Evidence for clinical subtypes of early childhood caries

Abstract The current early childhood caries (ECC) case definition contains a substantial degree of clinical heterogeneity, and to address this, we sought to identify clinical subtypes of the disease. We used tooth surface-level dental caries experience from a discovery and 3 replication community-based cohorts of 3-to-5-year-old children (N=226,471). We identified five disease subtypes with distinct patterns of caries lesion intraoral distribution that largely replicated across cohorts. These subtypes were associated with established caries risk factors (e.g., history of nighttime bottle-feeding), showed familial concordance and microbiome differences, and predicted dental caries experience 7 years after subtype assignment. Notably, classification of children in these subgroups can be achieved by inspecting small sets of easily examinable tooth surfaces with reasonable accuracy. Collectively, our findings provide evidence for generalizable and clinically recognizable subtypes of ECC. Etiology, targeted prevention, and optimal management of these subtypes should be systematically investigated in future studies.