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Background: Early childhood caries (ECC) represents a significant public health challenge, characterized by the rapid decay of primary teeth in young children. This condition adversely affects oral health, overall well-being, and quality of life (QoL).Aim: The study aimed to assess the prevalence of ECC among children attending a dental outpatient department in Meerut City.Materials and methods: An institute-based cross-sectional study was conducted among children aged 2-6 years who visited the dental outpatient department (OPD) of the Pediatric and Preventive Dentistry Department. A total of 1800 children were examined using Type III examination (employing a mouth mirror and explorer under proper illumination). Data were recorded using the WHO Oral Health Assessment Pro Forma (1997). The Decayed, Missing, and Filled Teeth (DMFT) index was used to evaluate dental caries. Data were tabulated based on gender, age, DMFT score, and symptoms. Statistical analysis was conducted using IBM SPSS Statistics software version 23, with the level of significance set at P < 0.05. Descriptive data were presented as percentages, and Fisher’s exact test was employed for statistical analysis.Results: Of the 1800 children examined, 1086 were found to have ECC, yielding a prevalence of 60.3%. Among the affected children, 61.6% were males, and 38.4% were females. ECC prevalence was significantly higher in children aged 3-6 years compared to those under 3 years (P = 0.001). The mean DMFT score of the study population was 4.27 ± 2.62, with the highest prevalence observed for a DMFT score of 4. The frequency of ECC was higher in patients who presented to the OPD with pain (70.9%).Conclusion: The prevalence of ECC among children aged 2-6 years who visited the dental OPD was 60.3%, with a mean DMFT score of 4.27 ± 2.62. The prevalence was higher in male children compared to female children. Additionally, the most common reason for visiting the dental OPD was pain.