What do systematic reviews say?

Highest BMI category (overweight/obese) vs Lowest BMI category (normal weight/underweight)

In the Region: Asian countries subgroup, the BMI (highest vs lowest)-childhood caries association was significant (OR 1.70, 95% CI 1.25 to 2.32; ungraded).

• Childhood obesity in relation to risk of dental caries: a cumulative and dose-response systematic review and… 2024 All outcomes

  Dental examinations of children; 15 countries across Europe, Asia, the Americas and Oceania · Region: Asian countries
  OR 1.70 [1.25, 2.32]
  6 studies
  GRADE not reported
• Childhood obesity in relation to risk of dental caries: a cumulative and dose-response systematic review and… 2024 All outcomes

  Dental examinations of children; 15 countries across Europe, Asia, the Americas and Oceania · Study design: cross-sectional
  OR 1.58 [1.20, 2.08]
  9 studies
  GRADE not reported
• Childhood obesity in relation to risk of dental caries: a cumulative and dose-response systematic review and… 2024 All outcomes

  Dental examinations of children; 15 countries across Europe, Asia, the Americas and Oceania · Adjustment for age: yes
  OR 1.04 [0.84, 1.30]
  6 studies
  GRADE not reported

Intervention not reported

The intervention led to higher dental caries (early childhood caries); GRADE not reported.

• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  Narrative single study (Matee 1994): nocturnal breast-feeding
  OR 17.8 [6.3, 50.3]
  1 study
  GRADE not reported

Nocturnal breastfeeding vs No nocturnal breastfeeding

After excluding one study, nocturnal breastfeeding was associated with higher ECC risk (RR 3.05, 95% CI 2.40 to 3.87; I²=33%).

• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  First dental examination before age 6 years · Clinical, field, or unclear dental examination settings · Cohort studies; sensitivity analysis excluding study 39
  RR 3.05 [2.40, 3.87]
  2 studies
  GRADE not reported
• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  Preschool children in high- and middle-income countries; caries assessed in clinical or field/community settings · Cohort studies
  RR 2.35 [1.42, 3.89]
  3 studies · 1590 participants
  GRADE not reported

Breastfeeding <24 months vs Breastfeeding for ≥24 months

After excluding Peres et al. (2017), breastfeeding for less than 24 months was associated with fewer caries (RR 0.49, 95% CI 0.39 to 0.62; I²=6%).

• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  First dental examination before age 6 years · Clinical, field, or unclear dental examination settings · Cohort studies; sensitivity analysis excluding Peres et al. (2017)
  RR 0.49 [0.39, 0.62]
  3 studies
  GRADE not reported
• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  Preschool children in high- and middle-income countries; caries assessed in clinical or field/community settings · Cohort studies
  RR 0.59 [0.33, 1.05]
  4 studies · 2271 participants
  GRADE not reported

Breastfeeding vs No breastfeeding

After excluding five studies, breastfeeding was associated with lower ECC risk in cohort studies (RR 0.82, 95% CI 0.71 to 0.95; I²=0%).

• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  First dental examination before age 6 years · Clinical, field, or unclear dental examination settings · Cohort studies; sensitivity analysis excluding studies 37, 41, 45, 53, and 56
  RR 0.82 [0.71, 0.95]
  5 studies
  GRADE not reported
• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  Preschool children in high- and middle-income countries; caries assessed in clinical or field/community settings · Case-control studies
  OR 1.04 [0.78, 1.38]
  5 studies · 1022 participants
  GRADE not reported
• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  Preschool children in high- and middle-income countries; caries assessed in clinical or field/community settings · Cohort studies
  RR 0.98 [0.77, 1.26]
  10 studies · 8506 participants
  GRADE not reported

Breastfeeding <12 months vs Breastfeeding for ≥12 months

Breastfeeding for <12 vs ≥12 months was associated with significantly fewer caries (RR 0.65, 95% CI 0.50-0.86), indicating breastfeeding beyond 12 months increases ECC risk (substantial heterogeneity; ungraded).

• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  Preschool children in high- and middle-income countries; caries assessed in clinical or field/community settings · Cohort studies
  RR 0.65 [0.50, 0.86]
  8 studies · 4365 participants
  GRADE not reported
• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  First dental examination before age 6 years · Clinical, field, or unclear dental examination settings · Cohort studies; sensitivity analysis excluding studies 35, 42, and 48
  RR 0.70 [0.62, 0.80]
  5 studies
  GRADE not reported

Intervention not reported

The intervention led to lower dental caries (early childhood caries); GRADE not reported.

• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  Narrative single study (Lima 2016): no nocturnal BF vs nocturnal BF at 16 months
  OR 0.51 [0.39, 0.65]
  1 study
  GRADE not reported

Intervention not reported

• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  Narrative single study (Ganesh 2022): BF during sleep
  AOR 6.5
  1 study
  GRADE not reported

Breastfeeding <18 months vs Breastfeeding for ≥18 months

Breastfeeding for <18 vs ≥18 months was associated with significantly fewer caries (RR 0.41, 95% CI 0.18-0.92; substantial heterogeneity; ungraded).

• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  Preschool children in high- and middle-income countries; caries assessed in clinical or field/community settings · Cohort studies
  RR 0.41 [0.18, 0.92]
  5 studies · 2332 participants
  GRADE not reported
• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  First dental examination before age 6 years · Clinical, field, or unclear dental examination settings · Cohort studies; sensitivity analysis excluding studies 48 and 52
  RR 0.26 [0.16, 0.42]
  3 studies
  GRADE not reported

Breastfeeding for <4 months vs Breastfeeding for ≥4 months

Breastfeeding for <4 vs ≥4 months was not significantly associated with early childhood caries (RR 0.95, 95% CI 0.80-1.13; ungraded).

• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  Preschool children in high- and middle-income countries; caries assessed in clinical or field/community settings · Cohort studies
  RR 0.95 [0.80, 1.13]
  2 studies · 1017 participants
  GRADE not reported

Breastfeeding for <6 months vs Breastfeeding for ≥6 months

In cohort studies, breastfeeding for <6 vs ≥6 months was not significantly associated with early childhood caries (RR 0.97, 95% CI 0.88-1.06; ungraded).

• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  Preschool children in high- and middle-income countries; caries assessed in clinical or field/community settings · Cohort studies
  RR 0.97 [0.88, 1.06]
  6 studies · 4850 participants
  GRADE not reported
• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  Preschool children in high- and middle-income countries; caries assessed in clinical or field/community settings · Case-control studies
  OR 0.53 [0.41, 0.67]
  2 studies · 1201 participants
  GRADE not reported

Intervention not reported

• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  Narrative single study (Ganesh 2022): BF in early morning sleep hours
  AOR 3.7
  1 study
  GRADE not reported

Intervention not reported

• Association of Breastfeeding and Early Childhood Caries: A Systematic Review and Meta-Analysis. 2024 All outcomes

  Narrative single study (Ganesh 2022): BF at beginning of sleep
  AOR 6.7
  1 study
  GRADE not reported

Mixed breast- and bottle-feeding vs Bottle feeding

No significant difference in caries odds was found between mixed breast-and-bottle-fed and bottle-fed-only children (meta-analysis reported no difference; pooled estimate in an unavailable supplementary figure; not GRADE-rated).

• Maternal and infant risk factors and risk indicators associated with early childhood caries in South Africa: a… 2022 All outcomes

  South Africa
  OR 1.04 [0.76, 1.41]
  2 studies · 863 participants
  GRADE not reported

Higher parental education (tertiary) vs Parental high school (secondary) education

Parental tertiary education (vs high-school education) was associated with about 1.8 times higher odds of early childhood caries in South Africa (OR 1.77, 95% CI 1.22-2.57; 2 studies; not GRADE-rated).

• Maternal and infant risk factors and risk indicators associated with early childhood caries in South Africa: a… 2022 All outcomes

  South Africa
  OR 1.77 [1.22, 2.57]
  2 studies · 505 participants
  GRADE not reported

Bottle-feeding only vs Breastfeeding only

No significant difference in caries odds was found between bottle-fed-only and breast-fed-only children (meta-analysis reported no difference; pooled estimate in an unavailable supplementary figure; not GRADE-rated).

• Maternal and infant risk factors and risk indicators associated with early childhood caries in South Africa: a… 2022 All outcomes

  South Africa
  OR 1.30 [0.84, 2.02]
  2 studies · 911 participants
  GRADE not reported

Low parental socioeconomic status (SES) vs High parental socioeconomic status (SES)

No significant difference in caries odds was found between children of low- versus high-SES parents (meta-analysis reported no difference; pooled estimate in an unavailable supplementary figure; not GRADE-rated).

• Maternal and infant risk factors and risk indicators associated with early childhood caries in South Africa: a… 2022 All outcomes

  South Africa
  OR 2.21 [0.41, 11.96]
  3 studies · 1620 participants
  GRADE not reported

High-frequency sugar consumption (three or more times daily) vs Low sugar intake (fewer than three times daily)

In primary dentition, high-frequency sugar consumption was associated with slightly higher, non-significant odds of caries (OR 1.13, 95% CI 0.23 to 5.44), with high heterogeneity (I2=83%; ungraded).

• A systematic review and meta-analysis of the association between sugar intake and dental caries in Nigeria. 2024 All outcomes

  Community and school-based observational studies in Nigeria (12 of 14 in Southwest Nigeria) · Primary dentition
  OR 1.13 [0.23, 5.44]
  2 studies
  GRADE not reported