Short Description: Early Childhood Caries (ECC) is defined as dental decay on any primary tooth in children <6 years of age. Severe -ECC (S-ECC) is a more rampant manifestation that generally requires extensive treatment under general anaesthesia. Both are prevalent in Manitoba, especially among Aboriginal children in both remote and urban communities, where the prevalence can often exceed 90%. Every year, >2000 Manitoba preschool children make the pilgrimage for dental surgery because of S-ECC, a preventable disease. Traditional oral health promotion has had little impact on reducing the prevalence of ECC in certain groups. This has prompted innovative solutions to the problem at hand like the Manitoba Collaborative Project for the Prevention of Early Childhood Tooth Decay (Healthy Smile Happy Child), which began in 2000. Three fundamental pillars were adopted – foster community-development, promote early childhood oral health, and research/evaluation. 4 pilot communities initially participated including 2 First Nations. The goals were to: 1. Promote acceptance of the project; 2. Use existing community-based programs and services to deliver oral health promotion and ECC prevention; 3. Train leaders in each community who would assist in the program development and deliver ongoing ECC prevention; 4. Build capacity within existing programs to ensure the sustainability of oral health promotion; 5. Determine the project's impact on the oral health of children <6 years and on caregiver knowledge and attitudes towards ECC; 6. Foster effective and sustainable community-driven programs to reduce the incidence and severity of children with ECC. In 2006/07 the project received a Manitoba Health grant to expand to all communities in the province. 5 community facilitators along with a project coordinator now carry out the project's mandate. Printed resources developed, some of which are translated into French and Cree, were made available on-line and have received >40,000 hits. Telehealth is another new medium to support staff in their regions and pioneer 'distance' early oral health promotion activities. The ideal framework to solve ECC will need to be based on principles adopted in this project - empowering communities, partnering with local stakeholders, oral health is part of overall health, sustainability, equity, intersectoral approach, and ongoing evaluation.