Table 1. Search terms and examples of search strategies using PubMed, Medline and Google scholar
Search category
|
Search words
|
Children
|
Children
|
Dental caries
|
Caries
|
Determinants
|
Behaviours, Determinants, Dietary causes, Dietary habits, Education, Factors, Income, Socio, Social determinants
|
Geographic Context#
|
Algeria, Bahrain, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Syria, Tunisia, Turkey, UAE, Yemen, Middle East, North Africa
|
Examples of
search strategies
|
· Determinants AND caries AND children AND Middle East
· Factors AND caries AND children AND North Africa
· Behaviours AND caries AND children AND Algeria
· Socio AND caries AND children AND Bahrain
· Dietary causes AND caries AND children AND Egypt.
· Dietary habits AND caries AND children AND Iran
· Education AND caries AND children AND Iraq
· Income AND caries AND children and Jordan
· Social determinants AND caries AND children AND Kuwait
|
#Countries being part of the Middle East and North Africa (MENA) according to the World Atlas categorization, 2018.
Table 2 Statistically significant determinants related to children’s sex, age and weight status contributing to dental caries
Determinants
|
Association: Positive (+), negative (-)
|
Author
Study design
|
Country
|
Type of dentition
|
N
|
Age group (Gender)
|
Study
setting
|
Scoring system
|
Type/s of statistical analysis
|
Dental caries/
scoring results
|
Gender
|
|
|
|
|
|
|
|
|
|
|
Male
(primary dentition)
|
+
|
Abbass et al. 2019 (1)
(CS)
|
Egypt
|
Primary
Mixed Permanent
|
369
|
3-18 y (M, F)
|
Clinic
|
WHO
(dmft, deft, DMFT)
|
Kruskal- Wallis, Spearman’s
|
DCP=74% dmft=3.23 (SD 4.07)
deft=4.21 (SD 3.21)
DMFT=1.04 (SD 1.56)
|
Male
|
+
|
Kabil & Eltawil,
2016 (2)
(CS)
|
Egypt
|
Primary
|
140
|
2-4 y
(M, F)
|
Clinic
|
WHO
AAPD-ECC
|
Logistic regression
|
DMFT=9.96
|
Male
|
+
|
Kabil & Eltawil,
2017 (3)
(CS)
|
Egypt
|
Primary
|
108
|
2-4 y
(M, F)
|
Clinic
|
WHO
|
Logistic regression
|
ECCP=57% (2-3 y) ECCP=73% (3-4 y)
|
Male
|
+
|
Abu Hamila, 2013 (4)
(CS)
|
Egypt
|
Primary
|
560
|
1-3.5 y
(M, F)
|
Clinic
|
WHO
(dmft)
|
Chi-Square
|
ECCP=69.6%
dmft=2.1-7.6
|
Male
|
+
|
Bayat-Movahed et al. 2011 (5)
(CS)
|
Iran
|
Primary
Permanent
|
18946
|
3,6,9,12 y
(M, F)
|
Community health centres
|
WHO
(dmft, DMFT)
|
T-test
Z-test
|
dmft= 1.9 (3y)
dmft=5.0 (6y)
dmft=3.6 (9y)
dmft=0.6 (12y)
DMFT=0.2 (6y)
DMFT=0.9 (9y)
DMFT=1.9 (12y)
|
Male
|
+
|
Sadeghi et al. 2011 (6)
(CS)
|
Iran
|
Permanent
|
747
|
12-15 y
(M, F)
|
School
|
WHO (DMFT)
|
T-test,
Chi-Square
|
Caries free=16.1%
DMFT=2.83 (SD 2.2)
|
Male
|
+
|
Saied-Moallemi et al. 2006 (7)
(CS)
|
Iran
|
Primary
Permanent
|
459
|
9 y
(M, F)
|
School
|
WHO (dmft, DMFT)
|
One-way ANOVA,
Kruskal- Wallis,
Mann- Whitney
|
dmft=4.2 (M)
dmft=3.4 (F)
DMFT=0.4
|
Male
|
+
|
Goodson et al. 2013 (8)
(CS)
|
Kuwait
|
Primary
Mixed
Permanent
|
8,319
|
Mean age=11.36 y (grade 4 & 5)
(M, F)
|
School
|
Percentage of decayed or filled teetha
|
Multivariate rank-based Wilcoxon regression
|
Decayed or filled teeth (all body weights)
=11.01% (SEM 0.11)
Decayed or filled teeth
(males)=11.76 % (SEM 0.19)
Decayed or filled teeth
(females)=10.53% (SEM 0.14)
|
Male
|
+
|
Hashim et al. 2006 (9)
(CS)
|
UAE
|
Primary
|
1036
|
5,6 y
(M, F)
|
School
|
WHO (dmft, dmfs)
|
Chi-Square,
ZINB regression
|
DCP=76.1%
dmft=4.4
dmfs=10.2
|
Female
|
+
|
Bashirian et al. 2018 (10)
(CS)
|
Iran
|
Primary
Permanent
|
988
|
7-12 y
(M, F)
|
School
|
WHO
(dmft, DMFT)
|
Multiple regression
|
DCP=80.36%
dmft=3.61
DMFT=0.79
|
Female
|
+
|
Khani-Varzegani et al. 2017 (11)
(CS)
|
Iran
|
Primary
|
756
|
4-7 y
(M, F)
|
School
|
WHO
(dmft)
|
Multivariate analysis
|
dmft median (25th-75th percentile):
All=4(2-8)
Males= 4(2-9)
Females=5(2-8)
|
Female
|
+
|
Jahani et al. 2013 (12)
(CS)
|
Iran
|
Primary
Permanent
|
845
|
9 y
(M, F)
|
School
|
WHO (dmft, DMFT)
|
Ordinal logistic regression
|
Moderate to high DCPb=50% of the children
|
Female
|
+
|
Farsi &Elkhodary 2017 (13)
(CS)
|
KSA
|
Permanent
|
801
|
Mean age=16.5 y (Grade 11)
(M, F)
|
School
|
ASTDD (DT)
|
Mann- Whitney
|
DT boys=3.9 (SD 3.5)
DT girls=4.9 (SD 3.7)
|
Female
|
+
|
Huew et al. 2011 (14)
(CS)
|
Libya
|
Permanent
|
791
|
12 y
(M, F)
|
School
|
WHO (DMFT, DMFS)
|
Multivariate analysis
|
DCP=57.8%
DMFT=1.78
DMFS=2.39
|
Female
|
+
|
Bener et al. 2013 (15)
(CS)
|
Qatar
|
Permanent
|
1284
|
6-15 y
(M, F)
|
Clinic
|
WHO (DMFT)
|
Multivariate
analysis
|
DCP=73%
DMFT=4.5
|
Gender
|
Unclear
|
Khadri et al. 2018 (16)
(CS)
|
UAE
|
Permanent
|
803
|
11-17 y
(M, F)
|
School
|
WHO (DMFT)
|
Multivariate regression
|
DCP=75%
DMFT=3.19 (SD 2.9)
|
Age
|
|
|
|
|
|
|
|
|
|
|
Age
|
+
|
Abbass et al. 2019 (1)
(CS)
|
Egypt
|
Primary. Mixed, Permanent
|
369
|
3-18 y, (M, F)
|
Clinic
|
WHO
(dmft, deft, DMFT)
|
Kruskal- Wallis, Spearman’s
|
DCP=74% dmft=3.23 (SD 4.07)
deft=4.21 (SD 3.21)
DMFT=1.04 (SD 1.56)
|
Age
|
+
|
Abu Hamila, 2013 (4)
(CS)
|
Egypt
|
Primary
|
560
|
1-3.5 y
(M, F)
|
Clinic
|
WHO
(dmft)
|
Chi-Square
|
ECCP=69.6%
dmft=2.1-7.6
|
Age
|
+
|
Bashirian et al. 2018 (10)
(CS)
|
Iran
|
Primary
Permanent
|
988
|
7-12 y
(M, F)
|
School
|
WHO
(dmft, DMFT)
|
Multiple regression
|
DCP=80.36%
dmft=3.61
DMFT=0.79
|
Age
|
+
|
Shaghaghian et al. 2018 (17)
(CS)
|
Iran
|
Primary
|
396
|
3-6 y,
(M, F)
|
School
|
WHO
(dmft)
|
Multivariate analysis
|
DCP=69.9%
dmft=3.88
|
Age
|
+
|
Khani-Varzegani et al. 2017 (11)
(CS)
|
Iran
|
Primary
|
756
|
4-7 y
(M, F)
|
School
|
WHO
(dmft)
|
Multivariate analysis
|
Median (25th-75th percentile) dmft:
All=4 (2-8)
Boys=4 (2-9)
Girls=5 (2-8)
|
Age
|
+
|
Eslamipour et al. 2010 (18)
(CS)
|
Iran
|
Permanent
|
748
|
11-20 y
(M, F)
|
School
|
WHO (DMFT)
|
Chi-Square, Binary logistic regression
|
DCP=88.8%
DMFT (11-14 y) =4.94 (SD 3.59)
DMFT (11-14 y) =3.02 (SD 2.51)
DMFT=5.00 (SD 3.37) (14-17 y)
DMFT (17-20 y) =6.66 (SD 3.82)
|
Age
|
+
|
Mohebbi et al.
