To oral health and beyond: integrating maternal-child oral health to prevent early childhood caries

Early childhood caries (ECC) remains one of the most prevalent chronic diseases affecting children worldwide. Increasing evidence suggests that maternal biological, behavioral, and developmental factors during pregnancy influence infant oral microbiome establishment and early caries susceptibility before clinical disease becomes evident. Prenatal oral healthcare, maternal oral health education, and caregiver-centered interventions have therefore emerged as important components of preventive strategies. This Perspective synthesizes current evidence on maternal–infant transmission dynamics and proposes the Three-Dimensional Maternal Axis as a conceptual framework for understanding early-life influences on ECC development. Building on prior models of maternal influence on childhood caries, this framework foregrounds biological, behavioral, and developmental influences as proximal and interconnected pathways operating across pregnancy and early childhood. A critical preventive window appears to extend from pregnancy through approximately three years of age, during which enamel development, microbial colonization, feeding transitions, and oral health behaviors become established. The article further discusses the translational implications of maternal-centered prevention approaches, including integration of oral health into prenatal care, continuity of care during early childhood, and the potential role of digital health technologies in expanding access to preventive support. Particular attention is given to implementation challenges, health equity, and opportunities for interdisciplinary and cross-sector prevention models. Together, these findings support broader and earlier approaches to ECC prevention that integrate maternal-child oral health across developmental stages and caregiving contexts.