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Systematic Review of Evidence Pertaining to Factors That Modify Risk of Early Childhood Caries

Moynihan, P; Tanner, LM; Holmes, RD; Hillier-Brown, F; Mashayekhi, A; Kelly, SAM; Craig, D

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Authors

P Moynihan

LM Tanner

RD Holmes

F Hillier-Brown

A Mashayekhi

SAM Kelly

D Craig



Abstract

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.

Citation

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

Journal Article Type Article
Online Publication Date Feb 14, 2019
Publication Date Jul 1, 2019
Deposit Date Mar 1, 2019
Publicly Available Date Apr 30, 2019
Journal JDR Clinical and Translational Research
Print ISSN 2380-0844
Electronic ISSN 2380-0852
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 4
Issue 3
Pages 202-216
DOI https://doi.org/10.1177/2380084418824262
Related Public URLs https://eprint.ncl.ac.uk/254062

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Copyright 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





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