ECC is a particularly virulent form of caries and progresses very quickly from white spot lesions or subsurface decalcifications to frank cavitation.

The enamel is thin - approximately 0.5 mm - in the primary incisors, compared to 1.0 mm or more in the permanent incisors. The thinnest enamel surfaces at the cervical aspect of crowns are the first to demineralize. It is not unusual to see white spot lesions in the cervical area in children under 12 months of age. The teeth are at greatest risk when they are erupting because erupting surfaces are readily colonized. Plaque collects at the cervical aspect of incisors if they are not cleaned.

Note the gross decay indicative of Early Childhood Caries on the maxillary anterior teeth in this toddler.