Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

177 questions · 309 findings · 26 reviews · Dental caries

No studies found 10 · 3.2%GRADE not reported 268 · 86.7%Very low 15 · 4.9%Low 14 · 4.5%Moderate 2 · 0.6%High 0 · 0%

Secondary (passive/secondhand) smoking exposure during childhood vs No secondary smoking exposure

Early childhood caries (ECC) - incidence/risk · Preschool children aged <=71 months (caries outcome assessed at 3-6 years)

Children exposed to secondary smoking from infancy have a higher incidence of early childhood caries by age 3 (RR 1.45; low certainty).

1 finding from 1 review

Nocturnal breastfeeding vs No nocturnal breastfeeding

Early childhood caries (ECC) · Preschool children (<6 years)

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

2 findings from 1 review

Breastfeeding <24 months vs Breastfeeding for ≥24 months

Early childhood caries (ECC) · Preschool children (<6 years)

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%).

2 findings from 1 review

Breastfeeding vs No breastfeeding

Early childhood caries (ECC) · Preschool children (<6 years)

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%).

3 findings from 1 review

Breastfeeding <12 months vs Breastfeeding for ≥12 months

Early childhood caries (ECC) · Preschool children (<6 years)

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).

2 findings from 1 review

Breastfeeding <18 months vs Breastfeeding for ≥18 months

Early childhood caries (ECC) · Preschool children (<6 years)

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

2 findings from 1 review

Breastfeeding for <4 months vs Breastfeeding for ≥4 months

Early childhood caries (ECC) · Preschool children (<6 years)

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

1 finding from 1 review

Breastfeeding for <6 months vs Breastfeeding for ≥6 months

Early childhood caries (ECC) · Preschool children (<6 years)

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).

2 findings from 1 review

Growth stunting (linear growth retardation, low height-for-age) vs Children without growth stunting (normal height-for-age)

Early childhood caries (ECC) · Children aged ≤6 years (early childhood)

One Nigerian cross-sectional study reported a significant adjusted association between nutritional (stunting) status and ECC (APR 0.14, 95% CI 0.03-0.69); ungraded.

4 findings from 1 review
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Mixed breast- and bottle-feeding vs Bottle feeding

Early childhood caries (ECC) · Healthy children under 6 years in South Africa

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).

1 finding from 1 review

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

Early childhood caries (ECC) · Healthy children under 6 years in South Africa

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).

1 finding from 1 review