2006 (19)
(CS)
|
Iran
|
Primary
|
504
|
12-36 mo
(M, F)
|
Clinic
|
WHO
(dmft)
|
Logistic regression
|
ECCP:
12-15 mo=3%
16-19 mo=9%
20-25 mo=14%
26-36 mo=33%
dmft=
<0.1 (12-15 mo)
dmft=0.2 (16-19 mo)
dmft=0.4(20-25 mo)
dmft=1.2(26-36 mo)
|
Age
|
+
|
Askarizadeh & Siyonat,
2004 (20)
(CS)
|
Iran
|
Primary
|
620
|
2-6 y
(M, F)
|
School
|
WHO
(dmft)
|
Chi-Square
|
DCP=17.2%
dmft=8.5 (M)
dmft=7.8 (F)
|
Age
|
+
|
Sayegh et al. 2002c
(21)
(CS)
Sayegh et al. 2005c (22)
(CS)
|
Jordan
|
Primary
|
1140
|
4-5 y
(M, F)
|
School
|
WHO (dmft)
|
Multivariate analysis
|
DCP=67%
dmft >4 in 31%
|
Age
|
+
|
Al-Malik et al. 2002 (23)
(CS)
|
KSA
|
Primary
|
987
|
2-5 y
(M, F)
|
School
|
BASCD
|
Stepwise multiple logistic regression
|
DCP=73%
ECCP=43%
dmft=4.8
dmfs=12.7
|
Age
|
+
|
Wyne et al. 2001 (24)
(CS)
|
KSA
|
Primary
|
1016
|
2-6 y
(M, F)
|
School
|
WHO
(dmft)
|
Logistic regression
|
DCP=27.3%
dmft=8.6
|
Age
|
+
|
Al-Mutawa el al. 2006 (25)
(CS)
|
Kuwait
|
Primary
Permanent
|
4588
|
5,6,12,14 y
(M, F)
|
School
|
WHO (dft, DMFT, DFS)
|
Multivariate analysis
|
dft=4.6 (5-6 y)
DMFT=0.4(6 y)
DMFT=2.6 (12y)
DMFT=3.9 (14 y)
DFS=0.4 (6y)
DFS=3.4 (12 y)
DFS=5.2 (14 y)
|
Age
|
+
|
Qadri et al. 2012 (26)
(CS)
|
Syria
|
Primary
|
400
|
3-5 y
(M, F)
|
School
|
ECC
WHO (dmft, dmfs)
|
Logistic regression
|
ECCP=48%
DCP=70%
dmft=4.25 (SD 4.24)
|
Age
|
+
|
İnan-Eroğlu et al. 2017 (27)
(CS)
|
Turkey
|
Primary
|
395
|
36-71 mo,
(M, F)
|
School
|
WHO
(dmft, dmfs)
|
Mann-Whitney,
Kruskal-Wallis
|
dmft =4.7
dmfs= 8.0
|
Age
|
+
|
Dogan et al. 2013 (28)
(CS)
|
Turkey
|
Primary
|
3171
|
8-60 mo
(M, F)
|
Clinic
|
WHO (dft)
|
Chi-Square
|
ECCP=17.3%
dft=0.63 (1.79)
|
Age
|
+
|
Namal et al. 2005 (29)
(CS)
|
Turkey
|
Primary
|
598
|
3-6 y
(M, F)
|
School
|
WHO (dft)
|
Multiple logistic regression
|
dft=74.1%
|
Age
|
+
|
Olmez et al. 2003 (30)
(CS)
|
Turkey
|
Primary
|
95
|
9-57 mo
(M, F)
|
Clinic
|
WHO (dft)
|
Chi-Square,
Kruskal- Wallis
|
DCP=75.5%
dft=6.2
|
Age
|
+
|
Bener et al. 2013 (15)
(CS)
|
Qatar
|
Permanent
|
1284
|
6-15 y
(M, F)
|
Clinic
|
WHO (DMFT)
|
Multivariate
analysis
|
DCP=73%
DMFT=4.5
|
Age
|
Unclear
|
Khadri et al. 2018 (16)
(CS)
|
UAE
|
Permanent
|
803
|
11-17 y
(M, F)
|
School
|
WHO (DMFT)
|
Multivariate regression
|
DCP=75%
DMFT=3.19 (SD 2.9)
|
Age
|
+
|
Hashim et al. 2006 (9)
(CS)
|
UAE
|
Primary
|
1036
|
5,6 y
(M, F)
|
School
|
WHO (dmft, dmfs)
|
Chi-Square,
ZINB regression
|
DCP=76.1%
dmft=4.4
dmfs=10.2
|
Weight status
|
|
|
|
|
|
|
|
|
|
|
Over weight
|
+
|
Jahani et al. 2013 (12)
(CS)
|
Iran
|
Primary
Permanent
|
845
|
9 y
(M, F)
|
School
|
WHO (dmft/DMFT)
|
Ordinal logistic regression
|
Moderate to high DCP1=50% of the children
|
BMI
|
+
|
Bagherian & Sadeghi, 2013 (31)
(CS)
|
Iran
|
Primary
|
400
|
30-70 m (M, F)
|
Not specified
|
WHO (defs)
|
Multiple logistic regression
|
ECCP=55.2%
S-ECCP=51.2%
defs=8.37 (SD 11.2)
|
BMI
|
+
|
Abu El Qomsan et al. 2017 (32)
(CS)
|
KSA
|
Permanent
|
386
|
6-12 y
(M, F)
|
School and Clinic
|
WHO (DMFT, DT, FT)
|
One-way ANOVA,
Spearman’s
|
DT:
Underweight=3.06 (SD 1.48)
Normal weight=2.90 (SD 2.34)
Over weight=3.69 (SD 2.39)
Obese=4.00 (SD 2.57)
FT:
Underweight=0.25 (SD 0.68)
Normal weight=0.34 (SD 0.95)
Over weight=0.39 (SD 0.70)
Obese=0.68 (SD 1.18)
|
BMI
|
-
|
Alghamdi & Almahdy,
2017 (33)
(CS)
|
KSA
|
Permanent
|
610
|
14-16 y
(M)
|
School
|
Not specified DMFT
|
Logistic regression
|
DCP=54.1%
|
Low BMI
|
+
|
Quadri et al. 2017 (34)
(CS)
|
KSA
|
Primary
Permanent
|
360
|
6-15 y
(M, F)
|
School
|
WHO (dft/DMFT)
|
Logistic regression
|
dft/DMFT=
2.52 (F),
1.88 (M)
|
BMI
|
-
|
Goodson et al. 2013 (8)
(CS)
|
Kuwait
|
Primary
Mixed
Permanent
|
8,319
|
Mean age=11.36 y (grade 4 & 5)
(M, F)
|
School
|
Percentage of decayed or filled teeth1
|
Multivariate rank-based Wilcoxon regression
|
Decayed or filled teeth (all body weights)
=11.01% (SEM 0.11)
Decayed or filled teeth
(males)=11.76 % (SEM 0.19)
Decayed or filled teeth
(females)=10.53% (SEM 0.14)
|
Under weight
|
+
|
Köksal et al. 2011 (35)
(CS)
|
Turkey
|
Primary
Permanent
|
245
|
5-6 y
(M. F)
|
Unclear
|
WHO (dmft, DMFT, dmfs)
|
Chi-Square,
Mann- Whitney, Spearman’s
|
DCP=85.9%
dmft=5.3 (SD 3.78)
DMFT=0.27(SD 0.74)
dmfs=10.5(SD 9.67)
DMFS=0.33(SD 0.95)
|
Weight status
|
Variedd
|
Bhayat et al. 2016 (36)
(CS)
|
KSA
|
Permanent
|
402
|
12 y
(M)
|
School
|
WHO
(DMFT)
|
Linear regression
|
DCP=49%
DMFT=1.46 (SD 2.04)
|
BMI
|
+
|
Bener et al. 2013 (15)
(CS)
|
Qatar
|
Permanent
|
1284
|
6-15 y
(M, F)
|
Clinic
|
WHO (DMFT)
|
Multivariate analysis
|
DCP=73%
DMFT=4.5
|
AAPD American Association Paediatric Dentistry, BASCD British Association for the Study of Community Dentistry, CS Cross-sectional, CC Case control, DCP Dental caries prevalence, deft decayed, extracted due to caries and filled primary teeth, dfs decayed, filled surfaces in primary teeth, dft decayed, filled primary teeth, dmfs decayed, missing and filled surfaces in primary teeth; DMFS decayed, missing and filled surfaces in permanent teeth, dmft decayed, missing, filled primary teeth, DMFT decayed, missing, filled permanent teeth, ECC Early childhood caries, ECCP Early childhood caries prevalence, F Female, ICADS The international caries Detection and Assessment System, L Longitudinal, KSA Kingdom of Saudi Arabia, m months M Male, WHO World Health Organisation, SiC Significant caries index, SD Standard deviation, y years
aThe author calculated this as follows the decayed or filled teeth (%)=100 x [(number of primary teeth with fillings) +(number of permanent teeth with fillings) +(number of decayed primary teeth)+(number decayed permanent teeth)]/[(number of primary teeth)+(number of permanent teeth)].
bThe children were categorized into three groups on the basis of WHO caries severity classification. Low caries level was defined as dmft/DMFT≤2.6, moderate caries as dmft/DMFT of 2.7-4.4 and high caries as dmft/DMFT>4.4.
cSayegh et al. 2002 and Sayegh et al. 2005 seem to be based on the same study population and the results mentioned in this table, have been reported in both articles.
