Early childhood caries (ECC) is the most common chronic disease condition in childhood and involves the presence of one or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled teeth in children under 72 months of age (American Academy of Pediatric Dentistry, 2010a). ECC is a multifactorial disease that is preventable and requires intervention by the nurse. When teeth are discolored and damaged by dental caries, children may be reluctant to smile, have difficulty talking, miss school, or be unable to focus on studies due to dental pain. This "state of the science" article reviews the literature to determine the risk factors for ECC, assess the prevention strategies, and apply that information to enhance nursing practice. Computerized searches from MEDLINE, CINAHL, and the Cochrane Library were used.