mutans and Candida (OR = 1.67); behavioral risks such as nocturnal feeding (OR = 3.54) and screen time > 2 h/day (↑60% caries); and effective policy interventions like fluoride varnish (42% reduction in caries) and sugar taxes. Controlling ECC requires integrating the Socioecological Model with Sustainable Development Goals, prioritizing equity-focused upstream policies and interdisciplinary collaboration (e.g., dentistry and data science). The "Zero-Caries Childhood" vision must shift from disease management to health promotion, incorporating emerging environmental considerations.

Developmental defects of enamel (DDE) frequently occur in preterm infants (< 37weeks) and in those with low birth weight (< 2500g). Children with enamel hypoplasia and hypomineralisation are at an increased risk of developing caries lesions. Therefore, the present study aims to assess the influence of various perinatal risk factors on the prevalence and severity of DDE and dental caries in the primary teeth of high-risk infants. The study, which included a sample of 240 high-risk children (aged 18-48 months), employed a cross-sectional analysis to assess the prevalence and severity of DDE in the primary teeth of high-risk infants admitted to the Neonatal Intensive Care Unit of a tertiary care centre. Oral examinations were done at follow-up. The mean chronological age was 29.48 ± 6.7 months; 112 (46.67%) children were preterm, and 105 (43.75%) had a birth weight of <2500g. The prevalence of DDE and dental caries was 32.1% and 16.31%, respectively. DDE were significantly associated with extremely low birth weight (birth weight < 1000) (p = 0.014; OR = 5.33). Dental caries was commonly associated with maternal pregnancy-induced hypertension (p = 0.032; OR = 2.4) and endotracheal intubation (p = 0.042; OR = 3.13). The prevalence of dental caries in maxillary incisors was higher in intubated when compared to non-intubated children (p = 0.024). Dental caries and DDE are common in high-risk children. DDE might serve to be a valuable predictor for early risk assessment of dental caries. Consequently, early preventive measures and interventions could be implemented to prevent early childhood caries.

ObjectiveTo estimate the prevalence and dmft burden of early childhood caries (ECC) among preschool children and to examine associations between ECC and anthropometric growth indicators (HAZ, WAZ, WHZ) as well as behavioral and parental factors.MethodsWe conducted a cross-sectional study of 380 children aged 3–6 years selected via multistage cluster sampling from 15 kindergartens in Shijiazhuang, China. ECC was assessed according to WHO Oral Health Survey methods, and dmft (decayed, missing, and filled primary teeth) was calculated. Anthropometric growth was evaluated using WHO Z-scores: height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ), with standard cutoffs (Z < −2 indicating stunting, underweight, and wasting, respectively). Parents completed structured questionnaires on feeding patterns (including night feeding), frequency of sweet-food consumption, bedtime toothbrushing, use of fluoride toothpaste, annual oral examinations, vitamin D and calcium supplementation, and parental oral-health knowledge. Group comparisons used chi-square and t-tests; multivariable logistic regression identified factors associated with ECC; Spearman correlation assessed associations between caries count and growth Z-scores.ResultsECC prevalence was 58.68% (223/380), and mean dmft was 2.34 ± 2.35, with no significant differences by sex or age group. In adjusted models, higher sweet-food frequency was associated with greater odds of ECC (OR 1.72, 95% CI 1.19–2.49). Protective factors included vitamin D supplementation for ≥2 years (OR 0.40, 95% CI 0.18–0.86), bedtime toothbrushing (OR 0.22, 95% CI 0.13–0.38), use of fluoride toothpaste (OR 0.04, 95% CI 0.01–0.13), annual oral examinations (OR 0.26, 95% CI 0.15–0.44), and qualified parental oral-health knowledge (OR 0.38, 95% CI 0.23–0.65). Children with ECC had higher proportions of stunting, underweight, and wasting than those without ECC. Caries count was inversely correlated with WHZ (r = −0.649, P < 0.001).ConclusionIn this population, ECC was common. Modifiable behaviors and parental knowledge were strongly associated with ECC, and greater caries severity was linked to lower WHZ, suggesting a relationship between ECC and acute nutritional status. Strengthening sugar intake control, bedtime toothbrushing, fluoride use, and routine dental examinations may help prevent ECC and mitigate its potential impact on growth.

