Early Childhood Caries Research Articles

Impact of Marital Status, Education, and Family Size on Parental Behaviors Toward Early Childhood Caries in Romania

Background and Objectives: This study aimed to examine the influence of socio-demographic factors (marital status, number of children, and education level) on the knowledge, attitudes, and practices (KAP) concerning Early Childhood Caries (ECC) prevention among parents in Bihor, Romania. This research seeks to address the lack of regional data on the influence of socio-demographic factors, such as marital status, number of children, and education level, on parental knowledge, attitudes, and practices regarding ECC prevention. These insights are essential for developing targeted public health interventions in Romania. Materials and Methods: Conducted from March to September 2024, this cross-sectional study utilized a KAP questionnaire distributed online to parents of children under six. The survey was adapted to local contexts and included sections on demographic data and ECC-specific knowledge, attitudes, and practices. Statistical analyses, including Chi-square tests, were performed to evaluate the relationship between socio-demographic factors and KAP outcomes, ensuring robust data interpretation under ethical standards set by the Declaration of Helsinki. Results: Of the 798 respondents who accessed the questionnaire, 419 completed it, resulting in a completion rate of 52.5%. The participants had a mean age of 33.8 years. In terms of gender distribution, 348 (83.1%) were female and 71 (16.9%) were male. Higher educational levels were strongly correlated with better ECC knowledge and preventive practices; parents with university degrees demonstrated significantly better understanding and engagement in ECC prevention (p < 0.05). Married parents participated more actively in ECC prevention than unmarried ones, with 61.1% adhering to recommended practices compared to significantly lower rates among unmarried parents (p = 0.020). While this difference was statistically significant, the lower representation of unmarried parents in the sample should be considered when interpreting this finding. Families with fewer children showed more effective ECC preventive practices (p = 0.001). Conclusions: The study suggests that higher education and smaller family sizes are associated with better ECC prevention behaviors, emphasizing the need for targeted public health interventions. These could include parental education campaigns on ECC prevention, community-based oral health workshops, subsidized fluoride programs, and increased accessibility to pediatric dental services for underprivileged families.

The first visit to the dental care practice

During a child s first 1,000 days, many important events take place, such as the eruption of its first tooth, taking its first bite, learning to brush its teeth and the first visits to a dental care practice. This article discusses the factors influencing a child s oral health during this crucial period. It offers oral care providers guidelines for young children s first visits. It is essential for oral care providers to be able to recognize disorders among this patient group and to treat these, when necessary. In addition, during a first visit, parents questions are answered and subjects like non-nutritive sucking, eating habits, oral hygiene and other risk factors for early childhood caries (ECC) are raised. By supporting the parents and making them aware of the importance of oral health from birth, oral care providers can play an essential role in establishing a solid foundation for a healthy future.

Multiancestry Genome-Wide Association Study of Early Childhood Caries

Early childhood caries (ECC) is the most common noncommunicable childhood disease—an important health problem with known environmental and social/behavioral influences lacking consensus genetic risk loci. To address this knowledge gap, we conducted a genome-wide association study of ECC in a multiancestry population of U.S. preschool-age children (N = 6,103) ages 3 to 5 y participating in a community-based epidemiologic study of early childhood oral health. Calibrated examiners used International Caries Detection and Assessment System criteria to measure ECC; the primary trait was the number of primary tooth surfaces with caries experience (i.e., dmfs index). We estimated heritability and concordance rates and conducted genome-wide association analyses to estimate overall genetic effects as well as stratified by sex, household water fluoride, and dietary sugar and leveraged combined gene/gene-environment effects using 2-degree-of-freedom joint tests. Common genetic variants explained 24% of ECC phenotypic variance among unrelated individuals, while concordance rates were 0.64 (95% confidence interval [CI] = 0.42–0.79) among monozygotic twins and 0.44 (95% CI = 0.34–0.53) among first-degree relatives. Across all analyses, we identified 21 novel nonoverlapping genome-wide significant loci (P < 5 × 10−8) and 1 genome-wide significant gene (TAAR6) associated with ECC. The taste receptor activity gene set, with known roles in chemosensing, bacterial recognition, and innate immunity in the oral cavity, was strongly associated with ECC. While no locus remained significant after studywise multiple-testing correction, 3 loci were nominally significant (P < 0.05) and directionally consistent in external cohorts of 285,248 adults (rs1442369, DLGAP1 and rs74606067, RP11-856F16.2) and 18,994 children (rs71327750, SLC41A3). Meanwhile, the strongest marker known to be associated with adult caries (rs1122171, tagging the long noncoding RNA PITX1-AS1) was nominally significant (P = 0.01) and directionally consistent with ECC in our study. Taken together, the results of this study add to the genomics knowledge base for early childhood caries, offer several plausible candidates for future mechanistic studies, and underscore the importance of accounting for sex and pertinent environmental exposures in genetic investigations.

