Cochrane · intervention · CD012155
Interventions with pregnant women, new mothers and other primary caregivers for preventing early childhood caries
Gomersall, JC, Slack-Smith, L, Kilpatrick, N, et al. · Cochrane Database of Systematic Reviews · 2024 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
53
current version
GRADE rated
18
No studies
10
Included studies
23
as reported
No studies 10 · 18.9%Ungraded 25 · 47.2%Very low 11 · 20.8%Low 6 · 11.3%Moderate 1 · 1.9%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Pregnant women and new mothers of young infants (up to 12 months); studies where the intervention was provided to new mothers or other primary caregivers (e.g. fathers, grandmothers) of infants in their first year also eligible (all infants <12 months at baseline). For maternal outcomes, women of all ages; for child outcomes, infants and children up to and including 6 years. No restrictions on ethnicity, language, gestation period, medical history or geographical location | 23 RCTs (5 cluster-randomised) involving 25,953 caregivers (mainly pregnant women and new mothers; some fathers and grandmothers) and their children; maximum 1326 children and 130 mothers in any meta-analysis. Socioeconomically disadvantaged in 13 trials. Conducted across 12 countries (USA n=4, Brazil n=4, Canada n=2, Finland n=2, Uganda n=2, and one each in Australia, Belarus, Denmark, Hong Kong, India, Turkey, Sweden, UK) |
| Intervention | Interventions with pregnant women, new mothers or other primary caregivers of infants in the first year of life: (1) clinical treatments (e.g. application of antimicrobial agents); (2) oral health education and/or promotion (breastfeeding support, dietary advice for infants and young children, oral hygiene education); (3) health service and policy interventions to modify access to oral health information or services; dietary advice for mothers (including relating to vitamin intake) | Diet and feeding practice advice for infants/young children (n=3); Breastfeeding promotion and support (n=2); Dietary advice only (n=1); Oral hygiene + diet and feeding advice (n=8); High-dose vitamin D in pregnancy (n=1); Antimicrobial CHX or iodine-NaF + prophylaxis to mother dentition (n=4); Xylitol chewing gum for mother (n=2); Oral health/diet/feeding advice + dental treatment for mother (n=2) |
| Comparison | Placebo; standard care; or another intervention with pregnant women, new mothers or other primary caregivers of infants in the first year of life | Standard care; Placebo (n=4); Another clinical intervention - CHX or CHX+xylitol (n=2); Low-dose (standard) vitamin D (n=1) |
| Outcomes | Primary: caries presence in primary teeth (yes/no; incl non-cavitated and/or cavitated lesions); dmft; dmfs (incl d(e)fs and d(e)ft variants). Secondary (child): microbiological presence; plaque; oral health behaviour; dental attendance. Secondary (mother): caries (presence, DMFT, DMFS); plaque; microbiological presence; gingival health; change in self-reported oral health behaviours and attitudes | Caries presence in primary teeth; dmfs; dmft; caries severity d1+mfs>=5; SiC30 index; d1-4efs; child oral health behaviours; child dental attendance; child microbiological presence; mother caries (dmfs/DMFT increment); mother plaque; mother gingival health; mother oral health behaviours; adverse events; child plaque; child microbiological presence (MS colonisation) |
| Study designs | All RCTs and cluster-RCTs (published or unpublished); abstracts considered for inclusion | Individually randomised RCT (n=18); cluster-RCT (n=5) |
| Timing | Child outcomes measured in infants/children up to and including 6 years of age | Child caries assessed between infancy and 6 years of age |
Search date: 2023-01. Databases: Cochrane Oral Health's Trials Register; Cochrane Pregnancy and Childbirth Group Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; CINAHL EBSCO; US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov); WHO International…
Questions and results
Show all 3 versionsAdvice about a healthy diet (including breastfeeding promotion and sugar avoidance) and feeding practices (e.g. relating to bottle-feeding and sleep) for infants and young children vs Standard care
