Early childhood caries

Systematic review of evidence pertaining to factors that modify risk of early childhood caries.

A systematic review conducted at the WHO Collaborating Centre for Nutrition and Oral Health, Newcastle University, under a grant awarded by the Foundation, has informed the development of a manual on the prevention and management of early childhood caries. It was also the subject of a publication in the journal JDR Clinical & Translational Research (Moynihan et al 2019).

The review considered the evidence of the impact of modifiable risk factors. Twelve questions relating to infant feeding, diet, oral hygiene, and fluoride were addressed. A total of 13,831 papers were retrieved, reducing to 9,449 following de-duplication. Of those, 627 full papers were screened, after which 137 were eligible for inclusion.

With regard to the results, the best available, albeit limited, evidence, showed that breastfeeding up to 24 months is not associated with an increased risk of ECC. An increased risk was indicated where breastfeeding extends beyond 24 months although the authors pointed out that this risk should be balanced against the nutritional and health benefits of breastfeeding children beyond 2 years of age. It was also concluded that providing access to fluoridated water and delivering oral health education to caregivers are justified approaches to ECC prevention.

The evidence also suggested that limiting sugars in feeder bottles and avoiding addition of sugars to complementary foods and drinks should be part of this education. Fluoridated toothpaste was excluded from the review on the grounds that the evidence indisputably proves its efficacy and should therefore be made accessible and affordable to all. The authors also felt that in view of the evidence, efforts to increase access to fluoridated water should also be given priority. In populations without access to a fluoridated public water supply, the evidence shows that exposure to fluoride through milk schemes and, to a lesser extent, salt is justifiable as a means of prevention.