Early Childhood Caries (ECC) Management Efforts

The Problem

Early Childhood Caries (ECC), or tooth decay in very young children, is a chronic, infectious dental disease. Yet, ECC is almost completely preventable. Children with ECC may have pain, difficulty with eating, sleeping and speech which can affect learning in the classroom. If left untreated, ECC can impact the proper development of permanent teeth.

Many children with ECC require surgical treatment at hospital-based dental clinics or with sedation or general anesthesia in the operating room. However, despite receiving such costly surgical treatment, high rates of children develop new and recurrent decay.

The Need

Hospital-based dental clinics and dental safety net programs such as Federally Qualified Health Centers (FQHC) and school-based programs care for a disproportionate number of low-income and racial and ethnic minority children with early childhood caries. Many of the children require surgical treatment. However, months-long backlogs for expensive operating room care and a high rate of relapse after treatment are common.

About 28% of preschoolers have cavities.

What We Did – the ECC Collaboratives

ECC Phase I

In 2008, the DentaQuest Partnership, Boston Children’s Hospital, and St. Joseph's Health Services of Rhode Island developed a protocol to implement an evidence-based method of managing and preventing early childhood tooth decay in patients seeking treatment at hospital-based dental clinics. Over the next 24 months, more than 450 children were enrolled, received caries risk assessments, risk-based preventive and restorative care, and recall based on their caries risk.

The goal was to reduce the rate of new decay in patients, reduce the number of patients treated in the operating room, and reduce the number of patients complaining of pain on their most recent visit. The ECC pilot used an evidence- and risk-based disease management approach adapted from the concept of chronic care management of medical conditions.

ECC Phase II

In 2011, the DentaQuest Partnership launched Phase II of the ECC Collaborative. Seven FQHC's and hospital-based dental clinics began implementing and testing the disease management protocol with patients six months to 71 months old who presented with at least one caries lesion.

Using a modified CAMBRA approach, teams at each site followed the established protocol: conduct a caries risk assessment with each child between six and 71 months of age, provide oral health educational information to and engage caregivers to make changes in dietary and oral hygiene practices through self-management care plans, and provide risk-based preventive and surgical care as needed and desired by the caregivers. In addition, teams collected monthly and quarterly data about risk, pain due to untreated decay, and new cavitation.

Phase II sites successfully demonstrated that a disease management and prevention model in oral health care improves patient care delivery and improves patient outcomes.

The work of this phase and the results demonstrated have been reported in several national journals and publications, including the International Journal Dentistry, the Journal for Healthcare for the Poor and Underserved, the Dental Clinics of North America, the Boston Globe and the New York Times.


The DentaQuest Partnership launched Phase III in 2013 and built upon the first two phases by expanding to 32 sites nationwide participating in an 18-month learning collaborative that ran through February 2015. Phase III teams consisted of FQHCs, hospital-based dental clinics, and private practices. Participating sites tested and implemented the disease management protocol with patients from six and 60 months of age, and worked to re-design their care delivery systems so that every child receives a caries risk assessment, the parent receives an explanation of the caries process and an invitation to collaborate with the care provider to prevent and manage their child’s disease and caries risk.

The disease management protocol

Similar to Phase II, sites collected monthly data about rates of caries risk assessments, self-management goal review, new cavitation, untreated pain, caries risk status, and referrals. Phase III sites also participated in regular meetings and conference calls to share change ideas, best practices, and feedback with other sites in order to learn from one another.

What We Found

Analysis of Phase I data showed very positive results.

Phase II continued with positive results.

Results reflect a random sample of 438 children/families drawn from a total ECC Collaborative population of 3,030.

Phase III site experienced similar successes and reported some of the following after participating in the 18-month collaborative:
• Increased rates of risk assessment and self-management goals for children
• Increased collaboration with medical departments
• Increased pediatric patient volume
• Improved communication and relationships with patients and families

To implement the disease management protocol in your practice, please visit our DCM Virtual Practicum.

To learn more about the Early Childhood Caries Collaborative, contact us at dcmpracticum@dentaquest.com.