dNormal weight status-positive association to caries, whereas the caries prevalence was lower in under and overweight children
Table 3 Statistically significant socio-economic, socio-demographic, school type and geographical-related determinants contributing to dental caries
Determinants
|
Association: Positive (+), Negative (-)
|
Author
Study design
|
Country
|
Type of dentition
|
N
|
Age group (Gender)
|
Study
setting
|
Scoring system
|
Type/s of statistical analysis
|
Dental caries/
scoring results
|
Mother’s attributes
|
|
|
|
|
|
|
|
|
|
|
Mother’s
education
|
-
|
Abu Hamila, 2013 (1)
(CS)
|
Egypt
|
Primary
|
560
|
1-3.5 y
(M, F)
|
Clinic
|
WHO
(dmft)
|
Chi-Square
|
ECCP=69.6%
dmft=2.1-7.6
|
Mother’s
education
|
-
|
Bashirian et al. 2018 (2)
(CS)
|
Iran
|
Primary
Permanent
|
988
|
7-12 y
(M, F)
|
School
|
WHO
(dmft, DMFT)
|
ANOVA
|
DCP=80.36%
dmft=3.61
DMFT=0.79
|
Mother’s
education
|
-
|
Shaghaghian et al. 2018 (3)
(CS)
|
Iran
|
Primary
|
396
|
3-6 y
(M, F)
|
School
|
WHO
(dmft)
|
Multivariate analysis
|
DCP=69.9%
dmft=3.88
|
Mother’s
education
|
-
|
Haghdoost et al. 2017 (4)
(CS)
|
Iran
|
Primary
Permanent
|
8725
|
6 y
(M, F)
|
Clinic
|
WHO
|
Linear regression,
Logistic regression
|
DCP=87%
|
Mother’s
education
|
-
|
Khani-Varzegani et al. 2017 (5)
(CS)
|
Iran
|
Primary
|
756
|
4-7 y
(M, F)
|
School
|
WHO
(dmft)
|
Multivariate analysis
|
dmft median (25th-75th percentile):
All=4(2-8)
Males= 4(2-9)
Females=5(2-8)
|
Mother’s
education (low levels)
|
+
|
Alhabdan et al. 2018 (6)
(CS)
|
KSA
|
Primary
|
578
|
6-8 y
(M, F)
|
School
|
WHO
(dmft)
|
Adjusted Odds Ratios
Multivariate model logistic regression
|
DCCP=83%
dmft 4.20 (SD 2.96)
|
Mother’s
education
|
-
|
Al-Meedani, 2016 (7)
(CS)
|
KSA
|
Primary
|
388
|
3-5 y
(M, F)
|
School
|
WHO
(dmft, dmfs)
|
Chi-Square
Z-test
|
DCP=69%
dmft=3.4
dmfs=6.9
|
Mother’s
education
|
-
|
Quadri et al. 2015 (8)
(CS)
|
KSA
|
Primary
Permanent
|
853
|
6-15 y
(M, F)
|
School
|
WHO
(dft, DMFT)
|
Multi regression
|
DCP=91.3%
|
Mother’s
education
|
-
|
Al-Malik et al. 2002 (9)
(CS)
|
KSA
|
Primary
|
987
|
2-5 y
(M, F)
|
School
|
BASCD
(dmft, dmfs)
|
Stepwise multiple
logistic regression
|
DCP=73%
Rampant caries=43%
dmft=4.8
dmfs=12.7
|
Mother’s
education (number of filled teeth in the child)
|
+
|
Azizi et al. 2014 (10)
(CS)
|
Palestine
|
Primary
|
1376
|
4-6 y
(M, F)
|
Clinic
|
WHO
(dmft)
|
Not indicated
|
DCP=76%
dmft =2.46
|
Mother’s
education
|
-
|
Ozer et al. 2011 (11)
(CS)
|
Turkey
|
Primary
|
226
|
3-6 y
(M, F)
|
School
|
WHO (dmft)
AAPD
|
Bivariate analysis
|
ECCP=46.9%
dmft=2.87
|
Mother’s
education
|
-
|
Namal et al. 2009 (12)
(CS)
|
Turkey
|
Primary
|
542
|
5-6 y
(M, F)
|
School
|
WHO (dmft)
|
Multiple logistic regression
|
DCP=76.8%
dmft=3.74 (3.49)
SiC=7.75 (2.56)
|
Mother’s
education
|
-
|
Elamin et al. 2018 (13)
(CS)
|
UAE
|
Primary
|
186
|
1.5-4 y (M, F)
|
School
|
WHO (dmft)
|
T-test,
Pearson-s
|
DCP: 41%
dmft:1.7±2.81
|
Mother’s
occupation (Employed)
|
+
|
Abu Hamila, 2013 (1)
(CS)
|
Egypt
|
Primary
|
560
|
1-3.5 y
(M, F)
|
Clinic
|
WHO
(dmft)
|
Chi-Square
|
ECCP=69.6%
dmft=2.1-7.6
|
Mother’s
occupation
(Not employed)
|
+
|
Amin & Al-Abad, 2008 (14)
(CS)
|
KSA
|
Permanent
|
1115
|
10-14 y
(M)
|
School
|
WHO
|
Stepwise logistic regression
|
DCP=68.9%
|
Mother’s caries experience
|
+
|
Kabil & Eltawil, 2016 (15)
(CS)
|
Egypt
|
Primary
|
140
|
2-4 y
(M, F)
|
Clinic
|
WHO
(DMFT)
AAPD
|
Logistic regression
|
DMFT=9.96
|
Mother’s current caries experience
|
+
|
Kabil & Eltawil,
2017 (16)
(CS)
|
Egypt
|
Primary
|
108
|
2-4 y
(M, F)
|
Clinic
|
WHO
|
Logistic regression
|
ECCP=57% (2-3yrs), 73% (3-4yrs)
|
Father’s attributes
|
|
|
|
|
|
|
|
|
|
|
Father’s education
(CAST score of ≥3 in primary molar teeth)
|
-
|
Babaei et al. 2019 (17)
(CS)
|
Iran
|
Primary & Permanent
molar teeth
|
739
|
6-7 y
(M, F)
|
School
|
CAST indexa
|
Multivariate logistic regression
|
Permanent molars:
Healthy status in
89.3–93.7% of the teeth.
Primary molars:
Morbidity status in 25.3 to 31.2% of the teeth
Serious morbidity status with
Pulp involvement in 2.9 -10.5% of the teeth and abscess/fistula in < 1% of the teeth
|
|
-
|
Bayat-Movahed et al. 2011 (18)
(CS)
|
Iran
|
Primary
Permanent
|
18946
|
3,6,9,12 y
(M, F)
|
Community health centres
|
WHO
(dmft, DMFT)
|
T-test,
Z test
|
dmft= 1.9 (3y)
dmft=5.0 (6y)
dmft=3.6 (9y)
dmft=0.6 (12y)
DMFT=0.2 (6y)
DMFT=0.9 (9y)
DMFT=1.9 (12y)
|
|
-
|
Huew et al. 2011 (19)
(CS)
|
Libya
|
Permanent
|
791
|
12 y
(M, F)
|
School
|
WHO (DMFT, DMFS)
|
Multivariate analysis
|
DCP=57.8%
DMFT=1.78
DMFS=2.39
|
Father’s Education
|
Unclear
|
Khadri et al. 2018 (20)
(CS)
|
UAE
|
Permanent
|
803
|
11-17 y
(M, F)
|
School
|
WHO (DMFT)
|
Multivariate regression
|
DCP=75%
DMFT=3.19 (SD 2.9)
|
Father’s Occupation
|
+
|
Shaghaghian et al. 2018 (3)
(CS)
|
Iran
|
Primary
|
396
|
3-6 y
(M, F)
|
School
|
WHO
(dmft)
|
Multivariate analysis
|
DCP=69.9%
dmft=3.88
|
Father’s occupation
(Low educational occupations)
|
+
|
Namal et al. 2005 (21)
(CS)
|
Turkey
|
Primary
|
598
|
3-6 y
(M, F)
|
School
|
WHO (dft)
|
Multiple logistic regression
|
DCP=74.1%
|
Father’s occupation
(Self-employment)
|
+
|
Amanlou et al. 2011 (22)
(CS)
|
Iran
|
Primary
Permanent
|
205
|
3-6 y
(M, F)
|
School
|
WHO
(DMFT)b
|
Stepwise multiple regression
|
DCP=49.3%
DMFT=0.99 (SD 0.13)
|
Parents attributes
|
|
|
|
|
|
|
|
|
|
|
Parents’ education (primary dentition)
|
-
|
Abbass et al. 2019 (23)
(CS)
|
Egypt
|
Primary. Mixed, Permanent
|
369
|
3-18 y
(M, F)
|
Clinic
|
WHO
(dmft, deft, DMFT)
|
Kruskal- Wallis, Spearman’s
|
DCP=74% dmft=3.23 (SD 4.07)
deft=4.21 (SD 3.21)
DMFT=1.04 (SD 1.56)
|
Parents’ education level
|
-
|
Sistani et al, 2017 (24)
(CS)c
|
Iran
|
Primary
|
2080
|
3-6 y
(M, F)
|
School
|
WHO (dmft)
|
T-test,
ANOVA
|
ECCP varied between 51.1%-71.9% during 2007-2015
dmft=4.01 (SD 3.89)
|
Socio-economic factorsd
|
+
|
Ahmed et al. 2007 (25)
(CS)
|
Iraq
|
Permanent
|
392
|
12 y
(M, F)
|
School
|
WHO
(DMFT)
|
ANOVA
|
DCP=62%
DMFT=1.7
|
|
-
|
Al-Mendalawi & Karam, 2014 (26)
(CC)
|
Iraq
|
Primary
|
684
|
<6 y
(M, F)
|
Clinic
|
WHO
(DMFT)e
|
Chi-Square
|
DMFT=2.03
|
Parents Education
|
-
|
Rajab et al. 2014 (27)
(CS)
|
Jordan
|
Primary
Permanent
|
2496 (6 y)
2560 (12 y)
|
6 y, 12 y
(M, F)
|
School
|
WHO (dmft, DMFT)
|
Multivariate analysis linear regression
|
DCP=76.4% (6 y)
DCP=45.5% (12 y)
dmft=3.3 (6 y)
DMFT=1.1 (12 y)
|
Parents’ employment status
|
-
|
Sistani et al, 2017 (24)
(CS)c
|
Iran
|
Primary
|
2080
|
3-6 y
(M, F)
|
School
|
WHO (dmft)
|
T-test,
ANOVA
|
ECCP varied between 51.1%-71.9% during 2007-2015
dmft=4.01 (SD 3.89)
|
Parents’ employment status
|
-
|
Khodadadi et al.
