What is the order of caries progression?

• A. Upper incisors (maxillary anterior teeth) → first molars (mandibular primary molars) → second molars (maxillary primary molars)
• B. Upper canines → first molars → second molars
• C. Lower incisors → first molars → second molars
• D. Lower canines → premolars → molars

Answer: (A)

In early childhood caries, the pattern of involvement follows a recognizable sequence because of how teeth erupt, how sugar exposure and plaque accumulate, and which surfaces are most susceptible early on. Caries often starts on the smooth surfaces of the maxillary anterior teeth (the upper incisors) due to frequent bottle feeding and prolonged exposure to fermentable sugars, especially at bedtime, making these teeth the first to show decay. As caries progresses and these teeth are already affected, the next most vulnerable surfaces are the erupting mandibular primary first molars, where plaque can easily collect on pits and fissures and where these teeth become part of the chewing surface early in eruption. After that, the maxillary primary second molars, which erupt later and remain exposed to same risk factors, become involved. So the typical progression is upper incisors first, then mandibular first molars, then maxillary second molars. Other sequences don’t align with the common ECC pattern because they start with teeth that are less commonly affected first or don’t reflect the eruption and plaque-retention dynamics seen in young children.