Population: For interventions, pregnant women, mothers or other caregivers of infants in the first year of life; for outcomes, children up to 6 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries presence in primary teeth Children assessed at 3-5 yrs | RR 0.85 [0.75, 0.97] -71 [-128, -10] per 1000 (fewer with intervention) | 3 studies · 782 participants | Moderate Downgraded: risk of bias |
Mother self-reported oral health behaviours and attitudes | One trial (Watt 2009) reported mother self-reported oral health behaviours (other data): some benefit in favour of the intervention. | 1 study | Ungraded |
dmfs index score (decayed, missing, filled primary surfaces; range 0-80) Children assessed at 1-3 yrs | MD -0.29 [-0.58, 0] Mean dmfs in standard care group ranged from 0.63 to 3.6 vs 0.29 lower (0.58 lower to equal) | 2 studies · 757 participants | Low Downgraded: risk of bias, imprecision |
Caries severity (d1 + mfs >= 5) Children assessed at 4 yrs | RR 0.68 [0.50, 0.92] | 1 study · 340 participants | Ungraded |
dmft index score (decayed, missing, filled primary teeth; range 0-20) Children assessed at 4 yrs | MD -0.90 [-1.85, 0.05] Mean dmft in standard care group was 4.15 vs 0.90 lower (1.85 lower to 0.05 higher) | 1 study · 340 participants | Very low Downgraded: risk of bias, imprecision |
Child oral health behaviours | Two trials (Feldens 2007; Watt 2009) reported infant/child oral health behaviours; not suitable for meta-analysis. Both observed some evidence of benefit favouring the intervention. | 2 studies | Ungraded |
Adverse events for mother or child | One trial only (Feldens 2007) provided information on adverse events and reported no events. | 1 study | Ungraded |
Breastfeeding promotion and support (e.g. individually tailored home-based peer counselling on the importance of breastfeeding, with advice and support for healthy breastfeeding) vs Standard care
Population: For interventions, pregnant and lactating women; for outcomes, children up to 6 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries presence in primary teeth Children assessed at 5-6 yrs | RR 0.96 [0.89, 1.03] -28 [-76, 20] per 1000 (fewer with intervention) | 2 studies · 1148 participants | Low Downgraded: risk of bias, imprecision |
dmft index score Children assessed at 5-6 yrs | MD -0.12 [-0.59, 0.36] Mean dmft in standard care group ranged from 1.7 to 4.2 vs 0.12 lower (0.59 lower to 0.36 higher) | 2 studies · 652 participants | Low Downgraded: risk of bias, imprecision |
dmfs index score | dmfs was listed in the SoF table but not assessed (not reported for this comparison). | 0 studies | No studies |
Dietary advice on how to achieve a healthy diet for infants (tailored advice focused on a diet low in saturated fat and cholesterol intake) vs Standard care
Population: For interventions, pregnant women, mothers or other caregivers of infants in the first year of life; for outcomes, children up to 6 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mother self-reported oral health behaviours | Data from Lapinleimu 1995 on mother oral health behaviour (other data) showed some evidence of benefit in favour of the intervention. | 1 study | Ungraded |
Mother plaque (sub- and supragingival calculus) | RR 0.92 [0.62, 1.37] | 1 study · 133 participants | Ungraded |
Child oral health behaviour | Data on oral health behaviours from Lapinleimu 1995 (other data) showed no evidence of a difference between groups. | 1 study | Ungraded |
dmft index score | dmft was listed in the SoF table but not assessed (not reported for this comparison). | 0 studies | No studies |
dmfs index score | dmfs was listed in the SoF table but not assessed (not reported for this comparison). | 0 studies | No studies |
Mother gingival health (mild or moderate bone loss) | RR 1.43 [0.42, 4.85] | 1 study · 133 participants | Ungraded |
Caries presence in primary teeth Children assessed at 3 yrs | RR 1.08 [0.34, 3.37] 6 [-46, 170] per 1000 (more with intervention) | 1 study · 148 participants | Very low Downgraded: risk of bias, imprecision |
Package of oral health education/promotion including oral hygiene advice for pregnant women, mothers, infants and young children, plus dietary and feeding practice advice for infants and young children vs Standard care
