Tooth decay remains the most prevalent chronic health condition among U.S. children and adolescents. While prevalence has significantly decreased in recent years among most children, early childhood caries (ECC) are becoming more frequent among those ages 2-5. The increase in tooth decay is especially pronounced among children living in low-income families, which indicates that the current oral health care system is not adequately addressing the needs of children with the highest risk for poor oral health. This brief explores the findings of the New York State ECC system dynamics model as they relate to cost-effective care delivery and reducing risks of disease and articulates policy options to better align the oral health care delivery system with established caries management science.