A Hybrid Approach to Modelling ECC Risk: Effectiveness of Nonparametric Regression and MLFNN Techniques

Introduction. Early childhood caries (ECC) is a prevalent dental condition that significantly impacts children’s quality of life and is influenced by both environmental and metabolic factors. Anthropometric variables such as weight, height, and body mass index serve as indicators of overall growth and nutritional status, which are closely linked to oral health. Additionally, family size may play a role in ECC risk by influencing dietary habits and oral hygiene practices. Despite these associations, the complex and nonlinear relationships between these factors and ECC risk remain insufficiently explored. This study aims to investigate the potential relationships between ECC risk and a combination of social (family size) and anthropometric parameters (weight, height, and body mass index) by employing nonparametric regression and validating these relationships with a multilayer feed-forward neural network (MLFNN). Methods. This cross-sectional observational study utilized secondary data from Universiti Sains Malaysia Hospital, Kota Bharu, Kelantan, Malaysia. The dataset was divided into training (60%), testing (30%), and validation (10%) subsets. A generalized additive model (GAM) was used to capture nonlinear relationships, followed by MLFNN validation. Model performance was assessed using root mean squared error (RMSE), mean absolute error (MAE), median absolute error (MedAE), and mean squared error (MSE). Results. The dataset exhibited non-normality, justifying the use of nonparametric regression. In the GAM, only weight showed a nonlinear relationship, with no other predictors significantly influencing ECC risk, except for the intercept. The MLFNN achieved an error value of 0.089 and an accuracy of 91.09%, with height contributing the most to ECC risk estimation. Conclusions. Integrating nonparametric regression and MLFNN validation provides a robust framework for modelling ECC risk, capturing complex nonlinear relationships between family size and anthropometric factors. Height emerged as the most influential predictor, highlighting its association with growth and systemic health, followed by weight, body mass index, and family size. These findings underscore the need for a multifactorial approach in ECC prevention, emphasizing nutritional and family-related factors in pediatric dental care.

Perceptions of mothers of preschool children towards oral health services - a qualitative study

BackgroundPoor oral health, especially dental caries in early childhood is a major public health concern. Parental oral health knowledge, behavior, and perceptions are important elements in determining the child’s oral health status. The aim of the study was to investigate the perceptions of mothers of preschool children in Qatar towards their children’s oral health and their experiences with oral health services provided to children.MethodsThe study is based on qualitative methods using focus groups. Purposive sampling was used to recruit mothers of preschool children at two kindergartens in the city of Doha, Qatar. The focus group consisted of a series of open-ended questions about the oral health of children and the opinion of mothers towards the current oral health services provided in the country. An inductive thematic content analysis at the statement level approach was used to analyze the qualitative data.ResultsTwelve mothers between the ages of 20 and 41 years old from two kindergartens participated in two separate focus groups. The average number of children per mother was 5 with 45 months being the mean age of children. Several themes emerged from analyzing the data retrieved from the discussion with mothers. For oral health knowledge, mothers demonstrated a different level of oral health knowledge, from good to poor. As for experiences with health services, recognized the value of oral health services in Qatar but expressed difficulties in access to oral health services for their children with almost all having had some negative experiences. Regarding the anticipated role of mothers in the oral health of their children, mothers were very positive about their potential role in supporting their children’s oral health. The mothers also gave recommendations to improve oral health services for young children.ConclusionMothers showed positive attitudes towards the oral health of their children and they recognized the importance of a good oral health care system.