Population: For interventions, pregnant women, mothers or other caregivers of infants in the first year of life; for outcomes, children up to 6 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries presence in top front four teeth Children assessed at 3 yrs · Higher-protein diet trial | RR 0.68 [0.42, 1.10] | 1 study · 226 participants | Very low Downgraded: risk of bias, imprecision |
Mother self-reported oral health behaviours | Two trials (Batliner 2018; Plutzer 2008) provided information on changes in mother oral health behaviours (other data): some benefit in favour of the intervention. | 2 studies | Ungraded |
Child dental attendance Birth to 6 yrs | Plutzer 2008 reported dental attendance as cumulative child-visit categories (other data): intervention children more likely to have 1-2 visits, no difference for 3-4 visits, less likely for >=5 visits. | 1 study | Ungraded |
Child plaque (any plaque visible on any teeth) | RR 0.35 [0.26, 0.47] | 1 study · 441 participants | Ungraded |
dmfs index score Children assessed at 3 yrs | MD -0.87 [-2.18, 0.43] Mean dmfs in standard care group ranged from 2.45 to 10.4 vs 0.87 lower (2.18 lower to 0.43 higher) | 2 studies · 657 participants | Low Downgraded: risk of bias, imprecision |
Caries presence in primary teeth Children assessed at 1-6 yrs | RR 0.73 [0.50, 1.07] -114 [-211, 30] per 1000 (fewer with intervention) | 5 studies · 1326 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events for mother or child | One trial (Harrison 2012) reported observing no adverse events; other trials provided no information on adverse events. | 1 study | Ungraded |
Child oral health behaviours | Three trials (Muhoozi 2017; Pereira 2021; Yu 2021) reported changes in child oral health behaviours (other data): some benefit in favour of the intervention. | 3 studies | Ungraded |
dmft index score Children assessed at 6 yrs | MD -0.30 [-0.96, 0.36] Mean dmft in standard care group was 1.29 vs 0.30 lower (0.96 lower to 0.36 higher) | 1 study · 187 participants | Low Downgraded: risk of bias, imprecision |
d1-4 efs | Veronneau 2010 (narrative): at 5-6 yrs mean d1-4efs 4.9 (test) vs 6.8 (control) (p < 0.001). | 1 study | Ungraded |
Child microbiological presence (mutans streptococci colonisation) | Yu 2021: MS colonisation level (CFU x10^4) lower with intervention at 2 yrs (MD -2.80) and 3 yrs (MD -15, 95% CI -27.75 to -2.25) but not 1 yr (MD -0.20, 95% CI -0.50 to 0.10); MS-to-total-bacteria ratio lower at 1 yr… | 1 study | Ungraded |
SiC30 index score Children assessed at 6 yrs | MD -0.93 [-1.73, -0.13] | 1 study · 187 participants | Ungraded |
Prophylaxis (teeth cleaning) and CHX or iodine-NaF solution application in the dentition of women (mothers) vs Placebo
Population: For interventions, pregnant women and mothers of infants in the first year of life; for outcomes, children up to 6 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mother microbiological presence | Narrative (Dasanayake 1993; Dasanayake 2002): significant reductions in MS and other bacteria immediately post-treatment; chlorhexidine varnish significantly reduced maternal S. mutans over ~12 months. | 2 studies | Ungraded |
dmft index score | dmft was listed in the SoF table but not assessed (no trial reported it). | 0 studies | No studies |
Adverse events for mother or child | Two trials (Dasanayake 1993; Dasanayake 2002) reported adverse events related to topical application of the treatment solutions (other data). | 2 studies | Ungraded |
dmfs index score | dmfs was listed in the SoF table but not assessed (no trial reported it). | 0 studies | No studies |
Caries presence in primary teeth Children assessed at 2-3 yrs | RR 0.97 [0.80, 1.19] -13 [-87, 83] per 1000 (fewer with intervention) | 3 studies · 479 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Child microbiological presence (mutans streptococci acquisition) | Narrative (Dasanayake 1993; Dasanayake 2002): crude incidence of MS acquisition 36% greater in treatment children (not significant after adjustment); no significant difference in detectable S. mutans or mean time to… | 2 studies | Ungraded |
Mother caries (DMFT increment) | MD -0.30 [-1.86, 1.26] | 1 study · 66 participants | Ungraded |
Mother caries (dmfs increment) | MD -0.21 [-2.22, 1.79] | 2 studies · 130 participants | Ungraded |
Consumption of xylitol chewing gum by women (mothers) vs Consumption of CHX/xylitol gum by women, or CHX varnish applied to women's dentition
