Which teeth do early childhood caries affect first?

• A. Teeth that erupt first and are least protected by saliva
• B. Molars only
• C. Teeth with the strongest enamel
• D. Teeth in the upper jaw only

Answer: (A)

Early childhood caries tends to appear first on the teeth that erupt earliest because they are exposed to a cariogenic environment for a longer period and have less mature defenses. The first teeth to erupt in infancy, mainly the incisors, arrive with enamel that is still developing and may be thinner, and the protective effects of saliva around those teeth are not fully established yet. This combination makes them more vulnerable to acid attack from frequent exposure to sugars, especially with bottle-feeding patterns at night. As a result, these early-eruption teeth are the ones most likely to be affected first. Molars come in later and typically don’t show initial decay as quickly; teeth with stronger enamel would be more resistant; and ECC commonly involves teeth from both jaws, not just the upper.