Knowledge, Attitudes, and Practices towards Early Childhood Caries among Affluent Parents of Lahore

Parents influence oral hygiene practices and children's health behaviours as young ones lack the comprehension and dexterity to maintain oral health. Objectives: To evaluate the knowledge, attitudes, and practices about early childhood caries among affluent parents of Lahore. Methods: A cross-sectional study was conducted from August 2024 to October 2024 using non-probability sampling with 203 participants. Revalidated questionnaires inquiring about knowledge, attitude, and practice were distributed to parents with children under 5 years old, enrolled in affluent schools within the city. Frequency and percentage distributions were obtained for each qualitative variable and mean, and standard deviation were acquired for quantitative variables. The differences between genders were analyzed using chi-squared statistics. A p-value of less than 0.05 was considered statistically significant. Results: Among 203 participants, the majority were mothers 56.2% and the sample comprised of most male children in age group 3-5 years. Among the participants, more than half of the parents had graduated from university; some had graduated from high school. Only a few had completed their primary-level education. The overall mean knowledge score was 52.77 ± 21.59, whereas the mean score for attitude and practice was 61.24 ± 25.49 and 65.61 ± 26.66 respectively. Mothers had significantly greater overall knowledge (p=&lt;0.001), better attitudes (p=0.164), and practices (p-value=0.112) towards early childhood caries as compared to fathers. Conclusions: It was concluded that although affluent parents of 5-year-old children had good knowledge regarding the Early Childhood Caries, their attitude and practices were still lacking in keeping up with the recommended standards.

Correlation Between Cariogenic Diets and Oral Hygiene Habits on Early Childhood Caries in Klungkung, Bali

Background: Early Childhood Caries (ECC) is one of the most common dental and oral diseases occurring in children aged 48-71 months. Several factors can influence the occurrence of dental caries in children, one of which is the consumption of cariogenic foods that easily stick to teeth. These foods are fermented by certain bacteria to form acids, which can lead to plaque formation and damage tooth structures if left unchecked for an extended period. Objective: To examine the influence of cariogenic dietary patterns and dental and oral hygiene habits on ECC in children aged 48-71 months at Kumara Bhuana Saraswati Kindergarten, Klungkung. Materials and Methods: This research employs a quantitative study design with an analytical cross-sectional approach. The sampling technique used was non-probability sampling. The study involved 67 pairs of parents and their children (aged 48-71 months) from Kumara Bhuana Saraswati Kindergarten, Klungkung. Results: This study indicate a correlation with a p-value of &lt;0.05 between the consumption of cariogenic foods with dental and oral hygiene maintenance behavior, and between the consumption of cariogenic foods with incidence of ECC in children aged 48-71 months at Kumara Bhuana Saraswati Kindergarten, Klungkung. Conclusion: There is a significant influence of cariogenic dietary patterns and dental and oral hygiene maintenance behavior on the incidence of Early Childhood Caries (ECC) in children aged 48-71 months at Kumara Bhuana Saraswati Kindergarten, Klungkung. Efforts to reduce ECC cases should focus on promoting healthier dietary choices and improving dental and oral hygiene practices among children and their caregivers.

Pediatricians’ Knowledge and Practices Regarding Infant Oral Health: A Pretest and Posttest Intervention Study

ABSTRACT Background: In India, early childhood caries (ECC) is a significant public health issue affecting young children, particularly those from disadvantaged backgrounds. The prevalence of ECC in India is influenced by factors such as dietary habits, oral hygiene practices, cultural norms, and access to oral healthcare services. According to the World Health Organization (WHO), ECC affects approximately 23% of children aged 2–4 years globally. Aim: The study was conducted on pediatricians’ knowledge and practices regarding infant oral health and ECC. It provides critical insights into the challenges and opportunities for improving oral health outcomes among young children, particularly in the context of Dwarka subcity, India. Methodology: A cross-sectional pretest and posttest study was conducted among pediatricians practicing in the Northern India. The study utilized pre- and posttraining questionnaires to evaluate pediatricians’ baseline knowledge and measure changes following educational interventions. To ensure questionnaire reliability and internal consistency, questions perceived as challenging were rephrased, and Cronbach’s alpha coefficient (α) was used to assess overall questionnaire reliability, demonstrating a high degree of internal consistency (α =0.95). Result: An improvement in the knowledge of the clinicians were observed postintervention. Conclusion: This study highlights the importance of addressing gaps in pediatricians’ knowledge and practices related to infant oral health and ECC through targeted educational interventions and collaborative efforts. By empowering pediatricians with the necessary skills and knowledge, we can enhance early intervention and preventive care measures, ultimately improving oral health outcomes for children in India and globally.

