Objectives: A prior study described the association between ecosystem vitality, environmental health, and early childhood caries (ECC). The objective of this study was to determine the association between 24 global environmental indicators and ECC in 3-5-year-old children. Results: In 61 countries, 55.5% of 3-5-year-old children had ECC. Eight factors had a small effect-size association with ECC: Percentage of area that is marine-protected (partial eta squared; 2 = 0.03); species habitat index (2 = 0.06); percentage of tree-cover loss (2 = 0.03); regional marine trophic index (2 = 0.03); total carbon dioxide emission intensity (2 = 0.03); methane emission intensity (2 = 0.04); nitrous oxide emission intensity (2 = 0.06); and sulfur dioxide emission intensity (2 = 0.03). Regression analysis revealed that two of these factors were significantly associated with the prevalence of ECC: Methane emission intensity was inversely associated with ECC prevalence (B =-0.34, 95% CI =-0.66,-0.03; p = 0.03), and nitrous oxide had a direct association with ECC prevalence (B = 0.35, 95% CI = 0.04, 0.67; p = 0.03).