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The Developmental Origins of Health and Disease (DOHaD) paradigm has transformed our understanding of how early-life biological and social environments shape lifelong health trajectories. While DOHaD research across Oceania has focused primarily on metabolic, cardiovascular, and nutritional outcomes, oral health, particularly early childhood caries (ECC), remains largely absent from life course research and policy despite its early onset, shared risk factors with childhood obesity and other noncommunicable diseases (NCDs), and strong social and intergenerational patterning. This conceptual paper synthesises the DOHaD paradigm, First 1000 Days approaches, common risk factor theory, and Pacific relational worldviews to propose a Pacific-centred framework that explicitly integrates oral health. Using the Cook Islands as a regional exemplar, the paper demonstrates how oral health can be aligned with existing maternal and child health, nutrition, and NCD policy priorities. The proposed framework reframes ECC as both a biologically embedded developmental outcome and an early indicator of broader NCD risk trajectories. It highlights the interconnected influence of biological, family, community, health system, and policy environments on oral health across the life course. Integrating oral health within a Pacific centred DOHaD framework addresses an important gap in research and policy and provides a culturally grounded and policy relevant model to strengthen early-life prevention, improve health equity, and guide future research and implementation across Oceania.