From Biofilm to Cavity: Clinical and Microbiological Determinants of Early Childhood Caries

Abstract

Early childhood caries (ECC) is one of the most prevalent chronic diseases of childhood and a major, socially patterned public health problem. It is a multifactorial, biofilm-mediated, sugar-driven disease in which a dysbiotic shift of the oral microbiota toward acidogenic and acid-tolerant organisms — including Streptococcus mutans, lactobacilli and the yeast Candida albicans — repeatedly lowers plaque pH and shifts the balance between demineralization and remineralization toward net mineral loss. This narrative review integrates the clinical and microbiological determinants of ECC and traces the continuum leading from a dysbiotic dental biofilm to clinical cavitation. We summarize current definitions, classification and epidemiology, including data from Romania; the microbiological basis of the disease (the dental biofilm, the ecological plaque hypothesis, the roles of mutans streptococci, lactobacilli and Candida albicans, and microbiome dysbiosis); and the host, dietary and behavioral factors that modulate risk. These mechanisms are linked to clinical presentation, diagnostic criteria (dmft indices and ICDAS) and severity classification, and to implications for prevention. An integrated, ecological perspective, rather than a single-pathogen model, most coherently accounts for ECC and supports early, risk-based, family-centered and interdisciplinary prevention.