What do systematic reviews say?

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

Genetically predicted gene expression (TWAS; S-PrediXcan with GTEx v8 cis-eQTL across 49 tissues; cross-tissue S-MultiXcan) vs ECC-unaffected children (association of genetically predicted expression)

Genetically predicted LINC02905 (C8orf49) expression reached the TWAS threshold for ECC (p = 1.82e-8) but was flagged as a possible false positive (LD misspecification) and not further considered; ungraded.

• Association of Early Childhood Caries with Bitter Taste Receptors: A Meta-Analysis of Genome-Wide Association Studies… 2022 All outcomes

  Cross-sectional (ECC ascertained at the last dental exam before age 6) · Population/community child cohorts: rural Appalachia (West Virginia, Pennsylvania) and Iowa (USA) and South West England; European / European non-Hispanic ancestry only · LINC02905 (C8orf49) (chr8p23.1); 9 (3) tissues; significant (Bonferroni p < 3.09x10-6) ; flagged possible false positive
  Z-score (cross-tissue mean, S-MultiXcan) -0.35
  5 studies · 2974 participants
  GRADE not reported

Common genetic variants genome-wide (GWAS; ~3.9 million SNPs with MAF > 5%) vs ECC-unaffected children (per-allele case-control association)

The common variant rs74470773 near PDCD6IP showed suggestive (not genome-wide significant) association with ECC (Z = -4.589, p = 4.46e-6); genetic association, ungraded.

• Association of Early Childhood Caries with Bitter Taste Receptors: A Meta-Analysis of Genome-Wide Association Studies… 2022 All outcomes

  Cross-sectional (ECC ascertained at the last dental exam before age 6) · Population/community child cohorts: rural Appalachia (West Virginia, Pennsylvania) and Iowa (USA) and South West England; European / European non-Hispanic ancestry only · rs74470773 (3:33958083); effect/non-effect allele T/C; MAF 0.47; direction across 5 cohorts -----
  Z-score (Stouffer's combined Z, 5 cohorts) -4.589
  5 studies · 2974 participants
  GRADE not reported

Genetically predicted gene expression (TWAS; S-PrediXcan with GTEx v8 cis-eQTL across 49 tissues; cross-tissue S-MultiXcan) vs ECC-unaffected children (association of genetically predicted expression)

Genetically predicted expression of CDH17 was significantly associated with ECC in the TWAS (p = 3.32e-8); genetic association, ungraded.

• Association of Early Childhood Caries with Bitter Taste Receptors: A Meta-Analysis of Genome-Wide Association Studies… 2022 All outcomes

  Cross-sectional (ECC ascertained at the last dental exam before age 6) · Population/community child cohorts: rural Appalachia (West Virginia, Pennsylvania) and Iowa (USA) and South West England; European / European non-Hispanic ancestry only · CDH17 (chr8q22.1); 23 (5) tissues; significant (Bonferroni p < 3.09x10-6)
  Z-score (cross-tissue mean, S-MultiXcan) 1.74
  5 studies · 2974 participants
  GRADE not reported

Cesarean section delivery vs Vaginal delivery

Caesarean section delivery may be associated with a modestly higher prevalence of early childhood caries than vaginal delivery (pooled OR 1.48), but the evidence is inconsistent and of very low certainty.

• Is the mode of childbirth delivery linked to the prevalence of early childhood caries? A systematic review and… 2021 All outcomes

  Caries assessed at 8 months to 6 years of age · Community/population-based; studies from Europe, Asia, South America and Israel
  OR 1.48 [1.07, 2.05]
  11 studies · 58682 participants
  Very low

Low birth weight (<2500 g) vs Normal birth weight (2500 g or more)

Adjusted analyses also showed no association between low birth weight and early childhood caries (adjusted OR 1.05, 95% CI 0.71 to 1.57); certainty not graded.