2016 (28)
(CS)
|
Iran
|
Primary
|
384
|
21-84 mo
(M, F)
|
Not specified
|
WHO (dmft)
|
Multiple linear regression
|
dmft=8.2
|
Socio-economic statusf
|
-
|
Abbass et al. 2019 (23)
(CS)
|
Egypt
|
Primary. Mixed, Permanent
|
369
|
3-18 y
(M, F)
|
Clinic
|
WHO
(dmft, deft, DMFT)
|
Kruskal- Wallis, Spearman’s
|
DCP=74% dmft=3.23 (SD 4.07)
deft=4.21 (SD 3.21)
DMFT=1.04 (SD 1.56)
|
Family affluent scale
|
-
|
Khani-Varzegani et al. 2017 (5)
(CS)
|
Iran
|
Primary
|
756
|
4-7 y
(M, F)
|
School
|
WHO
|
Multivariate analysis
|
dmft median (25th-75th percentile):
All=4(2-8)
Boys=4(2-9)
Girls= 5(2-8)
|
Income
|
-
|
Al-Mendalawi & Karam, 2014 (26)
(CC)
|
Iraq
|
Primary
|
684
|
<6 y
(M, F)
|
Clinic
|
WHO
(DMFT)e
|
Chi-Square
|
DMFT=2.03
|
Low family income
|
+
|
Alhabdan et al. 2018 (6)
(CS)
|
KSA
|
Primary
|
578
|
6-8 y
(M)
|
School
|
WHO
(dmft)
|
Adjusted Odds Ratios,
Multivariate model logistic regression
|
DCCP=83%
dmft 4.20 (SD 2.96)
|
Lack of dental insurance-
|
+
|
Alhabdan et al. 2018 (6)
(CS)
|
KSA
|
Primary
|
578
|
6-8 y
(M)
|
School
|
WHO
(dmft)
|
Adjusted Odds Ratios,
Multivariate model logistic regression
|
DCCP=83%
dmft 4.20 (SD ±2.96)
|
Socio-Economic Status8
|
-
|
Alghamdi & Almahdy, 2017 (29)
(CS)
|
KSA
|
Permanent
|
610
|
14-16 y
(M)
|
School
|
Not specified (DMFT)
|
Logistic regression
|
DCP=54.1%
|
Socio-Economic Statush
|
-
|
Rajab et al. 2014
(27)
(CS)
|
Jordan
|
Primary
Permanent
|
2496 (6 y)
2560 (12 y)
|
6 y, 12 y
(M, F)
|
School
|
WHO (dmft, DMFT)
|
Multivariate analysis linear regression
|
DCP=76.4% (6 y)
DCP=45.5% (12 y)
dmft=3.3 (6 y)
DMFT=1.1 (12 y)
|
Household income
|
+
|
Bener et al. 2013 (30)
(CS)
|
Qatar
|
Permanent
|
1284
|
6-15 y
(M, F)
|
Clinic
|
WHO (DMFT)
|
Multivariate
analysis
|
DCP=73%
DMFT=4.5
|
House Hold Income
|
-
|
Hashim et al. 2011 (31)
(CS)
|
UAE
|
Primary
|
1036
|
3-6 y
(M, F)
|
School
|
WHO
|
Logistic regression
|
Severe ECCP=31.1%
|
Family demographic
|
|
|
|
|
|
|
|
|
|
|
Sibling order
|
Varied i
|
Abu Hamila, 2013 (1)
(CS)
|
Egypt
|
Primary
|
560
|
1-3.5 y
(M, F)
|
Clinic
|
WHO
(dmft)
|
Chi-Square
|
ECCP=69.6%
dmft=2.1-7.6
|
Number of Siblings
|
+
|
Shaghaghian et al. 2018 (3)
(CS)
|
Iran
|
Primary
|
396
|
3-6 y
(M, F)
|
School
|
WHO
(dmft)
|
Multivariate analysis
|
DCP=69.9%
dmft=3.88
|
Large family size
|
+
|
Al-Meedani, 2016 (7)
(CS)
|
Iraq
|
Primary
|
684
|
0-6 y
(M, F)
|
Clinic
|
WHO
(dmft, dmfs)
|
Chi-Square,
Z-test
|
DCP=69%
dmft=3.4
dmfs=6.9
|
Large family size
|
+
|
Amin & Al-Abed, 2008 (14)
(CS)
|
KSA
|
Permanent
|
1115
|
10-14 y
(M)
|
School
|
WHO
|
Stepwise
logistic regression
|
DCP=68.9%
|
Nationality (Emirati)
|
+
|
Elamin et al. 2018 (13)
(CS)
|
UAE
|
Primary
|
186
|
1.5-4 y (M, F)
|
School
|
WHO (dmft)
|
T-tests,
Pearson’s
|
DCP=41%
dmft=1.7 (SD 2.81)
|
Geographical Location
|
Variedj
|
Al Mutawa et al. 2010 (32)
(CS)
|
Kuwait
|
Primary
|
1277
|
4 &5 y
(M, F)
|
School
|
WHO
|
T-test
Chi Square
|
dft/dfs=3.7/6.9 (4 y)
dft/dfs=4.8/9.6 (5 y)
|
Geographical Location
|
Variedk
|
Ballouk & Dashash 2019
(33)
(CS)
|
Syria
|
Primary
Permanent
|
1500
|
8-12 y
(M, F)
|
School
|
WHO
(DMFT, dmft)
|
ANOVA
Chi-Square
|
DCP=79.1%
dmft=2.47 (SD 2.94)
DMFT=2.03 (SD 1.81)
|
Rural living
|
+
|
Al-Mendalawi & Karam, 2014 (26)
(CC)
|
Iraq
|
Primary
|
684
|
<6 y
(M, F)
|
Clinic
|
WHO
(DMFT)e
|
Chi-Square
|
DMFT=2.03
|
Rural living
|
+
|
Elamin et al. 2018 (13)
(CS)
|
UAE
|
Primary
|
186
|
1.5-4 y (M, F)
|
School
|
WHO (dmft)
|
T-test,
-Pearson’s
|
DCP=41%
Dmft=1.7 (SD 2.81)
|
Urban living
|
+
|
Bayat-Movahed et al. 2011 (18)
(CS)
|
Iran
|
Primary
Permanent
|
18946
|
3,6,9,12 y
(M, F)
|
Community health centres
|
WHO
|
T-test
Z-test
|
dmft= 1.9 (3y)
dmft=5.0 (6y)
dmft=3.6 (9y)
dmft=0.6 (12y)
DMFT=0.2 (6y)
DMFT=0.9 (9y)
DMFT=1.9 (12y)
|
Semi-urban living
|
+
|
Al Darwish et al. 2014 (34)
(CS)
|
Qatar
|
Permanent
|
2113
|
12-14 y
(M, F)
|
School
|
WHO (DMFT)
|
Multinomial logistic regression,
Adjusted Odds Ratio
|
DCP=85%
DMFT (12 y) =4.62 (SD 3.2)
DMFT (13 y) =4.79 (SD 3.5)
DMFT (14 y) =5.51 (SD 3.7)
|
School type
|
|
|
|
|
|
|
|
|
|
|
Public Schools
|
+
|
Farsi & Elkhodary 2017 (35)
(CS)
|
KSA
|
Permanent
|
801
|
Mean age=16.5 y
(Grade 11)
(M, F)
|
School
|
ASTDD (DT)
|
Mann- Whitney
|
DT boys=3.9 (SD 3.5)
DT girls=4.9 (SD 3.7)
|
Public Schools
|
+
|
Al-Malik et al. 2002 (9)
(CS)
|
KSA
|
Primary
|
987
|
2-5 y
(M, F)
|
School
|
BASCD
(dmft, dmfs)
|
Stepwise multiple logistic regression
|
DCP=73%
Rampant caries=43%
dmft=4.8
dmfs=12.7
|
Private schools
|
-
|
Sgan-Cohen et al. 2015 (36)
(CS)
|
Palestine
|
Permanent
|
286
|
12 y
(M, F)
|
School
|
WHO
(DMFT)
|
Multivariate analysis
|
DMFT =1.98
|
Public schools
|
+
|
Cinar & Murtomaa, 2011 (37)
(CS)
|
Turkey
|
Permanent
|
611
|
10-12 y
(M, F)
|
School
|
WHO (DMFS)
|
T-test
Chi-Square
Logistic regression
|
DMFS=4.44 (public school)
DMFS=2.64 (private school)
|
Public schools
|
+
|
Cinar & Murtromaa, 2008 (38)
(CS)
|
Turkeyl
|
Permanent
|
611
|
10-12 y
(M, F)
|
School
|
WHO (DMFT)
|
T-test
Logistic regression
|
DMFT= 2.93
|
AAPD American Association Paediatric Dentistry, BASCD British Association for the Study of Community Dentistry, CS Cross-sectional, CC Case control, DCP Dental caries prevalence, deft decayed, extracted due to caries and filled primary teeth, dfs decayed, filled surfaces in primary teeth, dft decayed, filled primary teeth, dmfs decayed, missing and filled surfaces in primary teeth; DMFS decayed, missing and filled surfaces in permanent teeth, dmft decayed, missing, filled primary teeth, DMFT decayed, missing, filled permanent teeth, ECC Early childhood caries, ECCP Early childhood caries prevalence, F Female, ICADS The international caries Detection and Assessment System, L Longitudinal, KSA Kingdom of Saudi Arabia, m months M Male, WHO World Health Organisation, SiC Significant caries index, SD Standard deviation, y years
aThe CAST index scoring system is as follows: “0: sound”, “1: sealant”, “2: restoration”, “3: enamel lesions”, “4, 5: dentine lesions”, “6: pulp involvement”, “7: abscess/fistula”, “8: tooth loss”. If a situation did not match any codes from 0 to 8, a code 9 was assigned. The codes 0–2, 3, 4–5, 6–7, and 8 were considered as “healthy”, “pre-morbidity”, “morbidity”, “serious morbidity”, and “mortality”, respectively
bThe authors describe their scoring as WHO (DMFT) whereas it should be noted that the age group is 3-6 year olds where normally WHO (dmft) is being used.