The behavior of milk consumption based on the socioeconomic status of parents in the incidence of early childhood caries

Background: Dental caries in early childhood (ECC) is the presence of one or more damaged, missing or filled teeth. In Indonesia, the reported prevalence of ECC in children aged 5 years in Indonesia is 90.2%. The cause of high ECC is inappropriate milk giving to children, either bottled milk or breast milk, due to lack of knowledge of parents, especially mothers and involvement of socio-economic status. Objective: This study aims to examine the relationship between breastfeeding habits based on the socio-economic status of parents with the incidence of Early Childhood Dental Caries. Method: The method used is a literature review with a narrative review procedure. Result: There are still many parents who do not understand about proper breastfeeding, this is influenced by socio-economic factors so that the prevalence of early childhood caries is still high. Conclusion: Early Childhood Caries is caused by the habit of breastfeeding or formula milk, the level of knowledge of the parents, as well as the socioeconomic status of the family.

Assessing the Effectiveness of Groper’s Appliance for Anterior Rehabilitation in Young Children after GA: Challenges and the Need for Improved Alternatives

Background: Premature loss of primary anterior teeth due to early childhood caries (ECC) affects speech, chewing, and facial aesthetics. Groper’s appliance is commonly used for anterior rehabilitation in young children, yet concerns about discomfort, compliance, and durability highlight the need for further evaluation. Aim: To evaluate the clinical effectiveness of Groper’s appliance in children undergoing general anesthesia (GA) for dental rehabilitation, focusing on pain perception, compliance, dietary adaptation, and appliance durability. Materials and Methods: A prospective observational study was conducted with 40 children (aged 2–6 years) requiring anterior rehabilitation post-GA. Participants were divided into two groups: Group 1 received a standard Groper’s appliance, while Group 2 received a modified overdenture-type version. Pain perception (Wong-Baker Faces Pain Scale), compliance, dietary patterns, and appliance durability were assessed over six months. Data analysis included ANOVA and Chi-square tests. Results: Pain perception remained high in both groups, particularly during the initial weeks, with Group 1 reporting significantly greater discomfort. Compliance rates were lower in Group 1, with frequent appliance removal and discomfort-related resistance. Group 2 exhibited improved adaptation, reduced breakage, and better long-term acceptance. Dietary intake remained a challenge in both groups, with limited improvement in solid food consumption despite rehabilitation. Conclusion: Groper’s appliance is effective for anterior rehabilitation, but modifications such as an overdenture design enhance comfort, compliance, and durability. Further research is needed to explore alternative solutions.

Can we rely on delaying the uptake of sugar consumption in the prevention of early childhood caries?

Feldens C A, de Barros Coelho E M R, Vítolo M R, Rogrigues P H, Kramer P F, Peres K G Effectiveness of a sugar consumption prevention programme in the first year of life on the occurrence of early childhood caries: a multicentric randomized trial in Brazil. Caries Res 2024; https://doi.org/10.1159/000541028 . A multi-centre randomised controlled trial was carried out in Brazil. The intervention group received nutritional counselling based on dietary guidelines produced by UNICEF. The control group received standard dietary and maternal counselling provided by the hospital provider. Randomisation of participants was completed through a computer-based system with an investigator blinded to the recruitment process. Patients were followed up monthly using a combination of phone calls and home visits. Pregnant women were recruited from four hospitals, across three state capitals, participating in the Baby Friendly Hospital Initiative. Mothers were to be at least 18 years of age, testing negative for HIV/HTLV1, and had an uncomplicated pregnancy. Their newborns had to have a gestational age of more than 37 weeks and weigh more than 2.5 kg. A newborn with increased hospital stays due to infection or neonatal conditions which affected breastfeeding were not included. Sample size calculation was undertaken. Baseline data was collected. At 6- and 12-month intervals, a combination of validated questionnaires, including 24-hour recalls, and interviews were used to assess the diet. Oral health assessments were carried out by a blinded, trained and calibrated paediatric dentist. The primary outcome was a reduction in ECC. Effect measures (relative risk [RR]) were calculated to determine the effect of the intervention on not consuming sugar at 6 months and on the mean number of sugary items consumed at 12 months. Baseline demographic data were similar, with no significant differences noted, between the intervention and control groups. The probability of not consuming sugar in the first 6-months was 2.4 times less in the intervention group relative to the control group (p = 0.016). ECC was diagnosed in 17.4% of the whole sample; however, no significant difference was noted between groups at any time point (p = 0.281). Increased intervention to the mother in the first 6-months of life was effective at reducing the amount of sugar intake. However, this did not lead to a statistically significant reduction in ECC.

