Purpose <p>To assess the updated prevalence and severity of early childhood caries (ECC) amongst preschool children, and examine associations with parental socioeconomic characteristics, perceptions and knowledge.</p> Methods <p>In 2024, 815 children aged 4–5&#xa0;years from 8 preschools in Yangon were examined using ICDAS II criteria. Parents completed a structured questionnaire assessing socioeconomic status, perceptions of child health, and knowledge across three domains. ECC prevalence (ICDAS <i>d</i>^1–6) and severity (<i>d</i>⁰, <i>d</i>^1–2, <i>d</i>^3–6) in relation to parental factors were analysed using Chi-square tests, Kruskal–Wallis tests and logistic regressions.</p> Results <p>ECC prevalence was 96.2%, with 8.2% presenting non-cavitated and 88.0% cavitated lesions. Paternal education was significantly associated with both ECC prevalence (<i>p</i> = 0.030) and severity (<i>p</i> = 0.024) and remained the only significant associated factor in adjusted models. Parents who rated their child’s oral health as “fair or poor” had children with higher ECC severity (<i>p</i> &lt; 0.001). Parental perception was a significant factor in univariable models for both non-cavitated lesions (95% CI 1.03, 1.79) and cavitated lesions (95% CI 1.04, 4.48), although the association for cavitated lesions lost statistical significance after adjustment. Parental knowledge scores were not statistically significantly related to ECC outcomes.</p> Conclusion <p>ECC burden amongst Myanmar preschool children remains extremely high. Paternal education and parental perception of child oral health were key factors associated with ECC severity. Strengthening father-inclusive oral health education, enhancing parental awareness, and expanding preschool preventive programmes are recommended to address Myanmar’s severe ECC burden.</p>