Systematic Review of Evidence Pertaining to Factors That Modify Risk of Early Childhood Caries.
JDR clinical and translational research
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Moynihan, P., Tanner, L., Holmes, R., Hillier-Brown, F., Mashayekhi, A., Kelly, S., & Craig, D. (2019). Systematic Review of Evidence Pertaining to Factors That Modify Risk of Early Childhood Caries.. JDR clinical and translational research, 4 (3), 202-216. https://doi.org/10.1177/2380084418824262
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 WHO Manual on ECC prevention. OBJECTIVES: To systematically review published evidence pertaining to the effect on ECC of modifiable risk factors. METHODS: Twelve questions, prioritized by a WHO Expert Panel, relating to infant feeding, dietary practice, oral hygiene and fluoride were addressed. Due to proven efficacy, questions pertaining to use of fluoride toothpaste were excluded. The target population was children aged <72 months. Data sources included MEDLINE, EMBASE, CINAHL, and PubMed. Included were all human epidemiological studies. The highest-level of evidence was used for evidence synthesis and where possible, meta-analysis. The review was conducted in accordance with the PRISMA statement. Evidence was assessed using the GRADE method. RESULTS: 627 of the 13,831 papers identified were screened in duplicate; of these 139 were included. The highest-level evidence indicated breastfeeding ≤ 24 months does not increase ECC risk, but suggested longer duration breastfeeding increases risk (low quality evidence). Low quality evidence indicated increased risk associated with consumption of sugars in bottles. Only one 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 care-givers (OR (95% CI) 0.39 (0.19, 0.80) P=0.009). Meta-analysis of data on the impact on ECC of living in a fluoridated area showed a significant effect (mean difference (95% CI) -1.25 (-1.24,-0.36) P=0.006). Limited, moderate and low quality data indicated a benefit of exposure to fluoride from salt and milk respectively. CONCLUSION: The best available evidence indicates breastfeeding up to 2 years of age does not increase ECC risk. Providing access to fluoridated water and educating care-givers are justified approaches to ECC prevention. Limiting sugars in bottles and complementary foods should be part of this education.
Humans, Dental Caries, Fluorides, Oral Hygiene, Child, Child, Preschool, Infant, Oral Health, Female, Toothpastes
External DOI: https://doi.org/10.1177/2380084418824262
This record's URL: https://www.repository.cam.ac.uk/handle/1810/289497