Dietary patterns and their associations with the occurrence and severity of early childhood caries among 1-5-year-olds in Iran: A multicenter cluster randomized survey.

A health-promoting and tooth-friendly diet can reduce the risk factors associated with early childhood caries (ECC) and promote overall health in children. This study aimed to identify dietary habits and feeding practices and their associations with ECC among 1-5-year-olds in Iran. This analytical cross-sectional study utilized data from a survey conducted from August 1, 2020, to January 20, 2021. A three-stage stratified cluster sampling method was employed to recruit participants. Parents provided written informed consent in Persian before enrollment and were then interviewed via a valid and reliable questionnaire inquiring about background information, feeding practices, and dietary habits. Each child underwent a dental examination by one of four trained and calibrated dentists to assess dental plaque and ECC. After appropriate weightings were applied, associations between key covariates and outcome measures were analyzed using multivariable logistic regression modeling and multivariate generalized negative binomial regression modeling. Statistical analysis was performed using SPSS V25 and Stata V14.2 software. The mean age of the study population was 45.0 (±0.5) months, and 53% (±5%) had ECC. Visible dental plaque was present on the tooth surfaces of 39% ( ± 3%) of the toddlers and 66% ( ± 4%) of the preschoolers. The majority of the children had been breastfed for over 18 months (65%). Most children consumed sugar between meals once a day or less (66%) and fruits once (39%) or twice (37%) a day. ECC experience increased with age and poor oral hygiene across all age groups. Toddlers with a higher frequency of sugar intake between meals had higher dmft and ECC prevalence. The consumption of four to five servings of grain products per day was associated with a five-fold reduction in ECC occurrence (p = 0.047, OR = 0.2). In contrast, the consumption of two servings of fruits per day was associated with a doubling of the dmft score in toddlers (p = 0.015, IRR = 2.0). This study identified possible dietary risk factors for ECC in Iranian children, such as increased sugar intake and fruit consumption, while balancing diet with grain consumption played a protective role. Considering the role of oral hygiene and the multifactorial nature of the disease may highlight a route toward developing future targeted and effective preventive strategies.

Retrospective Evaluation of Fluoride Varnish Application Programs and Their Impact on Early Childhood Caries

Retrospective Evaluation of Fluoride Varnish Application Programs and Their Impact on Early Childhood Caries

Antimicrobial Potential of Calcium Nanoparticles in Fluoridated Toothpaste Against Lactobacillus and Candida albicans: An In Vitro Analysis

Background: Nanotechnology has emerged as a promising field in dentistry, particularly for improving antimicrobial efficacy in oral healthcare products. Candida albicans and Lactobacillus are key microorganisms associated with early childhood caries and oral infections. While fluoride-based toothpaste is effective against cariogenic bacteria, its efficacy against Candida albicans remains limited. Incorporating calcium nanoparticles into toothpaste formulations may enhance antimicrobial properties and offer broader-spectrum protection. Aim: To evaluate the antimicrobial efficacy of calcium nanoparticles combined with commercially available fluoride toothpaste against Lactobacillus and Candida albicans through an in vitro analysis. Materials and Methods: Calcium oxide (CaO) nanoparticles were synthesized using a microwave irradiation method. The antimicrobial efficacy of calcium nanoparticles in combination with fluoride toothpaste (Pediflor) was assessed against Lactobacillus and Candida albicans using the agar well diffusion method. Zones of inhibition were measured, and statistical analysis was performed using one-way ANOVA to determine significant differences across different concentrations. Results: The combination of calcium nanoparticles and fluoride toothpaste demonstrated a dose-dependent increase in antimicrobial activity, particularly against Candida albicans. However, Pediflor alone exhibited greater inhibition against Lactobacillus. Statistical analysis revealed significant differences at higher concentrations, highlighting the differential susceptibility of the microorganisms. Conclusion: Calcium nanoparticles enhance the antifungal efficacy of fluoride toothpaste, making them a potential additive in oral care formulations. However, their antibacterial activity against Lactobacillus was lower than that of standard fluoride toothpaste. Further research is needed to optimize formulations and assess long-term effects on oral microbiota.