cData was collected during 9 years. In each year data was collected in a new sample.
dThe mean FT score was significantly higher for children having mothers with higher education, fathers with higher education and for residents of higher socio-economic areas, as compared to their counterparts in the opposite groups.
eThe authors describe their scoring as WHO(DMFT) whereas it should be noted that the age group is 0-6 year olds where normally WHO (dmft) is being used.
fThe SES level was based on the level of parental education and its type, guardians’ occupation and address.
gSES score based on parental education and suburban location of residence.
hSES score based on school type: low SES: deprived areas and refugee camps, medium SES: state schools, high SES: private schools
iThe sibling order impacts dental caries status: 84.44%, 74,37%, 40.19% and 77.65% of only, eldest, middle and youngest child/ren had dental caries, respectively.
jDental caries prevalence differed between the 6 different regions/governorates in Kuwait but the characteristics of the regions are not described.
kDental caries prevalence differed between different parts/regions in Damascus but the characteristics of the regions are not described
lA comparative study with Finland.
Table 4 Statistically significant dental related determinants/risk factors contributing to dental caries
Determinants
|
Association:
Positive (+),
Negative (-)
|
Author, year
(Study design)
|
Country
|
Type of dentition
|
N
|
Age group
(gender)*
|
Study setting
|
Scoring system
|
Type/s of statistical analysis
|
Dental caries/ scoring system
|
Tooth brushing frequency
|
|
|
|
|
|
|
|
|
|
|
Tooth brushing-frequent
(Primary, mixed)
|
-
|
Abbas et al. 2019 (1)
(CS)
|
Egypt
|
Primary. Mixed, Permanent
|
369
|
3-18 y
(M, F)
|
Clinic
|
WHO
(dmft, deft, DMFT)
|
Kruskal- Wallis, Spearman’s
|
DCP=74% dmft=3.23 (SD 4.07)
deft=4.21 (SD 3.21)
DMFT=1.04 (SD 1.56)
|
Tooth brushing-frequent
|
-
|
Amanlou et al. 2011 (2) (CS)
|
Iran
|
Primary
Permanent
|
205
|
3-6 y
(M, F)
|
School
|
WHO (DMFT)a
|
Stepwise multiple regression
|
DCP=49.3%
DMFT=0.99 (SD 0.13)
|
Tooth brushing-frequent
|
-
|
Shaghaghian et al. 2018 (3)
(CS)
|
Iran
|
Primary
|
396
|
3-6 y
(M, F)
|
School
|
WHO
(dmft)
|
Multivariate analysis
|
DCP=69.9%
dmft=3.88
|
Tooth brushing-frequent
|
-
|
Al-Mendalawi & Karam,
2014 (4)
(CC)
|
Iraq
|
Primary
|
684
|
<6 y
(M, F)
|
Clinic
|
WHO
(dmft)
|
Chi-Square
|
dmft=2.03
|
Tooth brushing-frequent
|
-
|
Bener et al. 2013 (5)
(CS)
|
Qatar
|
Permanent
|
1284
|
6-15 y
(M, F)
|
Clinic
|
WHO (DMFT)
|
Multivariate analysis
|
DCP=73%
DMFT=4.5
|
Tooth brushing-frequent
|
-
|
Namal et al. 2009 (6)
(CS)
|
Turkey
|
Primary
|
542
|
5-6 y
(M, F)
|
School
|
WHO (dmft)
|
Multiple
logistic regression
|
DCP=76.8%
dmft=3.74 (SD 3.49)
SiC=7.75 (SD 2.56)
|
Tooth brushing-frequent
|
-
|
Tulunoğlu et al. 2007 (7)
(L)b
|
Turkey
|
Primary
Permanent
|
733
|
6-8 y
(M, F)
|
School
|
WHO
(dfs, DFS)
|
Chi-Square
|
dfs Baseline:
GI:2.79, GII:3.12,
GIII: 2.9
Dfs Final:
GI: 2.14, GII:3.79,
GIII: 3.69
DFS Baseline:
GI: 0.16, GII: 0.20,
GIII: 0.15
DFS Final:
GI: 0.79, GII: 0.80
GIII: 1.46
|
Tooth brushing-frequent
|
-
|
Elamin et al. 2018 (8)
(CS)
|
UAE
|
Primary
|
186
|
1.5-4 y
(M, F)
|
School
|
WHO (dmft)
|
T-test,
Pearson’s
|
DCP: 41%
dmft:1.7 (SD 2.81)
|
Tooth brushing-frequent
|
-
|
Kowash et al. 2017(9)
(CS)
|
UAE
|
Primary
|
540
|
4-6 y
(M, F)
|
School
|
WHO
(dmft)
|
Chi-Square
|
ECCP=74.1%
dmft=3.01
SiC=13.3
|
Tooth brushing -irregular or no brushing
|
+
|
Alhabdan et al. 2018 (10)
(CS)
|
KSA
|
Primary
|
578
|
6-8 y
(M)
|
School
|
WHO
(dmft)
|
Adjusted Odds Ratios,
Multivariate model logistic regression
|
DCP: 83%
dmft=4.20 (SD 2.96)
|
Tooth brushing -Irregular or no brushing
|
+
|
Paul, 2003 (11)
(CS)
|
KSA
|
Primary
|
103
|
5 y
(M, F)
|
Clinic
|
WHO (dmft)
|
Chi-Square
|
DCP=83.5%
dmft=7.1 (SD 5.7)
|
Tooth brushing initiation age
|
|
|
|
|
|
|
|
|
|
|
Tooth brushing initiation -late
|
+
|
Alhabdan et al. 2018 (10)
(CS)
|
KSA
|
Primary
|
578
|
6-8 y
(M)
|
School
|
WHO
(dmft)
|
Adjusted Odds Ratios,
Multivariate model logistic regression
|
DCP: 83%
dmft 4.20 (SD 2.96)
|
Tooth brushing initiation -late
|
+
|
Al-Malik et al. 2002 (12)
(CS)
|
KSA
|
Primary
|
987
|
2-5 y
(M, F)
|
School
|
BASCD
|
Stepwise multiple ogistic regression
|
DCP=73%
ECCP=43%
dmft=4.8
dmfs=12.7
|
Tooth brushing with adult help & aid
|
|
|
|
|
|
|
|
|
|
|
Tooth brushing with adult help
|
-
|
Bashirian et al. 2018 (13)
(CS)
|
Iran
|
Primary
|
988
|
7-12 y
(M, F)
|
School
|
WHO
(dmft, DMFT)
|
ANOVA
|
DCP=80.36%
dmft=3.61
DMFT=0.79
|
Tooth brushing with adult help
|
-
|
Al-Malik et al. 2002 (12)
(CS)
|
KSA
|
Primary
|
987
|
2-5 y
(M, F)
|
School
|
BASCD
|
Stepwise multiple logistic regression
|
DCP=73%
ECCP =43%
dmft=4.8
dmfs=12.7
|
Tooth brushing- with use of fluoridated toothpaste
|
-
|
Alghamdi & Almahdy,
2017 (14)
(CS)
|
KSA
|
Permanent
|
610
|
14-16 y
(M)
|
School
|
Not specified
|
Logistic regression
|
DCP=54.1%
|
Oral hygiene and practices attributes
|
|
|
|
|
|
|
|
|
|
|
Oral hygienec
(CAST score of ≥3 in primary molar teeth)
|
+
|
Babaei et al. 2019 (15)
(CS)
|
Iran
|
Primary & Permanent
molar teeth
|
739
|
6-7 y
(M, F)
|
School
|
CAST indexd
|
Multivariate logistic regression
|
Permanent molars:
Healthy status in
89.3–93.7% of the teeth.
Primary molars:
Morbidity status in 25.3 to 31.2% of the teeth
Serious morbidity status with
Pulp involvement in 2.9 -10.5% of the teeth and abscess/fistula in
<1% of the teeth
|
Oral Hygiene-dental plaque presence
|
+
|
Mohebbi et al.