Objective: To explore the impact of area-level deprivation on 5-year-olds' (school year 1) oral health-related quality of life (OHRQoL) in Wales. Basic research design: During the 2022/23 academic year, a sample of 5-year-old children in state-maintained schools in Wales were selected to undergo a clinical examination. A random stratified sample of 15,625 children were invited to participate. The British Association for the Study of Community Dentistry diagnostic criteria was used to calculate d3mft (decayed, missing, and filled teeth) and PUFA (pulpal involvement, ulceration, fistula, and abscess) scores for each child. Main outcome measures: Before the examination, parents/guardians completed the Early Childhood Oral Health Impact Scale (ECOHIS), a validated measure of OHRQoL. Results and Conclusion: Data were gathered from 8,463 children from 612 schools, with a mean age of 5.95years. 28.6% had experienced dental caries. Mean d3mft was 1.07 (3.39 in those with caries experience) and PUFA was present in 2.0%. 18.4% of parents/guardians reported a negative impact on the ECOHIS and this increased to 35.1% amongst children with caries experience (d3mft>0). The most common impacts reported were pain (11.6%, 23.6% if d3mft>0) and feelings of guilt in parents/guardians (6.7%, 16.5% if d3mft>0). The highest levels of impact were recorded amongst children from deprived communities, and this persisted after controlling for caries experience or untreated decay (p < 0.05). These data reinforce the need for measures to tackle early childhood caries alongside other efforts to minimise childhood disadvantage.

BackgroundEarly childhood caries (ECC) remains a common childhood condition that affects 600 million children worldwide. Providing parents with support for oral health behavior change can address ECC risk factors and complement preventive clinical care. Mobile health (mHealth) text message programs that are co-designed and evaluated by parents and health professionals using behavior theory have been shown to be effective in improving oral health outcomes.ObjectiveThis study aimed to describe the co-design process, development, and content evaluation of a text message program designed to promote oral health behavior change among parents of children diagnosed with ECC using the Behavior Change Wheel (BCW) framework.MethodsThe SmilesUp mHealth program was co-designed with parents in 2 stages using the BCW, a widely used theoretical framework to underpin mHealth programs, recommended by the World Health Organization. Through focus groups with parents in phase 1, the BCW was used to understand parental perspectives by identifying barriers and enablers and selecting target behaviors that could be feasibly delivered within a mHealth intervention. Barriers and enablers were mapped to the relevant theoretical domains and behavior change technique (BCT) of the BCW. Phase 2 evaluated content acceptability, measured by understandability, usefulness, and appropriateness of the program through questionnaires with parents and health professionals. Highly rated messages were finalized into an algorithm for the SMS text message program.ResultsIn phase 1, the overall target behavior was parental behavior change to support good oral health, including oral hygiene, reduced dietary sugar intake, and bedtime routines for their children. The 5 intervention functions focused on education, modeling, persuasion, environmental restructuring, and enablement, and 16 BCTs focused on addressing the motivational enablers and knowledge gap barriers identified by the parents. A total of 111 draft health messages were developed and mapped to the BCTs. In phase 2, a total of 2045 reviews of the 111 draft messages were completed by parents (14/31, 45.2%) and health professionals (17/31, 54.8%). Parents rated 77.4% (86/111) and health professionals rated 61.2% (68/111) of the messages as understandable, useful, and accepted. The messages that were considered understandable, useful, and appropriate by both groups were incorporated into the SmilesUp 12-week semipersonalized SMS message program.ConclusionsThe SmilesUp mHealth program uses behavioral theory to address knowledge gaps in tooth brushing, diet, and bedtime routines identified by parents. It provides parents with convenient, bite-sized nudges of information to support oral health–promoting behaviors in the home context. Robust content development and evaluation are crucial initial steps before further investments are made to conduct a clinical trial to assess the effectiveness of the program.