Risk factors for Early Childhood Caries

We aimed to perform a systematic review to assess current evidence for the association between various risk factors and Early Childhood Caries (ECC) prevalence or incidence. We included prospective and retrospective cohort and case-control studies. Two reviewers searched PubMed, Embase, IndMed, Cochrane library, EBSCO, LILACS and other sources through July 2016 to identify published and non-published studies without any language restrictions. We assessed risk of bias using the Newcastle-Ottawa Scale for observational studies. The included studies were categorized into lower income, lower middle income, upper middle income and upper income countries according to the World Bank classification. Data was summarized in a meta-analysis using fixed and random-effects inverse-generic meta-analyses. From 3178 screened records, 76 studies (59 cohort and 17 case control) evaluating a total of 3,32,792 individuals were included. Twenty two were of high and 35 of moderate and 22 of low quality. One hundred and twenty one risk factors were found to be significantly related to the prevalence or incidence of ECC. The strongest risk factors found in the high income countries were the presence of dentinal caries (dmft>0) [OR 4.12 (2.18-8.16)], high levels of streptococcus mutans [OR 3.83 (1.81-8.09)], frequent consumption of sweetened foods [OR 3.14 (0.89-11.04)], poor oral hygiene [OR 3.12 (1.77-5.49)] and visible plaque present [OR 3.10 (2.0-4.80)]. In the upper middle income countries presence of enamel defects [OR – 14.62 (6.10-35.03)] and high levels of streptococcus mutans [OR 9.21 (4.97-17.07)] were found significant. Only one study was conducted in the lower middle income category. No studies in the lower income countries evaluated the risk factors of ECC. In conclusion the risk factors found to be significant with ECC were presence of enamel defects, high levels of streptococcus mutans, presence of dentinal caries, frequent consumption of sweetened foods, poor oral hygiene and visible plaque. (registered with PROSPERO [CRD42016027476])