2006 (16)
(CS)
|
Iran
|
Primary
|
504
|
12-36 mo
(M, F)
|
Clinic
|
WHO
(dmft)
|
Logistic regression
|
ECCP:
12-15 mo=3%
16-19 mo=9%
20-25 mo=14%
26-36 mo=33%
dmft=
<0.1 (12-15 mo)
dmft=0.2 (16-19 mo)
dmft=0.4(20-25 mo)
dmft=1.2(26-36 mo)
|
Oral hygiene-poor
|
+
|
Al-Mutawa el al. 2006 (17)
(CS)
|
Kuwait
|
Primary
Permanent
|
4588
|
5,6,12,14 y
(M, F)
|
School
|
WHO
(dft, DMFT, DFS)
|
Multivariate analysis
|
dft=4.6 (5-6 y)
DMFT=0.4(6 y)
DMFT=2.6 (12y)
DMFT=3.9 (14 y)
DFS=0.4 (6y)
DFS=3.4 (12 y)
DFS=5.2 (14 y)
|
Oral hygiene-poor
|
+
|
Amin & Al-Abad, 2008 (18)
(CS)
|
KSA
|
Permanent
|
1115
|
10-14 y
(M)
|
School
|
WHO
|
Stepwise logistic regression
|
DCP=68.9%
|
Oral hygiene-poor
|
+
|
Dashash & Blinkhorn, 2012 (19)
(CS)
|
Syria
|
Primary
|
727
|
5 y
(M, F)
|
School
|
WHO (dmft, DMFT)
|
Multiple logistic regression
|
DCP=61%
dmft=3.27(3.71)
|
Oral hygiene-poor
|
+
|
Jaghasi et al. 2012 (20)
(CS)
|
Syria
|
Not specified
|
504
|
6-12y
(M, F)
|
School
|
WHO
|
Logistic regression
|
DCP=85%
|
Oral practices-poor
|
+
|
Kowash et al. 2017 (9)
(CS)
|
UAE
|
Primary
|
540
|
4-6 y
(M, F)
|
School
|
WHO
(dmft)
|
Chi-Square
|
ECCP=74.1%
dmft=3.01
SiC=13.3
|
Not feeling embarrassed when smiling
|
-
|
Ahmed et al. 2007 (21)
(CS)
|
Iraq
|
Permanent
|
392
|
12 y
(M, F)
|
School
|
WHO
(DMFT)
|
ANOVA
|
DCP=62%
DMFT=1.7
|
Permanent dentition
|
+
|
Al-Mutawa el al. 2006 (17)
(CS)
|
Kuwait
|
Primary
Permanent
|
4588
|
5,6,12,14 y
(M, F)
|
School
|
WHO
(dft, DMFT, DFS)
|
Multivariate analysis
|
dft=4.6 (5-6 y)
DMFT=0.4 (6 y)
DMFT=2.6 (12y)
DMFT-3.9 (14 y)
DFS=0.4 (6 y)
DFS=3.4 (12 y)
DFS=5.2 (14 y)
|
Dental services visits attributes
|
|
|
|
|
|
|
|
|
|
|
Dental services -child’s first visit
|
-
|
Kabil & Eltawil,
2017 (22)
(CS)
|
Egypt
|
Primary
|
108
|
2-4 y
(M, F)
|
Clinic
|
WHO
|
Logistic regression
|
ECCP=57% (2-3 y) ECCP=73% (3-4 y)
|
Dental visits-regular
|
-
|
Kabil and Eltawil, 2016 (23)
(CS)
|
Egypt
|
Primary
|
140
|
2-4 y
(M, F)
|
Clinic
|
WHO
AAPD-ECC
|
Logistic regression
|
DMFT=9.96
|
Dental visits-regular
|
-
|
Alhumaid et al. 2018 (24)
(CS)
|
KSA
|
Primary
Permanent
|
921
|
6-12 y
(M, F)
|
School
|
Basic screening survey
|
Multivariate analysis
|
DCP=63.5%
|
Dental services -not attending for preventive measures
|
+
|
Dashash & Blinkhorn, 2012 (19)
(CS)
|
Syria
|
Primary
|
727
|
5 y
(M, F)
|
School
|
WHO (dmft, DMFT)
|
Multiple logistic regression
|
DCP=61%
dmft=3.27 (SD 3.71)
|
Dental visits- for pain complaints/dental problems
|
+
|
Shaghaghian et al. 2018 (3)
(CS)
|
Iran
|
Primary
|
396
|
3-6 y
(M, F)
|
School
|
WHO
|
Multivariate analysis
|
DCP=69.9%
dmft=3.88
|
Dental visits- for pain complaints/dental problems
|
+
|
Alhabdan et al. 2018 (10)
(CS)
|
KSA
|
Primary
|
578
|
6-8 y
(M)
|
School
|
WHO (dmft)
|
Adjusted Odds Ratios,
Multivariate model logistic regression
|
DCP: 83%
dmft=4.20 (SD 2.96)
|
Dental visits
|
Unclear
|
Khadri et al. 2018 (25)
(CS)
|
UAE
|
Permanent
|
803
|
11-17 y
(M, F)
|
School
|
WHO (DMFT)
|
Multivariate regression
|
DCP=75%
DMFT=3.19 (SD 2.9)
|
Parental oral health status and knowledge attributes
|
|
|
|
|
|
|
|
|
|
|
Parental dental caries status
|
+
|
Yazdan et al. 2018 (26)
(CS)
|
Iran
|
Primary
Permanent
|
258
|
5-15 y
(M, F)
|
Clinic
|
WHO
(dmft, DMFT)
|
Pearson’s
|
dmft=6.33 (SD3.80)
DMFT=1.48 (SD1.90)
|
Parental knowledge on oral hygiene
|
-
|
Yazdan et al. 2018 (26)
(CS)
|
Iran
|
Primary
Permanent
|
258
|
5-15 y
(M, F)
|
Clinic
|
WHO
(dmft, DMFT)
|
Pearson’s
|
dmft=6.33 (SD3.80)
DMFT=1.48 (SD1.90)
|
Mother’s caries experience
|
+
|
Kabil & Eltawil, 2016 (23)
(CS)
|
Egypt
|
Primary
|
140
|
2-4 y
(M, F)
|
Clinic
|
WHO
(DMFT)
AAPD
|
Logistic regression
|
DMFT=9.96
|
Mother’s current caries experience
|
+
|
Kabil & Eltawil,
2017 (22)
(CS)
|
Egypt
|
Primary
|
108
|
2-4 y
(M, F)
|
Clinic
|
WHO
|
Logistic regression
|
ECCP=57% (2-3yrs), 73% (3-4yrs)
|
Parental knowledge on oral hygiene
|
-
|
Kowash et al. 2017 (9)
(CS)
|
UAE
|
Primary
|
540
|
4-6 y
(M, F)
|
School
|
WHO
(dmft)
|
Chi-Square
|
ECCP=74.1%
dmft=3.01
SiC=13.3
|
AAPD American Association Paediatric Dentistry, BASCD British Association for the Study of Community Dentistry, CS Cross-sectional, CC Case control, DCP Dental caries prevalence, deft decayed, extracted due to caries and filled primary teeth, dfs decayed, filled surfaces in primary teeth, dft decayed, filled primary teeth, dmfs decayed, missing and filled surfaces in primary teeth; DMFS decayed, missing and filled surfaces in permanent teeth;
dmft decayed, missing, filled primary teeth, DMFT decayed, missing, filled permanent teeth, ECC Early childhood caries, ECCP Early childhood caries prevalence, F Female, ICADS The international caries Detection and Assessment System, L Longitudinal, KSA Kingdom of Saudi Arabia, m months M Male, WHO World Health Organisation, SiC Significant caries index, SD Standard deviation, y years
aThe authors describe their scoring as WHO(DMFT) whereas it should be noted that the age group is 3-6 year olds where normally WHO (dmft) is being used.
bBased on the baseline assessment the participants were categorized into; Group I having sufficient oral health behaviours, Group II having moderate oral health behaviours and Group III having insufficient oral health behaviours and then the participants were followed for a 2-year period.
