Reducing Early Childhood Caries Through Caregiver-Targeted Interventions

Does providing dietary and feeding-practice advice to primary caregivers reduce the risk of early childhood caries in children?

Providing dietary and feeding-practice advice to mothers or other primary caregivers reduces the risk of early childhood caries in primary teeth by approximately 15% compared with standard care.¹ (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

Early childhood caries is the most prevalent chronic disease of childhood, affecting an estimated 43% of children worldwide, or more than 500 million individuals.² Early childhood caries is defined by the American Academy of Pediatric Dentistry as the presence of one or more decayed, missing, or filled tooth surfaces in any primary tooth in a child younger than 6 years.³ The number of early childhood caries cases has risen significantly since the 1990s, particularly in low-resource countries.² Untreated early childhood caries can lead to pain, infection, extractions, poor growth, nutritional deficiencies, and behavioral and sleep problems.¹ Caries in primary teeth are also a key risk factor for future dental disease, making early prevention essential for long-term oral and overall health.²

This updated Cochrane review included 23 randomized controlled trials with 25,953 primary caregivers (predominantly pregnant women and new mothers, with some grandmothers and fathers) and their children.¹ Eight caregiver-targeted interventions were assessed during pregnancy or infancy for their ability to prevent early childhood caries in children up to age 6 years. These included dietary and feeding-practice advice; breastfeeding promotion; dietary advice alone; combined oral hygiene, dietary, and feeding-practice advice; prenatal vitamin D supplementation; maternal antimicrobial tooth varnish treatments (eg, chlorhexidine); maternal xylitol chewing gum use (ie, antimicrobial chewing gum); and combined caregiver education with maternal dental care. Interventions were compared with standard care, placebo, or another intervention to prevent early childhood caries.

The primary outcome was the presence of early childhood caries, assessed using caries prevalence per 1,000 individuals; the decayed, missing, and filled surfaces index (score range of 0–80, with a higher score indicating more involved surfaces); or the decayed, missing, and filled teeth index (score range of 0–20, with a higher score indicating more involved teeth).¹ Studies varied in definitions of caries, assessment time points, and intervention delivery methods. Trials were conducted across high-, middle-, and low-resource countries, with 13 studies enrolling socioeconomically disadvantaged populations. No adverse effects were reported. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system.⁴

Dietary and feeding-practice advice was the only intervention to reduce early childhood caries by approximately 15% relative to standard care (relative risk = 0.85; 95% CI, 0.75–0.97; number needed to treat = 15; three trials; n = 782; moderate-certainty evidence).¹ This intervention also may slightly reduce the mean decayed, missing, and filled surfaces index (mean difference [MD] = −0.29; 95% CI, −0.58 to 0; two trials; n = 757; low-certainty evidence).

The dietary and feeding-practice interventions typically focused on breastfeeding promotion, healthy breastfeeding weaning practices, and discouraging behaviors such as bottle-feeding during sleep and offering sugary drinks.¹ Interventions were delivered via home visits or routine clinic appointments and were conducted by health care professionals, field workers, or trained local volunteers. Frequency and intensity varied across studies, with some providing structured, scheduled sessions and others offering advice opportunistically during prenatal and postnatal care. All three studies were conducted in Brazil or the United Kingdom and targeted mothers of infants during the prenatal or early postpartum period. Although formats varied, interventions consistently aimed to reduce dietary sugar exposure and promote healthy feeding behaviors aligned with national or World Health Organization guidelines.^3,5