Prevalence and factors associated with early childhood caries among three-year-old children attending child welfare clinics in Kalutara District, Sri Lanka: a cross-sectional study

Early childhood caries (ECC) remains a significant public health challenge in Sri Lanka, despite established preventive programs. Evidence on socio-behavioural and child-related factors associated with ECC among three-year-old children, particularly at the district level, is limited. This study assessed the prevalence of ECC and socio-behavioural and child-related factors associated with ECC among three-year-old children attending child welfare clinics (CWCs) in Kalutara District, Sri Lanka. We conducted a cross-sectional study involving 1,197 mother–child dyads attending CWCs in the Kalutara District from May to September 2025, following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Children aged three years (completed third but not fourth birthday) were included using multistage cluster sampling with probability proportional to size (PPS). Data on sociodemographics, dietary habits, and oral health behaviours were collected using a pre-tested, expert-validated, interviewer-administered questionnaire. Dental examinations were performed by a calibrated examiner using World Health Organization (WHO) criteria. Multivariable logistic regression identified variables independently associated with ECC (dmft ≥ 1). The prevalence of ECC was 51.8% (95% CI: 49.0-54.7), with severe ECC in 28.6% of the sample. The mean dmft score was 1.89 (± 2.84). Factors independently associated with ECC included lower maternal education (aOR 1.98, 95% CI: 1.20–3.29), daily sweet consumption (aOR 1.76, 95% CI: 1.24–2.49), daily sugared beverage intake (aOR 1.77, 95% CI: 1.26–2.49), previous dental discomfort (aOR 11.22, 95% CI: 7.11–17.70), caregiver-reported dental anxiety/fear-related delay in dental attendance (aOR 3.44, 95% CI: 2.31–5.13), and frequent medication use (aOR 1.91, 95% CI: 1.19–3.04). Caregiver-assisted toothbrushing (aOR 0.41, 95% CI: 0.25–0.66) and fluoridated toothpaste use (aOR 0.54, 95% CI: 0.31–0.94) were associated with lower odds of ECC. Over half of the three-year-old children in the Kalutara District had ECC. Modifiable dietary and oral hygiene behaviours were important factors associated with ECC. Strengthening caregiver-focused preventive interventions through CWCs, alongside population-level sugar reduction strategies, could substantially reduce the ECC burden. Not applicable.