Early Childhood Caries Susceptibility from 0-12 months: Systematic Review

Early Childhood Caries (ECC) describes dental caries affecting children 0-71 months of age. ECC is multifactoral in nature and there are gaps in our knowledge. Current research suggests ECC has important etiological roots in the first year of life. Early identification of 'at risk' children is crucial as effective prevention and early intervention will enhance a child's quality of life. For this to occur, disease progression must first be clarified to identify these children. Objectives: To conduct a systematic review of research studies to investigate indicators for initiation and progression of ECC during the first twelve months of an infant's life with focus on (a) acquisition and colonization of oral bacteria and ECC, and (b) risk and/or protective factors. Methods: Inclusion criteria were: infants 0-12 months; study designs: RCT, longitudinal, cross-sectional and qualitative. Ovid Medline and Embase databases from 1996-2011 were searched. Two investigators assessed and extracted data; study quality was assessed (CASP). Results: Inclusion criteria were met with (a)n=4, (b) n=13 papers; 5 papers were rated medium or high quality. Key risk indicators noted to modify bacterial acquisition and colonization were: maternal circumstances including maternal oral health (n=6 papers), infant feeding practices (n=9 papers), and infant related oral health behaviours (n=4 papers); however their inter-relationship and role in the caries process remained unclear. Conclusion: There remains some heterogeneity in direction of findings. It appears factors occurring during the first year of life strongly impact on caries experience with maternal transmission of bacteria a source of bacterial acquisition and levels of colonization further mediated by introduction of sweetened foods and liquids, frequency and types of feeding habits. In addition, tooth-brushing and use of fluoridated tooth-paste also contributed to infant oral health outcomes.