Objectives Early childhood caries (ECC) negatively impacts many child health outcomes and can lead to greater costs for medical and dental care as well as negatively impact future oral health wellness. ECC risk factors are rooted in many social determinants of health. Addressing ECC at the population‐level is a national public health priority. The purpose of this study was to identify the South Carolina counties with the greatest risk for ECC. As policy‐makers seek to address inequities stemming from early childhood caries, documenting its prevalence is essential. Methods Since no county level ECC rates were published for South Carolina, we identified an opportunity to strengthen ECC surveillance through public use data, so as to properly equip policy‐makers and pediatric providers with an evidence based understanding of the scope of the problem. As a result we sought to develop an overall county level prevalence measure for ECC risk through an ecological analysis of public use data. Results Ten counties with the greatest overall risk for ECC were all rural as hypothesized. Additionally, seven of the 10 highest risk counties fell into what is often referred to as the “Corridor of Shame.” Conclusions We have found an affordable way of measuring county level risk for ECC that allows pediatric advocates and policy‐makers to develop population level interventions to reduce and measure risk with public‐use data.