Supplementary Material for: Prenatal Oral Health Care and Early Childhood Caries Prevention: A Systematic Review and Meta-Analysis

Despite the advancement of early childhood caries (ECC) prediction and treatment, ECC remains a significant public health burden in need of more effective preventive strategies. Pregnancy is an ideal period to promote ECC prevention given the profound influence of maternal oral health and behaviors on children’s oral health. However, studies have shown debatable results with respect to the effectiveness of ECC prevention by means of prenatal intervention. Therefore, this study systematically reviewed the scientific evidence relating to the association between prenatal oral health care, ECC incidence, and <i>Streptococcus mutans</i> carriage<i></i> in children. Five studies (3 randomized control trials, 1 prospective cohort study, and 1 nested case-control study) were included for qualitative assessment. Tested prenatal oral health care included providing fluoride supplements, oral examinations/cleanings, oral health education, dental treatment referrals, and xylitol gum chewing. Four studies that assessed ECC incidence reduction were included in meta-analysis using an unconditional generalized linear mixed effects model with random study effects and age as a covariate. The estimated odds ratio and 95% confidence intervals suggested a protective effect of prenatal oral health care against ECC onset before 4 years of age: 0.12 (0.02, 0.77) at 1 year of age, 0.18 (0.05, 0.63) at 2 years of age, 0.25 (0.09, 0.64) at 3 years of age, and 0.35 (0.12, 1.00) at 4 years of age. Children’s <i>S. mutans</i> carriage was also significantly reduced in the intervention group. Future studies should consider testing strategies that restore an expectant mother’s oral health to a disease-free state during pregnancy.

尽管儿童早期龋病（early childhood caries, ECC）的预测与治疗技术已取得进展，但ECC仍是一项严重的公共卫生负担，亟需更有效的预防策略。鉴于母亲口腔健康及其行为对儿童口腔健康具有深远影响，妊娠期是推广ECC预防的理想时段。然而，现有关于产前干预手段预防ECC的有效性研究，结果尚存争议。因此，本研究系统回顾了与产前口腔保健、儿童ECC发病率及儿童变形链球菌（Streptococcus mutans）定植相关的科学证据。本研究共纳入5项研究（3项随机对照试验、1项前瞻性队列研究及1项巢式病例对照研究）进行定性评估。本次研究所评估的产前口腔保健干预措施包括：氟化物补充、口腔检查与洁治、口腔健康宣教、牙科诊疗转诊及咀嚼木糖醇口香糖。针对ECC发病率降低效果的4项研究，被纳入采用无条件广义线性混合效应模型的Meta分析，该模型以研究效应为随机效应、年龄作为协变量。估算得到的比值比及95%置信区间显示，产前口腔保健对4岁前儿童ECC发病具有保护作用：1岁时为0.12（0.02, 0.77），2岁时为0.18（0.05, 0.63），3岁时为0.25（0.09, 0.64），4岁时为0.35（0.12, 1.00）。干预组儿童的变形链球菌定植水平也显著降低。未来研究可考虑探索在妊娠期将孕产妇口腔健康恢复至无病状态的干预策略。