Project Ready Smile (PRS) provides services to children in selected early childhood settings in the six targeted counties in Missouri. ECC or early childhood carriers sites agree to support the project while providing access to children. Children were found with abscesses and tooth decay that had already spread through their mouth. PRS is an initiative that is based in Jackson County of Missouri State. Likewise, the initiative partners with many local agencies and institutions, such as University of Missouri, local dentists, Head Start and early childhood centers serving medically underserved children (REACH Health, n.d). The water system of some communities or towns in the Jackson County do not have the needed level of fluoride commonly known as Community Water Fluoridation (CWF). Required level of fluoride in community water systems is essential in the continued treatment and protection of tooth decay in children and adults. Community Water Fluoridation is a county initiative that has not been widely known by local residents, and not all communities have their tape water fluoridated to a level required to prevent dental caries. Again, not all states participate in CDC’s My Water’s Fluoride program. Community Water Fluoridation program exists to satisfy the required level of fluoride in the public water systems of communities. Some communities lack the CWF program. The absent of CWF narrates the issue of early childhood caries (ECC) as causative measure to children’s tooth decay. A systematic review on literature gaps from annotated bibliography and research articles established the need to further explore low-income parents’ perceptions on the absent of CWF, and on oral health of their children age 6 and under.