Table 1.
Emerging directions for ecological prevention and translational research in early childhood caries.
| Future area | Scientific rationale | Research and translational implications | Key references |
|---|---|---|---|
| Preconception oral ecosystem optimization | Maternal microbial communities contribute to early microbial transmission and may influence oral ecosystem assembly. | Integration of oral health into preconception and prenatal care; investigation of maternal ecological determinants of offspring oral health. | (14, 126, 132) |
| Ecologically designed infant nutrition | Human milk bioactive components influence microbial colonization, host–microbe interactions, and immune maturation. | Development of microbiome-targeted nutritional strategies, including HMOs and postbiotic-enriched formulations when breastfeeding is not possible. | (35, 133) |
| Ecological biomarkers and functional risk assessment | Microbial resilience, community interactions, and metabolic functions may better reflect disease susceptibility than individual taxa. | Development of ecological biomarkers and functional microbiome profiling tools for personalized caries risk assessment. | (7, 8, 86) |
| Functional biofilm modulation | Biofilm ecology may be influenced by targeting microbial functions, communication pathways, and ecological interactions rather than indiscriminate microbial elimination. | Investigation of postbiotics, bacteriocins, quorum-sensing inhibitors, and microbiome-directed therapies for ecological biofilm management. | (134, 135) |
| Longitudinal ecological research across the first 1,000 days | Oral ecosystem development is a dynamic process shaped by biological, nutritional, behavioral, and environmental exposures. | Prospective birth cohorts integrating microbial, nutritional, behavioral, and environmental data to identify critical developmental windows and validate ecological biomarkers. | (14, 17, 119) |
| Precision ecological prevention | Integration of developmental biology, oral microbiomics, and ecological risk assessment may support individualized prevention strategies. | Development of personalized prevention programs based on ecological profiles, developmental trajectories, and ecosystem resilience. | (8, 86, 115) |
The developmental-ecological framework proposed in this review supports a shift from disease-centered prevention toward strategies aimed at promoting oral ecosystem development, resilience, and long-term ecological stability. The table summarizes the main future research areas and their potential translational applications.