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])

本研究旨在开展一项系统综述，以评估现有关于各类危险因素与儿童早期龋（Early Childhood Caries, ECC）患病率或发病率相关性的证据。本研究纳入前瞻性队列、回顾性队列及病例对照研究。两名研究者检索了PubMed、Embase、IndMed、Cochrane图书馆、EBSCO、LILACS及其他数据源，检索时限截至2016年7月，未对研究语言设置限制，旨在纳入已发表及未发表的相关研究。针对观察性研究，采用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）评估偏倚风险。根据世界银行的分类标准，纳入的研究按所在国家分为低收入、中低收入、中高收入及高收入四组。本研究采用固定效应模型与随机效应模型的逆方差通用meta分析方法对数据进行汇总分析。经初始筛选的3178条记录中，最终纳入76项研究（其中59项队列研究、17项病例对照研究），涉及总样本量332792名个体。其中22项研究为高质量，35项为中等质量，22项为低质量。共发现121项危险因素与ECC的患病率或发病率存在显著关联。在高收入国家中，与ECC关联最强的危险因素包括牙本质龋（dmft>0）[比值比（OR）4.12（95%CI：2.18~8.16）]、高变形链球菌水平[OR 3.83（95%CI：1.81~8.09）]、频繁食用含糖食品[OR 3.14（95%CI：0.89~11.04）]、口腔卫生状况不佳[OR 3.12（95%CI：1.77~5.49）]以及可见牙菌斑存在[OR 3.10（95%CI：2.0~4.80）]。在中高收入国家中，牙釉质缺损[OR 14.62（95%CI：6.10~35.03）]以及高变形链球菌水平[OR 9.21（95%CI：4.97~17.07）]被证实为显著危险因素。仅1项研究纳入中低收入国家的样本，低收入国家中暂无针对ECC危险因素的相关研究。综上，与ECC存在显著关联的危险因素包括牙釉质缺损、高变形链球菌水平、牙本质龋、频繁食用含糖食品、口腔卫生状况不佳及可见牙菌斑存在。（本研究已在PROSPERO注册，注册号为CRD42016027476）