cOral hygiene measured by Oral Health index-Simplified (OHI-S)
dThe CAST index scoring system is as follows: “0: sound”, “1: sealant”, “2: restoration”, “3: enamel lesions”, “4, 5: dentine lesions”, “6: pulp involvement”, “7: abscess/fistula”, “8: tooth loss”. If a situation did not match any codes from 0 to 8, a code 9 was assigned. The codes 0–2, 3, 4–5, 6–7, and 8 were considered as “healthy”, “pre-morbidity”, “morbidity”, “serious morbidity”, and “mortality”, respectively
Table 5 Statistically significant nutrition-related determinants contributing to dental caries
Determinants
|
Association: Positive (+), Negative (-)
|
Author
(Study design)
|
Country
|
Type of dentition
|
N
|
Age group (Gender)
|
Study setting
|
Scoring system
|
Type/s of statistical
analysis
|
Dental caries/
scoring results
|
Beverages
|
|
|
|
|
|
|
|
|
|
|
Soft drinks
|
+
|
Chedid et al. 2011 (1)
(CS)
|
Lebanon
|
Primary
|
99
|
2-4 y
(M, F)
|
Clinic
|
WHO
(DFS score and bite wing radiographs)
|
Pearson’s
|
DCP=74.7%
|
Soft drinks
|
+
|
Alhabdan et al. 2018 (2)
(CS)
|
KSA
|
Primary
|
578
|
6-8 y
(M)
|
School
|
WHO
(dmft)
|
Adjusted Odds Ratios,
Multivariate model logistic regression
|
DCCP: 83%
dmft=4.20 (SD 2.96)
|
Soft drinks
|
+
|
Hashim et al. 2009a (3)
(CS)
|
UAE
|
Primary
|
1036
|
5-6 y
(M, F)
|
School
|
WHO
(dmft)
|
Adjusted Risk Ratio,
Bivariate analysis
|
dmft=4.5
|
Fruit juice- before bed
|
+
|
Al-Malik et al. 2002 (4)
(CS)
|
KSA
|
Primary
|
987
|
2-5y
(M, F)
|
School
|
BASCD
|
Stepwise multiple logistic regression
|
DCP=73%
Rampant caries=43%
dmft=4.8
dmfs=12.7
|
Fruit juice-frequent consumption
|
+
|
Hashim et al. 2009a (3)
(CS)
|
UAE
|
Primary
|
1036
|
5-6 y
(M, F)
|
School
|
WHO
|
Risk Ratio,
Bivariate analysis
|
dmft=4.5
|
Citrus juice-
frequent consumption (mixed dentition)
|
+
|
Abbass et al. 2019 (5)
(CS)
|
Egypt
|
Primary. Mixed, Permanent
|
369
|
3-18 y
(M, F)
|
Clinic
|
WHO
(dmft, deft, DMFT)
|
Kruskal- Wallis, Spearman’s
|
DCP=74% dmft=3.23 (SD 4.07)
deft=4.21 (SD 3.21)
DMFT=1.04 (SD 1.56)
|
Fruit squash- frequent consumption
|
+
|
Huew et al. 2012 (6)
(CS)
|
Libya
|
Permanent
|
791
|
12 y
(M, F)
|
School
|
WHO (DMFT)
|
Multivariate stepwise regression
|
DCP=57.8%
DMFT=1.68
DMFS=2.38
|
Fruit squash- frequent consumption
|
+
|
Sayegh et al. 2002b (7)
Sayegh et al. 2005b (8)
(CS)
|
Jordan
|
Primary
|
1140
|
4-5 y
(M, F)
|
School
|
WHO (dmft)
|
Multivariate analysis
|
DCP=67%
dmft >4 in 31%
|
Fruit squash-frequent consumption
|
+
|
Al-Malik et al. 2002 (4)
(CS)
|
KSA
|
Primary
|
987
|
2-5 y
(M, F)
|
School
|
BASCD
|
Stepwise multiple logistic regression
|
DCP=73%
ECCP=43%
dmft=4.8
dmfs=12.7
|
Tea with sugar
|
+
|
Sayegh et al. 2002 (7)
(CS)
|
Jordan
|
Primary
|
1140
|
4-5 y
(M, F)
|
School
|
WHO (dmft)
|
Multivariate analysis
|
DCP=67%
dmft >4 in 31%
|
Tea with sugar
|
+
|
Hashim et al. 2009a
(3)
(CS)
|
UAE
|
Primary
|
1036
|
5-6 y
(M, F)
|
School
|
WHO
(dmft)
|
Adjusted Risk Ratio
Bivariate analysis
|
dmft=4.5
|
Flavoured milk
|
+
|
Alhabdan et al. 2018 (2)
(CS)
|
KSA
|
Primary
|
578
|
6-8 y
(M)
|
School
|
WHO (dmft)
|
Adjusted Odds Ratios,
Multivariate model logistic regression
|
DCCP=83%
dmft=4.20 (SD 2.96)
|
Sweetened beveragesc
|
+
|
Elamin et al. 2018 (9)
(CS)
|
UAE
|
Primary
|
186
|
1.5-4 y
(M, F)
|
School
|
WHO (dmft)
|
T-test,
Pearson’s
|
DCP: 41%
dmft=1.7 (SD 2.81)
|
Sweetened beveragesc
|
Unclear
|
Khadri et al. 2018 (10)
(CS)
|
UAE
|
Permanent
|
803
|
11-17 y
(M, F)
|
School
|
WHO (DMFT)
|
Multivariate regression
|
DCP=75%
DMFT=3.19 (SD 2.9)
|
Sweetened beveragesc
|
+
|
Ahmed et al. 2007 (11)
(CS)
|
Iraq
|
Permanent
|
392
|
12 y
(M, F)
|
School
|
WHO (DMFT)
|
ANOVA
|
DCP=62%
DMFT=1.7
|
Sugar rich food
|
|
|
|
|
|
|
|
|
|
|
Sugar containing foodsd
|
+
|
Quadri et al. 2015 (12)
(CS)
|
KSA
|
Primary
Permanent
|
853
|
6-15 y
(M, F)
|
School
|
WHO
|
Multi regression
|
DCP=91.3%
|
Sugar containing foodsd
|
+
|
Abbass et al. 2019 (5)
(CS)
|
Egypt
|
Primary. Mixed, Permanent
|
369
|
3-18 y
(M, F)
|
Clinic
|
WHO
(dmft, deft, DMFT)
|
Kruskal- Wallis, Spearman’s
|
DCP=74% dmft=3.23 (SD 4.07)
deft=4.21 (SD 3.21)
DMFT=1.04 (SD 1.56)
|
Sugar containing foodsd
|
+
|
Jaghasi et al. 2012 (13)
(CS)
|
Syria
|
Not specified
|
504
|
6-12 y
(M, F)
|
School
|
WHO
|
Logistic regression
|
DCP=85%
|
Sugar containing foodsd
|
+
|
Hashim et al. 2009a (3)
(CS)
|
UAE
|
Primary
|
1036
|
5-6 y
(M, F)
|
School
|
WHO
(dmft)
|
Adjusted Risk Ratio, Bivariate analysis
|
dmft=4.5
|
Sugar containing foodsd-
frequent consumption
|
+
|
Elamin et al. 2018 (9)
(CS)
|
UAE
|
Primary
|
186
|
1.5-4 y
(M, F)
|
School
|
WHO (dmft)
|
T-test,
Pearson’s
|
DCP: 41%
dmft=1.7 (SD 2.81)
|
Sugar containing foodsd-
frequent consumption
|
+
|
Sayegh et al. 2002b
(7)
Sayegh et al. 2005b
(8)(CS)
|
Jordan
|
Primary
|
1140
|
4-5 y
(M, F)
|
School
|
WHO (dmft)
|
Multivariate analysis
|
DCP=67%
dmft >4 in 31%
|
Snacks and meal frequency
|
|
|
|
|
|
|
|
|
|
|
Sweet snackse
and beverages
|
+
|
Kowash et al. 2017
(14)
(CS)
|
UAE
|
Primary
|
540
|
4-6 y
(M, F)
|
School
|
WHO
(dmft)
|
Chi-Square
|
ECCP=74.1%
dmft=3.01
SiC=13.3
|
Sweet snackse and beverages
|
+
|
Kowash, 2015 (15)
(CS)
|
UAE
|
Primary
|
176
|
1.5-5 y
(M, F)
|
Clinic
|
BASCD (dmft, dmfs)
|
Descriptive statistics
|
dmft=10.9
dmfs=32.1
|
Sweet snackse and beverages
|
+
|
Hashim et al. 2011a (16)
(CS)
|
UAE
|
Primary
|
1036
|
3-6 y
(M, F)
|
School
|
WHO (ECC)
|
Logistic regression
|
Severe ECCP=31.1%
|
Sweet snackse-frequent consumption
|
+
|
Alhabdan et al. 2018 (2)
(CS)
|
KSA
|
Primary
|
578
|
6-8 y
(M)
|
School
|
WHO (dmft )
|
Adjusted odds ratios,
Multivariate model logistic regression
|
DCCP=83%
dmft= 4.20 (SD 2.96)
|
Snacks-frequent consumption
|
+
|
Hashim et al. 2013a
(17)
(CS)
|
UAE
|
Primary
|
1036
|
5-6 y
(M, F)
|
School
|
WHO (dmft)
|
Adjusted Risk Ratio, Bivariate analysis
|
dmft=4.5
|
Snacks
|
+
|
Chedid et al. 2011 (1)
(CS)
|
Lebanon
|
Primary
|
99
|
2-4 y
(M, F)
|
Clinic
|
WHO
(DFS score and bite wing radiographs)
|
Pearson’s
|
DCP=74.7%
|
Milk-as snack
|
-
|
Chedid et al. 2011 (1)
(CS)
|
Lebanon
|
Primary
|
99
|
2-4y
(M, F)
|
Clinic
|
WHO (DFS score and bite/wing radiographs)
|
Pearson’s
|
DCP=74.7%
|
Main meal consumption
|
Unclear
|
Khadri et al. 2018 (10)
(CS)
|
UAE
|
Permanent
|
803
|
11-17 y
(M, F)
|
School
|
WHO (DMFT)
|
Multivariate regression
|
DCP=75%
DMFT=3.19 (SD 2.9)
|
Eating frequently (>5times daily)
|
+
|
Hashim et al. 2009a
(3) (CS)
|
UAE
|
Primary
|
1036
|
5-6 y
(M, F)
|
School
|
WHO
(dmft)
|
Adjusted Risk Ratio,
Bivariate analysis
|
dmft=4.5
|
Other eating related factors
|
|
|
|
|
|
|
|
|
|
|
No fruit consumption-
|
-
|
Alhabdan et al. 2018 (2)
(CS)
|
KSA
|
Primary
|
578
|
6-8 y
(M)
|
School
|
WHO
(dmft)
