Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019;53(4):411-421.
doi: 10.1159/000495187. Epub 2019 Jan 10.

Prenatal Oral Health Care and Early Childhood Caries Prevention: A Systematic Review and Meta-Analysis

Jin Xiao  1 , Naemah Alkhers  2 , Dorota T Kopycka-Kedzierawski  2 , Ronald J Billings  2 , Tong Tong Wu  3 , Daniel A Castillo  4 , Linda Rasubala  2 , Hans Malmstrom  2 , Yanfang Ren  2 , Eli Eliav  2
Affiliations
Meta-Analysis

Prenatal Oral Health Care and Early Childhood Caries Prevention: A Systematic Review and Meta-Analysis

Jin Xiao et al. Caries Res. 2019.

Abstract

Despite the advancement of early childhood caries (ECC) prediction and treatment, ECC remains a significant public health burden in need of more effective preventive strategies. Pregnancy is an ideal period to promote ECC prevention given the profound influence of maternal oral health and behaviors on children's oral health. However, studies have shown debatable results with respect to the effectiveness of ECC prevention by means of prenatal intervention. Therefore, this study systematically reviewed the scientific evidence relating to the association between prenatal oral health care, ECC incidence, and Streptococcus mutans carriage in children. Five studies (3 randomized control trials, 1 prospective cohort study, and 1 nested case-control study) were included for qualitative assessment. Tested prenatal oral health care included providing fluoride supplements, oral examinations/cleanings, oral health education, dental treatment referrals, and xylitol gum chewing. Four studies that assessed ECC incidence reduction were included in meta-analysis using an unconditional generalized linear mixed effects model with random study effects and age as a covariate. The estimated odds ratio and 95% confidence intervals suggested a protective effect of prenatal oral health care against ECC onset before 4 years of age: 0.12 (0.02, 0.77) at 1 year of age, 0.18 (0.05, 0.63) at 2 years of age, 0.25 (0.09, 0.64) at 3 years of age, and 0.35 (0.12, 1.00) at 4 years of age. Children's S. mutans carriage was also significantly reduced in the intervention group. Future studies should consider testing strategies that restore an expectant mother's oral health to a disease-free state during pregnancy.

Keywords: Child dentistry; Early childhood caries; Prenatal oral health care.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests

The authors declare no conflict of interests.

Figures

Figure 1.
Figure 1.. Modified Fisher-Owens conceptual model of child, family, and community influences on oral health outcomes of children.
Factors underlined in red are those that could potentially be influenced by maternal attributes.
Figure 2.
Figure 2.. Flow diagram of study identification.
The four-phase Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram was used to determine the number of studies identified, screened, eligible, and included in the systematic review and meta-analysis (http://www.prisma-statement.org).
Figure 3.
Figure 3.. Summary of quality and risk of bias assessment using Cochrane Collaboration’s tool for assessing risk of bias in randomized trials and adapted Down and Black scoring tool.
The quality of the selected articles were assessed using two methodological validities: 1) Cochrane Collaboration’s tool for assessing risk of bias in randomized trials [Higgins et al., 2011]. 2) Adapted Down and Black scoring [Downs and Black, 1998] that assess the methodological quality of both randomized and non-randomized studies of health care interventions. A total score of 26 represents the highest study quality.
Figure 4.
Figure 4.. Odds Ratio of ECC events in prenatal oral health care intervention group and control group.
Meta-analysis was performed on four studies that assessed ECC incidence. In particular, Günay et al, 1998 examined the same cohort of children at two time points, when they reached 3- and 4- years of age; their results were included as two data sets in the meta-analysis. Study heterogeneity (I2=75.06%) and the related p-value were calculated using likelihood ratio test (p<0.0001). The empirical odds ratio (OR) and 95% confidence interval (CI) of each study included in the meta-analysis was shown in (A). Based on the generalized linear mixed effect model with covariate age, the estimates of OR and 95% CI shown in (B) indicate that regarding ECC incidence, there is a statistically significant difference between the intervention and control groups for children younger than 4 years of age. The solid line indicates when OR=1.
None
None
None
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

Excluded articles after full-text review

    1. Kanellis MJ, Logan HL, Jakobsen J. Changes in maternal attitudes toward baby bottle tooth decay. Pediatric dentistry. 1997;19(1):56–60. - PubMed
    1. Lydon-Rochelle MT, Krakowiak P, Hujoel PP, Peters RM. Dental care use and self-reported dental problems in relation to pregnancy. American Journal of Public Health. 2004;94(5):765–71. - PMC - PubMed
    1. Lopez NJ, Da Silva I, Ipinza J, Gutierrez J. Periodontal therapy reduces the rate of preterm low birth weight in women with pregnancy-associated gingivitis. Journal of periodontology. 2005;76(11 Suppl):2144–53. - PubMed
    1. Castaldi JL, Bertin MS, Gimenez F, Lede R. Periodontal disease: Is it a risk factor for premature labor, low birth weight or preeclampsia? Revista Panamericana De Salud Publica-Pan American Journal of Public Health. 2006;19(4):253–8. - PubMed
    1. Sadatmansouri S, Sedighpoor N, Aghaloo M. Effects of periodontal treatment phase I on birth term and birth weight. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2006;24(1):23–6. - PubMed

References

    1. American Academy of Pediatric Dentistry Council on Clinical A: Policy on early childhood caries (ecc): Unique challenges and treatment options. Pediatric dentistry 2005;27:34–35. - PubMed
    1. Axelsson P: Preventive programs Preventive Dental Health Center, Karlstad, Sweden: 1988.
    1. Azofeifa A, Yeung LF, Alverson CJ, Beltran-Aguilar E: Oral health conditions and dental visits among pregnant and nonpregnant women of childbearing age in the united states, national health and nutrition examination survey, 1999-2004. Prev Chronic Dis 2014;11:E163. - PMC - PubMed
    1. Berkowitz RJ, Amante A, Kopycka-Kedzierawski DT, Billings RJ, Feng C: Dental caries recurrence following clinical treatment for severe early childhood caries. Pediatric dentistry 2011;33:510–514. - PubMed
    1. Bliss JM, Basavegowda KP, Watson WJ, Sheikh AU, Ryan RM: Vertical and horizontal transmission of candida albicans in very low birth weight infants using DNA fingerprinting techniques. The Pediatric infectious disease journal 2008;27:231–235. - PubMed

Publication types

-