Presented by IAPD Early childhood caries (ECC) is a highly prevalent disease around the world, often remains untreated and exerts a major impact on children’s and parents’ quality of life. ECC was traditionally considered an unavoidable and communicable disease. The diagnosis was based on the number of cavities, which was only assessed from the age of three years onwards. Prevention was restricted to hygiene counseling and the treatment was exclusively restorative, necessarily involving the complete removal of the carious tissue. This approach had no impact on the global ECC burden. New evidence on the etiology, prevention and treatment has indicated a change in the paradigm of the understanding and clinical management of the disease: a) ECC is a non-communicable disease with an unacceptable burden for children, families and society; b) the high frequency of sugar intake in the first years of life is the primary cause of the disease; c) exposure to daily topical fluoride is fundamental to its control; and d) initial caries stages need to be addressed to enable arresting lesions on the enamel or even in the dentin. Taken together, this evidence indicates the need for action in the following key areas: a) limit sugar intake in foods and beverages and avoid free sugars for children under two years of age; b) perform twice daily tooth brushing with fluoridated toothpaste (at least 1,000 ppm) in all children; c) provide preventive guidance within the first year of life preferentially by a dentist for comprehensive continuing care and the early detection of carious lesions; and d) new thresholds and protocols for the use of noninvasive and invasive methods for the treatment of caries based on the concept of minimal intervention. In order for the new paradigm not to be merely a new "wave", it is essential a collaborative involvement of a broad range of professionals to the adoption of practices and policies that promote oral health in childhood. The aim of this presentation is to explore all aspects involved in this paradigm shift, with emphasis to the evidence-based clinical management of ECC