|
Adjusted Odds Ratios
Multivariate model logistic regression
|
DCCP=83%
dmft 4.20 (SD 2.96)
|
Sweet taste perception
|
+
|
Ashi et al. 2017 (18)
(CS)
|
KSAf
|
Permanent
|
225
|
15-15 y
(M, F)
|
School
|
ICDAS, (DMFS)
|
One-way ANOVA
LSD
|
DMFS= 2.99
|
Low dietary scoreg
|
+
|
Al-Otaibi et al. 2012 (19)
(CS)
|
Yemen
|
Not specified
|
400
|
12 y
(M, F)
|
School
|
WHO
(DMFT)
|
Multivariate logistic regression,
|
DCP=90.2%
DMFT=2.22
|
Low nutrient foodh-frequent consumption
|
+
|
İnan-Eroğlu et al. 2017 (20)
(CS)
|
Turkey
|
Primary
|
395
|
36-71 m
(M, F)
|
School
|
WHO
(dmft, dmfs)
|
Mann-Whitney,
Kruskal-Wallis
|
dmft =4.7
dmfs= 8.0
|
Dairy products-low consumption
|
+
|
Jaghasi et al. 2012 (13)
(CS)
|
Syria
|
Not specified
|
504
|
6-12 y
(M, F)
|
School
|
WHO
|
Logistic regression
|
DCP=85%
|
Cod liver intake
|
-
|
Bener et al. 2013 (21)
(CS)
|
Qatar
|
Permanent
|
1284
|
6-15 y
(M, F)
|
Clinic
|
WHO (DMFT)
|
Multivariate analysis
|
DCP=73%
DMFT=4.5
|
Nutritious foodi-frequent consumption
|
-
|
Abbass et al. 2019 (5)
(CS)
|
Egypt
|
Primary. Mixed, Permanent
|
369
|
3-18 y
(M, F)
|
Clinic
|
WHO
(dmft, deft, DMFT)
|
Kruskal- Wallis, Spearman’s
|
DCP=74% dmft=3.23 (SD 4.07)
deft=4.21 (SD 3.21)
DMFT=1.04 (SD 1.56)
|
Infant feeding practices
|
|
|
|
|
|
|
|
|
|
|
Feeding typej
|
+
|
Abu Hamila, 2013 (22)
(CS)
|
Egypt
|
Primary
|
560
|
1-3.5 y
(M, F)
|
Clinic
|
WHO
(dmft)
|
Chi-Square
|
ECCP=69.6%
dmft range =2.1-7.6
|
Breastfeeding-Long duration
|
+
|
Sayegh et al. 2002b (23)
Sayegh et al. 2005b
(8) (CS)
|
Jordan
|
Primary
|
1140
|
4-5 y
(M, F)
|
School
|
WHO (dmft)
|
Multivariate analysis
|
DCP=67%
dmft >4 in 31%
|
Breastfeeding
-On demand feeding
|
+
|
Sayegh et al. 2002b
(23)
Sayegh et al. 2005b
(CS)
(8)
|
Jordan
|
Primary
|
1140
|
4-5y
(M, F)
|
School
|
WHO (dmft)
|
Multivariate analysis
|
DCP=67%
dmft >4 in 31%
|
Formula feeding
|
+
|
Alhabdan et al. 2018 (2)
(CS)
|
KSA
|
Primary
|
578
|
6-8 y
(M)
|
School
|
WHO (dmft)
|
Adjusted Odds Ratios, Multivariate model logistic regression
|
DCCP=83%
dmft= 4.20 (SD 2.96)
|
Formula feeding
|
+
|
Bener et al. 2013 (21)
(CS)
|
Qatar
|
Permanent
|
1284
|
6-15 y
(M, F)
|
Clinic
|
WHO (DMFT)
|
Multivariate analysis
|
DCP=73%
DMFT=4.5
|
Formula feeding
|
+
|
Qadri et al. 2012 (24)
(CS)
|
Syria
|
Primary
|
400
|
3-5 y
(M, F)
|
School
|
ECC
WHO (dmft, dmfs)
|
Logistic regression
|
ECCP=48%
DCP=70%
dmft=4.25 (SD 4.24)
|
Night feeding -bottle
|
+
|
Mohebbi, 2008 (25)
(CS)
|
Iran
|
Primary
|
504
|
1-3 y
(M, F)
|
Clinic
|
WHO
|
T-test,
Chi-Square,
ANOVA,
Logistic regression
|
DCP=3-26% depending on age
|
Night feeding -bottle
|
+
|
Ozer et al. 2011 (26)
(CS)
|
Turkey
|
Primary
|
226
|
3-6 y
(M, F)
|
School
|
WHO (dmft)
AAPD
(ECC)
|
Bivariate analysis
|
ECCP=46.9%
dmft=2.87
|
Night feeding
|
+
|
Kabil & Eltawil,
2016 (27)
(CS)
|
Egypt
|
Primary
|
140
|
2-4y
(M, F)
|
Clinic
|
WHO (DMFT)
|
Logistic regression
|
DMFT=9.96
|
Night feeding
|
+
|
Kabil & Eltawil,
2017 (28)
(CS)
|
Egypt
|
Primary
|
108
|
2-4y
(M, F)
|
Clinic
|
WHO
(ECC)
|
Logistic regression
|
ECCP=57% (2-3yrs),
73% (3-4yrs)
|
Bottle feeding-on
demand
|
+
|
Sayegh et al. 2002b
(23)
Sayegh et al. 2005b
(8)(CS)
|
Jordan
|
Primary
|
1140
|
4-5 y
(M, F)
|
School
|
WHO (dmft)
|
Multivariate analysis
|
DCP=67%
dmft >4 in 31%
|
Sleep with bottle
|
+
|
Alhabdan et al. 2018 (2)
(CS)
|
KSA
|
Primary
|
578
|
6-8 y
(M)
|
School
|
WHO (dmft)
|
Adjusted Odds Ratios,
Multivariate model logistic regression
|
DCCP=83%
dmft=4.20 (SD 2.96)
|
Sleep next to mother
|
+
|
Sayegh et al. 2002b
(23)
Sayegh et al. 2005b
(8)
(CS)
|
Jordan
|
Primary
|
1140
|
4-5 y
(M, F)
|
School
|
WHO (dmft)
|
Multivariate analysis
|
DCP=67%
dmft >4 in 31%
|
Dummy use
|
+
|
Sayegh et al. 2002b
(23)
Sayegh et al. 2005b
(8)
(CS)
|
Jordan
|
Primary
|
1140
|
4-5 y
(M, F)
|
School
|
WHO (dmft)
|
Multivariate analysis
|
DCP=67%
dmft >4 in 31%
|
Dummy-sweetened
|
+
|
Al-Malik et al. 2002 (4)
(CS)
|
KSA
|
Primary
|
987
|
2-5 y
(M, F)
|
School
|
BASCD (dmft, dmfs))
|
Logistic regression
|
DCP=73%
ECCP=43%
dmft=4.8
dmfs=12.67
|
Shared spoons between mother and childk
|
+
|
Cogulu et al. 2008
(29)
(L- 24 months)
|
Turkey
|
Primary
|
92
|
15-35 m
(M, F)
|
Clinic
|
WHO
(dft, dfs)
|
Logistic regression
|
Final DCP=45%
Final dft=1.0
Final dfs=1.8
|
AAPD American Association Paediatric Dentistry, BASCD British Association for the Study of Community Dentistry, CS Cross-sectional, CC Case control, DCP Dental caries prevalence, deft decayed, extracted due to caries and filled primary teeth, dfs decayed, filled surfaces in primary teeth, dft decayed, filled primary teeth, dmfs decayed, missing and filled surfaces in primary teeth; DMFS decayed, missing and filled surfaces in permanent teeth, dmft decayed, missing, filled primary teeth, DMFT decayed, missing, filled permanent teeth, ECC Early childhood caries, ECCP Early childhood caries prevalence, F Female, ICADS The international caries Detection and Assessment System, L Longitudinal, KSA Kingdom of Saudi Arabia, m months M Male, WHO World Health Organisation, SiC Significant caries index, SD Standard deviation, y years
aHashim et al. 2006, Hashim et al. 2009, Hashim et al. 2011 and Hashim et al. 2013 seem to be based on the same study population but reporting different results.
bSayegh et al. 2002 and Sayegh et al. 2005 seem to be based on the same study population and the results mentioned in this table, have been reported in both articles.
cSweetend beverages refer to the consumption of various sweet beverages like soft drinks, fruit squashes, tea with sugar, flavoured milk, etc.
dSugar rich food may include consumption of all/and mix of items like candy, chocolates, dates, ice-cream, cakes, muffins, etc.
eSweet snacks include various food items with high sugar content.
fKSA was part of this multinational study which also included Italy and Mexico. Only the results for KSA are presented in this table.
gThe dietary score was based on a few questions related to the consumption of cariogenic food and eating patterns with yes/no answer options.
hAssessed by the Healthy Eating Index (HEI) 2010 and the Mediterranean Diet Quality Index for children and adolescents (KIDMED).
iNutritious food refers to a frequent consumption of high nutrient food like fruits, vegetables, beans, milk, eggs etc.
jThe feeding type had an impact on the caries prevalence as follows: 75.39% of breastfeed children, 70.39% of the formula fed, 68.67% of those who were weaned and 55% of those who got a mix of breast milk and formula had dental caries respectively.
kDuring the baseline sampling mothers reported that they put their child’s spoon into their own mouth while feeding their child.