Evidence of effectiveness for prevention of early childhood caries suggests that parent engagement needs to occur perinatally and that unconventional providers, helping professionals like social workers and dietitians and lay health workers like community health workers, are most effective. This finding, coupled with the emergence of population-based accountable care, value-based purchasing with global payments, understanding of common risk factors for multiple conditions, and social determinants of health behaviors, calls for a rethinking of early childhood oral health care. A population-based model that incorporates unconventional providers is suggested together with research needed to achieve caries reductions in at-risk families.