Risk factors for early childhood caries


Caries in children aged 71 months and younger or early childhood caries (ECC) has been reported with a prevalence of between 20 and 80% in some populations.  The aim of this review was two fold, to assess the association between the acquisition of oral cariogenic bacteria and caries outcomes in infants and to identify the proposed determinants of ECC during the first year of life.

The Medline and Embase databases were searched for randomised controlled trials (RCT), longitudinal, cross-sectional and qualitative studies. Two reviewers undertook a quality assessment for risk of bias.

  • 4 papers met the inclusion criteria for the first objective and 13 papers were included for the second objective, three papers were common to both searches, a qualitative summary of the findings was presented.
  • Bacterial acquisition/colonization and modifying factor inter-relationships were identified, but their role in the caries process was not clarified. Key risk indicators were infant feeding practices (nine papers), maternal circumstances and oral health (6) and infant- related oral health behaviours (4).

The authors concluded

 This review confirmed that factors occurring during the first year of life affect ECC experience. Despite heterogeneity, findings indicated maternal factors influence bacterial acquisition, whereas colonization was mediated by oral health behaviours and practices and feeding habits.


This review focused on caries risk factors in the first few years of life while other reviews have focused on specific risk factors eg. Parisotto et al (2010) looked at mutans streptococci (MS) including 16 studies in their review and concluding that MS were a strong risk indicator for ECC.   In 2004 Harris et al looked at risk factors for dental caries in young children and identified over 100 potential risk factors. More recently in a blog on the 8th October 2012 we considered a review, which highlighted that available caries risk assessment systems were not effective in the management of caries and in a blog on the 15th August 2012  we looked at a review of parental influences on ECC.


Leong PM, Gussy MG, Barrow SY, de Silva-Sanigorski A, Waters E. A systematic review of risk factors during first year of life for early childhood caries. Int  J Paediatr Dent. 2012 Aug 28. doi: 10.1111/j.1365-263X.2012.01260.x. [Epub ahead  of print] PubMed PMID: 22925469.

Parisotto TM, Steiner-Oliveira C, Silva CM, Rodrigues LK, Nobre-dos-Santos M.  Early childhood caries and mutans streptococci: a systematic review. Oral Health  Prev Dent. 2010;8(1):59-70. Review. PubMed PMID: 20480056.

Harris R, Nicoll AD, Adair PM, Pine CM. Risk factors for dental caries in young children: a systematic review of the literature. Community Dent Health. 2004 Mar;21(1 Suppl):71-85. Review. PubMed PMID: 15072476.

Dental Elf  8th October  2012

Dental Elf  15th August 2012

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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