The Updated Trend of Association between Dental Caries and Stunting in All Age Groups: A Systematic Review

Background: Stunting has a negative impact on the growth and development of children, which include their susceptibility to dental caries. Caries in primary teeth have been consistently related to malnutrition. Having a history of severe caries was connected with slower childhood growth. We aimed to explain the updated trend of association between stunting and dental caries among all age groups. Methods: A review was done using PRISMA. PubMed and Science Direct was used as database from Jan 2022 to Jan 2023. Studies obtained using specific keywords was 1.748 then filtered. All of the studies that were obtained using specific keywords about stunting and DMFT and or PUFA index. There is no limited year in this systematic search. Endnote software was used to help with the inclusion process; data was extracted into a table that had been prepared. Results: There were 10 included studies in this systematic review. Eight studies that reported higher dental caries in stunting children than the normal children. Two studies showed a connection between developing stunting malnutrition and severe dental caries. Early childhood caries may increase vulnerability to dental caries by causing odontogenesis to fail, delayed tooth eruption and changes in the salivary glands. Children's ability to eat and sleep may be negatively impacted by untreated caries pain. It might result in decreased nutrient intake and poor appetite, while sleep disturbances might prevent growth hormones from being secreted. Conclusion: There was a correlation between dental caries and growth stunting because of a decrease in the composition of saliva and defects in tooth formation in children suffered stunting. Thus, there were oral functional limitations and a decrease in food intake since severe dental caries.

Can promoting breastfeeding in pregnant or recently delivered mothers prevent early childhood dental caries?

Can promoting breastfeeding in pregnant or recently delivered mothers prevent early childhood dental caries?

Knowledge, perception and attitude of dentists regarding the role of artificial intelligence in the field of pediatric dentistry: An online questionnaire study.

Knowledge on the potential applications of artificial intelligence (AI) as a diagnostic instrument in the domain of pediatric dentistry is imperative, as AI may significantly influence present and future dental practice. The present study aimed to evaluate the knowledge, perception and attitude of pediatric dentists and postgraduate students in the pediatric specialty with regard to the employment of AI in pediatric dental practice. An online questionnaire survey was conducted among 375 participants (92 postgraduates, 203 faculty members and 80 private practitioners), who were provided with 19 closeended questions through the Google Forms link sent via email. The questions referred to the knowledge, perception and attitude of the participants, with 17 questions answered using a three-point Likert scale and 2 of them being multiple-choice questions. The responses were analyzed using the χ2, Kruskal-Wallis and Mann-Whitney U tests. A total of 62% of the participants were familiar with the term 'artificial intelligence', and the majority confirmed that AI could be used for the identification of plaque (57%) and supernumerary teeth (52%), the detection of early childhood caries (ECC) (68%) and the ectopic eruption of first permanent molars (67%), the assessment of child psychology (82%), and the estimation of chronological age (67%). Most participants felt that AI training should be incorporated into the postgraduate curriculum (82%) and were willing to introduce AI to clinical practice (87%). The barriers related to the use of AI were high costs (83%), the lack of training after graduation (78%), the lack of technical knowledge (77%), the fear of misdiagnosis (73%), and the lack of awareness (71%). The present study concluded that although most pedodontists and postgraduate students had knowledge on AI, there were many obstacles connected with the use of AI in the field of pediatric dentistry. Therefore, the basic training of AI should be included in the curriculum of postgraduate studies.

Can providing pregnant women and recently delivered mothers with advice on optimal infant diet and feeding practices prevent early childhood dental caries?

Can providing pregnant women and recently delivered mothers with advice on optimal infant diet and feeding practices prevent early childhood dental caries?

Evaluation of Viable Mutans Streptococci Colony Count and Its Association with Salivary Immunoglobulin A with Severity of Early Childhood Caries: An Original Research

Evaluation of Viable Mutans Streptococci Colony Count and Its Association with Salivary Immunoglobulin A with Severity of Early Childhood Caries: An Original Research

Early Childhood Feeding Practices and the Development of Severe Early Childhood Caries (S-ECC): A Prospective Cohort Study in Medan, Indonesia

Early Childhood Feeding Practices and the Development of Severe Early Childhood Caries (S-ECC): A Prospective Cohort Study in Medan, Indonesia