We use cookies to ensure that we give you the best experience on our website. By continuing to browse this repository, you give consent for essential cookies to be used. You can read more about our Privacy and Cookie Policy.

Durham Research Online
You are in:

Systematic review of evidence pertaining to factors that modify risk of early childhood caries.

Moynihan, P. and Tanner, L.M. and Holmes, R.D. and Hillier-Brown, F. and Mashayekhi, A. and Kelly, S.A.M. and Craig, D. (2019) 'Systematic review of evidence pertaining to factors that modify risk of early childhood caries.', JDR clinical & translational research., 4 (3). pp. 202-216.


Introduction: A systematic review of evidence on the impact of modifiable risk factors on early childhood caries (ECC) was conducted to inform recommendations in a World Health Organization manual on ECC prevention. Objectives: To systematically review published evidence pertaining to the effect of modifiable risk factors on ECC. Methods: Twelve questions relating to infant feeding, diet, oral hygiene, and fluoride were addressed, as prioritized by a World Health Organization expert panel. Questions pertaining to the use of fluoride toothpaste were excluded due to its proven efficacy. The target population was children aged <72 mo. Data sources included Medline, Embase, CINAHL, and PubMed, and all human epidemiologic studies were included. The highest level of evidence was used for evidence synthesis and, where possible, meta-analysis. The review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement, with evidence assessed via the GRADE method. Results: Of the 13,831 papers identified, 627 were screened in duplicate; of these, 139 were included. The highest-level evidence indicated that breastfeeding ≤24 mo does not increase ECC risk but suggested that longer-duration breastfeeding increases risk (low-quality evidence). Low-quality evidence indicated increased risk associated with consumption of sugars in bottles. Only 1 study had data on the impact of sugars in complementary foods, which increased risk. Moderate-quality evidence showed a benefit of oral health education for caregivers (odds ratio, 0.39; 95% CI, 0.19 to 0.80, P = 0.009). Meta-analysis of data on the impact on ECC from living in a fluoridated area showed a significant effect (mean difference, –1.25; 95% CI, –1.24 to −0.36; P = 0.006). Limited moderate- and low-quality data indicated a benefit of fluoride exposure from salt and milk, respectively. Conclusion: The best available evidence indicates that breastfeeding up to 2 y of age does not increase ECC risk. Providing access to fluoridated water and educating caregivers are justified approaches to ECC prevention. Limiting sugars in bottles and complementary foods should be part of this education.

Item Type:Article
Full text:(AM) Accepted Manuscript
Download PDF
Publisher Web site:
Publisher statement:Moynihan, P, Tanner, LM, Holmes, RD, Hillier-Brown, F, Mashayekhi, A, Kelly, SAM & Craig, D (2019). Systematic Review of Evidence Pertaining to Factors That Modify Risk of Early Childhood Caries. JDR Clinical & Translational Research 4(3): 202-216. Copyright © 2019 International & American Associations for Dental Research. DOI: 10.1177/2380084418824262
Date accepted:No date available
Date deposited:30 April 2019
Date of first online publication:14 February 2019
Date first made open access:30 April 2019

Save or Share this output

Look up in GoogleScholar