Individual, Family, and Socioeconomic Contributors to Dental Caries in Children from Low- and Middle-Income Countries

Abstract

Introduction: Collective evidence on risk factors for dental caries remains elusive in low- and middle-income countries (LMICs). The objective was to conduct a systematic review and meta-analysis on risk factors for dental caries in deciduous or permanent teeth in LMICs. Methods: Studies were identified electronically through databases, including Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, PubMed/MEDLINE, and CINAHL, using “prevalence, dental caries, child, family, socioeconomic, and LMIC” as the keywords. A total of 11 studies fit the inclusion criteria. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale (NOS). The MedCalc software and Review Manager 5.4.1 were used. Results: From 11,115 participants, 38.7% (95% CI: 28.4−49.5%) had caries and 49.68% were female. Among those with caries, 69.74% consumed sugary drinks/sweets (95% CI: 47.84−87.73%) and 56.87% (95% CI: 35.39−77.08%) had good brushing habits. Sugary drinks had a two times higher likelihood of leading to caries (OR: 2.04, p < 0.001). Good oral hygiene reduced the risk of caries by 35% (OR: 0.65, p < 0.001). Concerning maternal education, only secondary education reduced the likelihood of caries (OR: 0.96), but primary education incurred 25% higher risks (OR: 1.25, p = 0.03). A 65% reduction was computed when caregivers helped children with tooth brushing (OR: 0.35, p = 0.04). Most families had a low socioeconomic status (SES) (35.9%, 95% CI: 16.73−57.79), which increased the odds of caries by 52% (OR: 1.52, p < 0.001); a high SES had a 3% higher chance of caries. In the entire sample, 44.44% (95% CI: 27.73−61.82%) of individuals had access to dental services or had visited a dental service provider. Conclusion: Our findings demonstrate that high sugar consumption, low maternal education, and low and high socioeconomic status (SES) increased the risk of dental caries in LMICs. Good brushing habits, higher maternal education, help with tooth brushing, and middle SES provided protection against caries across LMIC children. Limiting sugars, improving oral health education, incorporating national fluoride exposure programs, and accounting for sociodemographic limitations are essential for reducing the prevalence of dental caries in these settings.

Keywords: bottle-feeding; breastfeeding; dental caries; education; fluoride; low- and middle-income countries; risk factors; socioeconomic status.

Figure 1

The PRISMA flow diagram.

Figure 2

(A) Pooled prevalence of dental caries (N = 4250) in the total population (N = 11,115); (B) Pooled prevalence of females (N = 993) in the population with caries (N = 1999); (C) Pooled prevalence of sugary drinks/sweets consumption (N = 1253) in the population with caries (N = 1682); (D) Pooled prevalence of good brushing habits/≥ 2 daily teeth brushing (n = 1371/2438) in the population with caries, presented as a proportion in a forest plot, applying the random-effects model; (E) Sugary drinks/sweets consumption: a forest plot depicting the odds ratio (OR) of children having caries compared to no caries. Heterogeneity: Tau² = 0.03; Chi² = 8.11, DF = 6; I² = 26%. Test for overall effect: Z = 5.69 (p < 0.00001); (F) Post good/ ≥ 2 daily teeth brushing: a forest plot depicting OR of children with caries compared to no caries. Heterogeneity: Tau² = 0.16; Chi² = 32.42, DF = 6 (p < 0.0001); I² = 81%. Test for overall effect: Z = 2.46 (p = 0.01).

Figure 3

(A) Pooled prevalence of no formal education for mothers (n = 128/1499); (B) primary education for mothers (n = 1297/3240); (C) secondary and higher education for mothers (n = 1491/3240) of children with caries, presented as a proportion in a forest plot, applying the random-effects model. (D) Secondary/higher education: a forest plot depicting the odds ratio (OR) of children having caries compared to no caries. Heterogeneity: Tau² = 0.26; Chi² = 71.98, DF = 6; I² = 92%. Test for overall effect: Z = 0.2 (p = 0.84); (E) Primary education: a forest plot depicting the odds ratio (OR) of children having caries compared to no caries. Heterogeneity: Tau² = 0.05; Chi² = 16.41, DF = 6; I² = 63%. Test for overall effect: Z = 2.12 (p = 0.03); (F) No formal education: a forest plot depicting the odds ratio (OR) of children having caries compared to no caries. Heterogeneity: Tau² = 0.2; Chi² = 9.41, DF = 2; I² = 79%. Test for overall effect: Z = 1 (p = 0.32).

Figure 4

(A) Pooled prevalence of caregivers (i.e., mother) helping children with tooth brushing (n = 381/830) in the population with caries; (B) Pooled prevalence of children with caries using fluoride toothpaste (n = 438/1279); (C) Pooled prevalence of accessed and visited dental services in both groups (n= 2758/5629); (D–F) Pooled prevalence of low (n = 1040/3450), middle (n = 1338/3450), and high (n = 578/3450) socioeconomic status of the children/their families in the caries group, presented in a forest plot, applying the random-effects model.

Figure 5

(A) Mothers helping children in tooth brushing: a forest plot depicting OR of children with caries compared to no caries. Heterogeneity: Tau² = 0.71; Chi² = 42.09, df = 2 (p < 0.00001); I² = 95%. Test for overall effect: Z = 2.10 (p = 0.04); A forest plot depicting OR of children with caries compared to no caries belonging to the following socioeconomic status: (B) Low socioeconomic status: Heterogeneity: Tau² = 0.05; Chi² = 14.27, df = 6 (p = 0.03); I² = 58%. Test for overall effect: Z = 3.74 (p = 0.0002) (C) Middle socioeconomic status: Heterogeneity: Tau² = 0.14; Chi² = 38.46, df = 6 (p < 0.00001); I² = 84%. Test for overall effect: Z = 1.36 (p = 0.17); (D) High socioeconomic status: Heterogeneity: Tau² = 0.04; Chi² = 8.56, df = 4 (p = 0.07); I² = 53%. Test for overall effect: Z = 0.24 (p = 0.81).