What do systematic reviews say?

Late tooth brushing initiation (>=12 months, or >=2 years in some studies) vs Early tooth brushing initiation (<12 months, or <2 years)

In the primary pooled analysis, late tooth brushing initiation was associated with a non-significant 40% higher odds of early childhood caries (OR 1.40, 95% CI 0.91 to 2.16), with very high heterogeneity (I2=90.5%); ungraded.

• Optimal tooth brushing initiation age and frequency for preventing early childhood caries: a systematic review and… 2025 All outcomes

  Community/population-based; preschool children across Asia, Europe, North America, South America, Africa, and Australia (32 studies; 34,050 children) · Primary analysis (all 10 studies)
  OR 1.40 [0.91, 2.16]
  10 studies · 23200 participants
  GRADE not reported
• Optimal tooth brushing initiation age and frequency for preventing early childhood caries: a systematic review and… 2025 All outcomes

  Community/population-based; preschool children across Asia, Europe, North America, South America, Africa, and Australia (32 studies; 34,050 children) · Leave-one-out sensitivity analysis (Wagner 2017 outlier excluded, k=9)
  OR 1.75 [1.50, 2.03]
  9 studies
  GRADE not reported

Presence of oral Candida albicans vs Absence of oral Candida albicans

RETRACTED. Among studies before 2017, oral C. albicans presence was associated with higher odds of ECC (OR 4.89, 95% CI 2.79-8.58); ungraded subgroup from a retracted review.

• RETRACTED: Investigating the association between Candida albicans and early childhood dental caries: A comprehensive… 2024 All outcomes

  Exposure and outcome assessed concurrently (observational); children aged ≤6 years · Children aged ≤6 years; multiple countries (Asia, Europe, Americas); dental/clinical and community settings · Time period: before 2017
  OR 4.89 [2.79, 8.58]
  10 studies
  GRADE not reported
• RETRACTED: Investigating the association between Candida albicans and early childhood dental caries: A comprehensive… 2024 All outcomes

  Exposure and outcome assessed concurrently (observational); children aged ≤6 years · Children aged ≤6 years; multiple countries (Asia, Europe, Americas); dental/clinical and community settings · Sample collection: dental plaque
  OR 4.08 [2.65, 6.27]
  13 studies
  GRADE not reported
• RETRACTED: Investigating the association between Candida albicans and early childhood dental caries: A comprehensive… 2024 All outcomes

  Exposure and outcome assessed concurrently (observational); children aged ≤6 years · Children aged ≤6 years; multiple countries (Asia, Europe, Americas); dental/clinical and community settings · Region: Europe
  OR 10.13 [6.01, 17.09]
  5 studies · 635 participants
  GRADE not reported

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

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.

• The bi-directional relationship between growth stunting and early childhood caries: a rapid review. 2023 All outcomes

  Nigeria (Ile-Ife, sub-urban) · Folayan et al. 2019 (Nigeria; adjusted, model 3)
  APR 0.14 [0.03, 0.69]
  1 study · 370 participants
  GRADE not reported
• The bi-directional relationship between growth stunting and early childhood caries: a rapid review. 2023 All outcomes

  Brazil · Vieira et al. 2020 (Brazil)
  Correlation (r) -0.091
  1 study · 82 participants
  GRADE not reported
• The bi-directional relationship between growth stunting and early childhood caries: a rapid review. 2023 All outcomes

  2-year follow-up · Ecuador (rural) · Sokal-Gutierrez et al. 2016 (Ecuador; pre vs post intervention)
  Pre/post ECC prevalence, dmft, and deep-caries proportion (2-year follow-up) Age 1: prevalence 53.8% to 30.3%, dmft 2.1 to 0.9; Age 2: prevalence 82% to 60%, dmft 5.3 to 3.0, deep caries 19% to 12% (pre vs post)
  1 study · 1575 participants
  GRADE not reported

Analogue (conventional) radiographs vs Reference standard (histology, excavation, or enhanced visual examination)

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Sensitivity 0.44 [0.38, 0.50]
  51 studies
  GRADE not reported

Radiographic imaging methods (any: analogue radiographs, digital radiographs, or CBCT) vs Reference standard (histology, excavation, or enhanced visual examination)

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Reference standard: enhanced visual (non-CBCT)
  Sensitivity 0.47 [0.29, 0.66]
  8 studies
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Permanent dentition (non-CBCT)
  Sensitivity 0.44 [0.37, 0.51]
  Studies not reported
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Dentine-caries (D3) prevalence medium 15-34% (non-CBCT)
  Sensitivity 0.51 [0.40, 0.61]
  Studies not reported
  GRADE not reported

Cone beam computed tomography (CBCT) vs Reference standard (histology, excavation, or enhanced visual examination)

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Proximal surfaces (CBCT)
  Specificity 0.90 [0.77, 0.96]
  Studies not reported
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Specificity 0.81 [0.73, 0.88]
  7 studies
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Occlusal surfaces (CBCT)
  Specificity 0.54 [0.31, 0.75]
  Studies not reported
  GRADE not reported

Radiographic imaging methods (any: analogue radiographs, digital radiographs, or CBCT) vs Reference standard (histology, excavation, or enhanced visual examination)

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Permanent dentition (non-CBCT)
  Specificity 0.90 [0.85, 0.93]
  Studies not reported
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Sensitivity analysis: low risk of bias for index test
  Specificity 0.88 [0.82, 0.92]
  Studies not reported
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Dentine-caries (D3) prevalence high >=35% or unreported (non-CBCT)
  Specificity 0.89 [0.82, 0.93]
  Studies not reported
  GRADE not reported

