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1. Background
Early childhood caries (ECC) is the term used to describe the presence of decayed, missing or restored teeth in the primary dentition of children younger than six years old [1]. It is considered one of the most prevalent diseases in childhood, affecting 60% to 90% of children globally [2]. Although fluoridated toothpaste and the continued use of fluoride in various forms are effective in caries prevention [3], ECC is still prevalent among children in disadvantaged communities in both developing and developed countries [4]. Untreated decayed teeth causes difficulties with sleeping and eating and affects children’s growth and development [5]. The International Federation of Dentistry (FDI) reported that ECC is one of the main reasons for school absence in several countries [5]. It can progress rapidly, resulting in pain and infection and affecting child’s oral health related quality of life [6]. Such problems could become serious and even life threatening [7]. Despite the decline of dental caries in adults, an increase of caries prevalence among preschool children has occurred in many countries [8]. In Southeast Asia, dental caries is highly prevalent in preschool children. Their median caries prevalence was 79%, and their caries experience in terms of dmft (decayed, missing and filled primary teeth) score was 5.1 [9]. The situation seems more severe in low-income countries. For instance, caries prevalence among 6-year-old children in Cambodia was as high as 91%, and their mean dmft score was 7.9 [10]. In Vietnam, high caries prevalence (74%) and a large proportion of untreated decayed teeth (95%) were observed [11]. China and India are the two most populated countries in the world. Their caries prevalence of preschool children is relatively high at 66% in China [12] and 63% in India [13] compared with that in high-income countries, such as the USA (23%) [14] and the UK (28%) [15].
Early and regular dental visits can slow down the onset of dental caries in very young children and may result in fewer subsequent treatment visits and reduce the cost of treatment [16]. Despite the benefit of early prevention, access to dental care remains very low in deprived communities. These problems may be due to the poorly developed oral healthcare systems. Many countries in Asia and Africa have severe shortages of...