Beyond the dental clinic: ending the global stagnation in pediatric caries with program science

Globally, early childhood caries is the most prevalent disease in children, even after a century of development. This demonstrates an "effectiveness illusion" where clinical methods fail to deliver true equity. The reason for this inconsistency arises from "dental exceptionalism", which excludes oral health from the systemic medical care systems. Through this article, we advocate moving from a reactive, tools-focused Clinical Science model to a proactive, population-specific Program Science approach. By utilizing the principle of proportionate universalism, prevention can be integrated into the children's natural environment. We present an operational framework to guide Medical-Dental Integration, emphasizing the upskilling of primary care workforces and the use of real-time programmatic data to iteratively resolve implementation bottlenecks. Furthermore, we address structural barriers, including the commercial determinants of health, macro-economic sugar policies, and the health system feasibility, data governance, and financing shifts required to transition from fee-for-service models to value-based care. Ultimately, this framework provides actionable pathways for low-, middle-, and high-income health systems to achieve equitable, sustainable pediatric oral health outcomes.