• Relationship between preterm, low birth weight and early childhood caries: a meta-analysis of the case-control and… 2020 All outcomes

  Community/epidemiological studies of preschool children (multiple countries) · Adjusted OR
  OR 1.05 [0.71, 1.57]
  2 studies
  GRADE not reported
• Relationship between preterm, low birth weight and early childhood caries: a meta-analysis of the case-control and… 2020 All outcomes

  Community/epidemiological studies of preschool children (multiple countries) · Children aged 3 years or younger
  OR 0.78 [0.24, 2.51]
  3 studies
  GRADE not reported
• Relationship between preterm, low birth weight and early childhood caries: a meta-analysis of the case-control and… 2020 All outcomes

  Community/epidemiological studies of preschool children (multiple countries) · Overall (crude OR)
  OR 1.12 [0.94, 1.33]
  15 studies
  GRADE not reported

Preterm birth (<37 weeks gestation) vs Full-term birth (37 weeks or more gestation)

In children aged 3 years or younger, preterm birth was not associated with early childhood caries (OR 0.90, 95% CI 0.59 to 1.37); certainty not graded.

• Relationship between preterm, low birth weight and early childhood caries: a meta-analysis of the case-control and… 2020 All outcomes

  Community/epidemiological studies of preschool children (multiple countries) · Children aged 3 years or younger
  OR 0.90 [0.59, 1.37]
  2 studies
  GRADE not reported
• Relationship between preterm, low birth weight and early childhood caries: a meta-analysis of the case-control and… 2020 All outcomes

  Community/epidemiological studies of preschool children (multiple countries) · Overall
  OR 1.59 [1.36, 1.87]
  16 studies · 21279 participants
  GRADE not reported

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

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

High snack consumption vs Low snack consumption

High snack consumption was associated with higher odds of severe early childhood caries.

• Oral Health of Children and Adolescents in the United Arab Emirates: A Systematic Review of the Past Decade. 2021 All outcomes

  Overall
  OR 1.80 [1.26, 2.58]
  1 study · 1036 participants
  GRADE not reported

Near-infrared (NIR) transillumination vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Transillumination and optical coherence tomography for the detection and diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately)
  Sensitivity 0.58 [0.46, 0.68]
  5 studies
  GRADE not reported

Fibre-optic transillumination (FOTI) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Transillumination and optical coherence tomography for the detection and diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately)
  Sensitivity 0.47 [0.35, 0.59]
  8 studies
  GRADE not reported

Transillumination and optical coherence tomography devices (all illumination devices combined: NIR, OCT, and FOTI/DIFOTI) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Transillumination and optical coherence tomography for the detection and diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately)
  Specificity 0.87 [0.82, 0.92]
  23 studies
  Low

Fibre-optic transillumination (FOTI) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Transillumination and optical coherence tomography for the detection and diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately)
  Specificity 0.92 [0.86, 0.96]
  8 studies
  GRADE not reported

Low income vs High family income

Low family income was associated with higher odds of severe early childhood caries.

• Oral Health of Children and Adolescents in the United Arab Emirates: A Systematic Review of the Past Decade. 2021 All outcomes

  Overall
  OR 1.43 [1.11, 1.85]
  1 study · 1036 participants
  GRADE not reported

Near-infrared (NIR) transillumination vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Transillumination and optical coherence tomography for the detection and diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately)
  Specificity 0.86 [0.80, 0.91]
  5 studies
  GRADE not reported

Optical coherence tomography (OCT) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Transillumination and optical coherence tomography for the detection and diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately)
  Sensitivity 0.94 [0.88, 0.97]
  10 studies
  GRADE not reported

Optical coherence tomography (OCT) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Transillumination and optical coherence tomography for the detection and diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately)
  Specificity 0.83 [0.68, 0.91]
  10 studies
  GRADE not reported

Dental visit because of a problem vs No dental visit in previous year

A problem-driven dental visit was associated with higher odds of severe early childhood caries.

• Oral Health of Children and Adolescents in the United Arab Emirates: A Systematic Review of the Past Decade. 2021 All outcomes

  Overall
  OR 1.92 [1.49, 2.49]
  1 study · 1036 participants
  GRADE not reported

Transillumination and optical coherence tomography devices (all illumination devices combined: NIR, OCT, and FOTI/DIFOTI) vs Reference standard (histology, excavation, radiographs/microCT, or tooth separation)

• Transillumination and optical coherence tomography for the detection and diagnosis of enamel caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo; in vitro no limit if stored appropriately)
  Sensitivity 0.75 [0.62, 0.85]
  23 studies
  Low