Analogue (conventional) radiographs vs Digital radiographs (direct within-person / paired comparison); reference standard: histology, excavation, or enhanced visual examination

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Analogue
  Specificity 0.91 [0.86, 0.94]
  15 studies
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Digital
  Specificity 0.88 [0.83, 0.92]
  15 studies
  GRADE not reported

Analogue (conventional) radiographs vs Reference standard (histology, excavation, or enhanced visual examination)

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Specificity 0.90 [0.86, 0.93]
  51 studies
  GRADE not reported

Cone beam computed tomography (CBCT) vs Reference standard (histology, excavation, or enhanced visual examination)

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Sensitivity 0.60 [0.51, 0.68]
  7 studies
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Proximal surfaces (CBCT)
  Sensitivity 0.68 [0.42, 0.86]
  Studies not reported
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Occlusal surfaces (CBCT)
  Sensitivity 0.76 [0.55, 0.89]
  Studies not reported
  GRADE not reported

Cone beam computed tomography (CBCT) vs Digital radiographs (direct within-person / paired comparison); reference standard: histology

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Digital
  Specificity 0.76 [0.43, 0.93]
  6 studies
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · CBCT
  Specificity 0.69 [0.35, 0.90]
  6 studies
  GRADE not reported

Cone beam computed tomography (CBCT) vs Digital radiographs (direct within-person / paired comparison); reference standard: histology

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · CBCT
  Sensitivity 0.76 [0.65, 0.85]
  6 studies
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Digital
  Sensitivity 0.69 [0.57, 0.80]
  6 studies
  GRADE not reported

Analogue (conventional) radiographs vs Digital radiographs (direct within-person / paired comparison); reference standard: histology, excavation, or enhanced visual examination

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Digital
  Sensitivity 0.47 [0.36, 0.59]
  15 studies
  GRADE not reported
• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies) · Analogue
  Sensitivity 0.41 [0.30, 0.53]
  15 studies
  GRADE not reported

Digital radiographs vs Reference standard (histology, excavation, or enhanced visual examination)

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Sensitivity 0.49 [0.42, 0.56]
  40 studies
  GRADE not reported

Digital radiographs vs Reference standard (histology, excavation, or enhanced visual examination)

• Imaging modalities to inform the detection and diagnosis of early caries 2021 · Cochrane All outcomes

  Up to 3 months between index test and reference standard (in vivo studies)
  Specificity 0.87 [0.82, 0.91]
  40 studies
  GRADE not reported

Early childhood caries (ECC) vs Caries-free controls

Veillonella spp. mean relative abundance was higher in ECC children, without a comparative effect estimate or CI.

• A systematic review of Streptococcus Mutans and Veillonellae species interactions in dental caries progression:… 2025 All outcomes

  Indonesia
  Mean relative abundance (%) ECC 3.29 (SD 6.83) vs caries-free 2.13 (SD 2.30)
  1 study · 87 participants
  GRADE not reported
• Meta-Analysis Using NGS Data: The Veillonella Species in Dental Caries. 2022 All outcomes

  Saliva and supragingival biofilm (pooled) · Overall (all sample types)
  MD 2.22 [0.54, 3.90]
  6 studies · 319 participants
  Very low
• Meta-Analysis Using NGS Data: The Veillonella Species in Dental Caries. 2022 All outcomes

  Saliva · Saliva
  MD -1.05 [-7.67, 5.57]
  2 studies · 161 participants
  GRADE not reported

Early childhood caries (ECC) vs Caries-free controls

Fewer salivary bacterial genera were reported in the caries-affected group, without a comparative effect estimate or CI.

• A systematic review of Streptococcus Mutans and Veillonellae species interactions in dental caries progression:… 2025 All outcomes

  Hong Kong
  Number of genera caries-affected 117 vs caries-free 123 genera
  1 study · 40 participants
  GRADE not reported

Early childhood caries (ECC) vs Caries-free controls

The reported multi-genus community had similar relative abundance in caries-affected and caries-free children, without a comparative effect estimate or CI.

• A systematic review of Streptococcus Mutans and Veillonellae species interactions in dental caries progression:… 2025 All outcomes

  Hong Kong
  Relative abundance (%) caries-affected 75% vs caries-free 74%
  1 study · 40 participants
  GRADE not reported

Early childhood caries (ECC) vs Caries-free controls

Veillonella spp. levels were reported as substantially greater in caries subjects, but the review gave no numerical effect estimate or CI.

• A systematic review of Streptococcus Mutans and Veillonellae species interactions in dental caries progression:… 2025 All outcomes

  USA
  Veillonella spp. significantly greater in caries subjects, but detection unrelated to lesion development and unlikely to modify caries attack (qualitative)
  1 study · 9 participants
  GRADE not reported

Early childhood caries (ECC) vs NA (within-white-spot-lesion correlation, not a caries vs caries-free comparison)

Veillonella spp. levels were correlated with acidogenic streptococci in white spot lesions (r²=0.38); no CI was reported.

• A systematic review of Streptococcus Mutans and Veillonellae species interactions in dental caries progression:… 2025 All outcomes

  USA
  R² 0.38
  1 study · NA (white-spot correlation analytic sample not reported) participants
  GRADE not reported