The aim of this case-control study of 617 children was to investigate early childhood caries (ECC) risk indicators in a non-fluoridated region in Australia. ECC cases were recruited from childcare facilities, public hospitals and private specialist clinics to source children from different socioeconomic backgrounds. Non-ECC controls were recruited from the same childcare facilities. A multinomial logistic modelling approach was used for statistical analysis. The results showed that a large percentage of children tested positive for Streptococcus mutans if their mothers also tested positive. A common risk indicator found in ECC children from childcare facilities and public hospitals was visible plaque (OR 4.1, 95% CI 1.0–15.9, and OR 8.7, 95% CI 2.3–32.9, respectively). Compared to ECC-free controls, the risk indicators specific to childcare cases were enamel hypoplasia (OR 4.2, 95% CI 1.0–18.3), difficulty in cleaning child’s teeth (OR 6.6, 95% CI 2.2–19.8), presence of S. mutans (OR 4.8, 95% CI 0.7–32.6), sweetened drinks (OR 4.0, 95% CI 1.2–13.6) and maternal anxiety (OR 5.1, 95% CI 1.1–25.0). Risk indicators specific to public hospital cases were S. mutans presence in child (OR 7.7, 95% CI 1.3–44.6) or mother (OR 8.1, 95% CI 0.9–72.4), ethnicity (OR 5.6, 95% CI 1.4–22.1), and access of mother to pension or health care card (OR 20.5, 95% CI 3.5–119.9). By contrast, a history of chronic ear infections was found to be protective for ECC in childcare children (OR 0.28, 95% CI 0.09–0.82). The biological, socioeconomic and maternal risk indicators demonstrated in the present study can be employed in models of ECC that can be usefully applied for future longitudinal studies.

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Home visits and telephone contacts conducted 6 monthly from birth are effective in reducing ECC prevalence by 24 months.