PDF: Ending childhood dental caries: WHO implementation manual

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Early childhood caries (ECC) affects teeth of children aged under six years. According to the Global Burden of Disease Study in 2017, more than 530 million children globally have dental caries of the primary teeth.


However, as primary teeth are exfoliated due to growth of the child, ECC has previously not been considered important. ECC has significant influence on individuals, families and societies.


The disease affects primary teeth and permanent teeth and influences general health and quality of life across the entire life course. ECC links with other frequent diseases of childhood, primarily due to risk factors shared with other noncommunicable diseases (NCDs) such as high sugar intake, and the disease relates to other health conditions such as obesity. 

Dental caries can lead to abscesses and cause toothache, which may compromise ability to eat and sleep and restrict life activity of children. Severe dental caries is associated with poor growth. 

Moreover, ECC is an economic burden to the family and society; treatment of ECC under general anaesthesia for extensive dental repair is especially costly. Prevalence of ECC is increasing rapidly in low- and middle-income countries, and dental caries is particularly frequent or severe among children living in deprived communities.


In many countries, access to dental care is not equitable, leaving poor children and familiesunderserved. Fortunately, ECC is preventable, with almost all risk factors modifiable. 

ECC differs from dental caries in older children and adults in its rapid development, its diversity of risk factors, and in the control of disease. As with most NCDs, both cause and prevention are strongly determined by sociobehavioural, economic, environmental and societal factors, known as the social determinants of health. 

ECC is influenced strongly by health behaviours and practices of children, families and caregivers. ECC prevention and control approaches range from changing personal behaviour, to working with families and caregivers, to public health solutions such as building health policies, creating supportive environments, and health promotion and orientation of health services towards universal health coverage. 

Building supportive environments for integration of ECC prevention and control into general health activities is essential. In addition, primary care teams, including community health workers, are key to successful programmes.


The Ending Childhood Dental Caries

WHO Implementation Manual has been developed to serve different stakeholders in their work for better health of children; these stakeholders include community agencies, ministries of health, academia, and nongovernmental and professional organizations. 

The manual is based on evidence from systematic reviews and WHO recommendations, especially on nutrition, including breastfeeding, and primary care workers’ programmes. 

The current manual focus on tackling ECC in its global context defines the disease and outlines known risk factors and approaches to prevention and treatment. 

It is intended to inform and support: 

► Policy-makers on actions and rationales for ECC interventions; 
► Chief dental officers, ministry of health focal points and public health administrators in the development and implementation of plans for ECC prevention and control, using the primary health-care approach. 

The manual may also be used in training activities to help primary care teams: 

► Understand ECC as a public health problem; 
► Recognize the essential risk factors for ECC, especially lack of exclusive breastfeeding, consumption of free sugars, and inadequate exposure to fluoride in prevention of dental caries; 
► Identify opportunities for intervention against ECC and its causes. 



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