Population: For interventions, pregnant women and mothers of infants in the first year of life; for outcomes, children up to 6 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries presence in primary teeth Children assessed at 4 yrs | RR 0.62 [0.27, 1.39] -95 [-182, 98] per 1000 (fewer with xylitol) | 1 study · 96 participants | Very low Downgraded: risk of bias, imprecision |
Child microbiological presence (any mutans streptococci colonisation) | RR 0.60 [0.45, 0.81] | 2 studies | Ungraded |
dmfs index score | dmfs was listed in the SoF table but not assessed (not reported for this comparison). | 0 studies | No studies |
Mother microbiological presence (mutans streptococci colonisation level, CFU/mL) | MD 0.50 [0.15, 0.85] | 1 study · 126 participants | Ungraded |
defs index score (categories) | Thorild 2003 defs score categories (very low-certainty): 1-3 defs RR 0.48 (95% CI 0.15 to 1.54); 3-4 defs RR 0.85 (95% CI 0.18 to 3.98); >=5 defs RR 0.28 (95% CI 0.01 to 6.78); 96 participants. | 1 study · 96 participants | Very low Downgraded: risk of bias, imprecision |
defs index score | MD -0.28 [-0.83, 0.27] | 1 study · 96 participants | Very low Downgraded: risk of bias, imprecision |
dmft index score Children assessed at 5 yrs | MD -2.39 [-4.10, -0.68] Mean dmft in CHX varnish group was 3.22 vs 2.39 lower (4.10 to 0.68 lower) | 1 study · 113 participants | Low Downgraded: risk of bias, imprecision |
Health service and/or policy intervention designed to modify access to oral health information or services for pregnant women, new mothers or other primary caregivers vs Standard care (or any comparator)
Population: For interventions, pregnant women, mothers or other caregivers of infants in the first year of life; for outcomes, children up to 6 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | No trials evaluated policy or health service interventions designed to modify access to oral health information or services. | 0 studies | No studies |
High-dose vitamin D3 supplementation during pregnancy (2400 IU/day from pregnancy week 24 to 1 week postpartum, in addition to the recommended 400 IU/day) vs Low-dose (standard) vitamin D supplementation as recommended in national pregnancy guidelines
Population: For interventions, pregnant women, mothers or other caregivers of infants in the first year of life; for outcomes, children up to 6 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Caries presence in primary teeth Children assessed at 6 yrs | RR 0.99 [0.70, 1.41] 0 [-60, 83] per 1000 | 1 study · 496 participants | Very low Downgraded: risk of bias, imprecision |
dmft index score | dmft was listed in the SoF table but not assessed (not reported for this comparison). | 0 studies | No studies |
dmfs index score | dmfs was listed in the SoF table but not assessed (not reported for this comparison). | 0 studies | No studies |
Oral health education/promotion (oral hygiene advice plus diet and feeding practice advice) combined with clinical treatment for mother's dentition (basic restorative and preventive; 1 trial included CHX varnish application) vs Standard care
Population: For interventions, pregnant women and mothers of infants in the first year of life; for outcomes, children up to 6 years of age
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
dmft index score Children assessed at 18 months | The mean dmft index score was 0.52 (standard care) versus 0 (advice + treatment group); relative effect not estimable; 50 participants (1 study); very low-certainty evidence. Mean dmft in standard care group was 0.52 vs 0 (intervention group) | 1 study · 50 participants | Very low Downgraded: risk of bias, imprecision |
Mother microbiological presence (high-level mutans streptococci / lactobacilli) | RR 0.53 [0.28, 1.03] | 1 study · 50 participants | Ungraded |
Child oral health behaviour | One trial (Shenoy 2022) reported changes in child oral health behaviours (other data): some benefit in favour of the intervention. | 1 study | Ungraded |
dmfs index score | dmfs was listed in the SoF table but not assessed (not reported for this comparison). | 0 studies | No studies |
Caries presence in primary teeth Children assessed at 18-24 months | RR 0.44 [0.05, 3.95] -95 [-161, 498] per 1000 (fewer with intervention) | 2 studies · 324 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |