Risk Factors for Early Childhood Caries: A Systematic Review and Meta-Analysis of Case Control and Cohort Studies

Overview

Journal Pediatr Dent

Specialty Dentistry

Date 2019 Apr 18

PMID 30992106

Citations 76

Authors

M Kirthiga

Muthu Murugan

Ankita Saikia

Richard Kirubakaran

Affiliations

Soon will be listed here.

Abstract

The purpose of this study was to perform a systematic review to assess current evidence for association between various risk factors and the prevalence or incidence of early childhood caries (ECC). Two reviewers searched various databases until January 2019. The Newcastle-Ottawa scale was used to perform risk of bias assessment. The included studies were categorized according to the World Bank classification. Data were summarized in a meta-analysis using fixed and random effects inverse-generic meta-analyses. A total of 7,034 records involving 89 studies that evaluated 1,352,097 individuals were included; 23 were high, 46 were moderate, and 20 were of low quality. A total of 123 risk factors were found. Meta-analysis revealed that the strongest risk factors found in the high-income countries were presence of dentinal caries (dmft greater than zero; odds ratio [OR] equals 4.21 [2.18 to 8.16]) and high levels of mutans streptococci (OR equals 3.83 [1.81 to 8.09]). In upper-middle-income countries, presence of enamel defects (OR equals 14.62 [6.10 to 35.03]) was found to be the strongest risk factor. The strongest risk factors associated with early childhood caries was the presence of enamel defects, presence of dentinal caries and high levels of mutans streptococci.

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References

Higgins J, Thompson S . Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11):1539-58. DOI: 10.1002/sim.1186. View

Cabral M, Mota E, Cangussu M, Vianna M, Floriano F . Risk factors for caries-free time: longitudinal study in early childhood. Rev Saude Publica. 2017; 51:118. PMC: 5708267. DOI: 10.11606/S1518-8787.2017051006558. View

Hong L, Levy S, Warren J, Broffitt B . Infant breast-feeding and childhood caries: a nine-year study. Pediatr Dent. 2014; 36(4):342-7. PMC: 5568557. View

Mahesh R, Muthu M, Rodrigues S . Risk factors for early childhood caries: a case-control study. Eur Arch Paediatr Dent. 2013; 14(5):331-7. DOI: 10.1007/s40368-013-0089-5. View

Warren J, Blanchette D, Dawson D, Marshall T, Phipps K, Starr D . Factors associated with dental caries in a group of American Indian children at age 36 months. Community Dent Oral Epidemiol. 2015; 44(2):154-61. PMC: 4777677. DOI: 10.1111/cdoe.12200. View

Levy S, Warren J, Broffitt B, Hillis S, Kanellis M . Fluoride, beverages and dental caries in the primary dentition. Caries Res. 2003; 37(3):157-65. DOI: 10.1159/000070438. View

OSullivan D, Thibodeau E . Caries experience and mutans streptococci as indicators of caries incidence. Pediatr Dent. 1996; 18(5):371-4. View

Law V, Seow W . A longitudinal controlled study of factors associated with mutans streptococci infection and caries lesion initiation in children 21 to 72 months old. Pediatr Dent. 2006; 28(1):58-65. View

Gao X, Stephen Hsu C, Loh T, Hwarng B, Koh D . Role of microbiological factors in predicting early childhood caries. Pediatr Dent. 2014; 36(4):348-54. View

10.

Schroth R, Lavelle C, Tate R, Bruce S, Billings R, Moffatt M . Prenatal vitamin D and dental caries in infants. Pediatrics. 2014; 133(5):e1277-84. DOI: 10.1542/peds.2013-2215. View

11.

Peltzer K, Mongkolchati A, Satchaiyan G, Rajchagool S, Pimpak T . Sociobehavioral factors associated with caries increment: a longitudinal study from 24 to 36 months old children in Thailand. Int J Environ Res Public Health. 2014; 11(10):10838-50. PMC: 4211009. DOI: 10.3390/ijerph111010838. View

12.

Tanaka S, Shinzawa M, Tokumasu H, Seto K, Tanaka S, Kawakami K . Secondhand smoke and incidence of dental caries in deciduous teeth among children in Japan: population based retrospective cohort study. BMJ. 2015; 351:h5397. PMC: 4613892. DOI: 10.1136/bmj.h5397. View

13.

Tanaka K, Miyake Y, Sasaki S, Hirota Y . Socioeconomic status and risk of dental caries in Japanese preschool children: the Osaka Maternal and child health study. J Public Health Dent. 2013; 73(3):217-23. DOI: 10.1111/jphd.12016. View

14.

Seow W, Clifford H, Battistutta D, Morawska A, Holcombe T . Case-control study of early childhood caries in Australia. Caries Res. 2009; 43(1):25-35. DOI: 10.1159/000189704. View

15.

Ismail A, Lim S, Sohn W, Willem J . Determinants of early childhood caries in low-income African American young children. Pediatr Dent. 2008; 30(4):289-96. View

16.

Kay E, Northstone K, Ness A, Duncan K, Crean S . Is there a relationship between birthweight and subsequent growth on the development of dental caries at 5 years of age? A cohort study. Community Dent Oral Epidemiol. 2010; 38(5):408-14. DOI: 10.1111/j.1600-0528.2010.00548.x. View

17.

Kato T, Yorifuji T, Yamakawa M, Inoue S, Saito K, Doi H . Association of breast feeding with early childhood dental caries: Japanese population-based study. BMJ Open. 2015; 5(3):e006982. PMC: 4368903. DOI: 10.1136/bmjopen-2014-006982. View

18.

Peretz B, KAFKA I . Baby bottle tooth decay and complications during pregnancy and delivery. Pediatr Dent. 1997; 19(1):34-6. View

19.

Ghazal T, Levy S, Childers N, Broffitt B, Cutter G, Wiener H . Factors associated with early childhood caries incidence among high caries-risk children. Community Dent Oral Epidemiol. 2015; 43(4):366-74. PMC: 4911172. DOI: 10.1111/cdoe.12161. View

20.

Grytten J, Rossow I, Holst D, Steele L . Longitudinal study of dental health behaviors and other caries predictors in early childhood. Community Dent Oral Epidemiol. 1988; 16(6):356-9. DOI: 10.1111/j.1600-0528.1988.tb00581.x. View