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Meta-Analysis
. 2019 Mar 15;41(2):95-112.

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

M Kirthiga  1 , Muthu Murugan  2 , Ankita Saikia  3 , Richard Kirubakaran  4
Affiliations
Meta-Analysis

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

M Kirthiga et al. Pediatr Dent. .

Abstract

Purpose: 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). Methods: 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. Results: 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. Conclusion: 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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Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) flow diagram.
Figure 2
Figure 2
Risk factors found in the high-income category. (a) Forest plot showing presence of dentinal caries (decayed, filled, and missing primary teeth [dmft] index score greater than zero) as a risk factor for early childhood caries. (b) Forest plot showing presence of mutans streptococci as a risk factor for ECC. (c) Forest plot showing frequent consumption of sweetened foods as a risk factor for ECC. (d) Forest plot showing poor oral hygiene as a risk factor for ECC. (e) Forest plot showing visible plaque present as a risk factor for ECC.
Figure 3
Figure 3
Risk factors found in the upper-middle-income category. (a) Forest plot showing presence of enamel defects as a risk factor for ECC. (b) Forest plot showing presence of mutans streptococci as a risk factor for ECC.
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