|Year : 2022 | Volume
| Issue : 5 | Page : 3-11
Prevalence of early childhood caries in India: A systematic review and meta-analysis
Induja Devan1, Venkitachalam Ramanarayanan2, Chandrashekar Janakiram3
1 PhD Scholar, Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
2 Reader, Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
3 Professor, Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
|Date of Submission||09-Aug-2022|
|Date of Decision||19-Aug-2022|
|Date of Acceptance||19-Aug-2022|
|Date of Web Publication||11-Nov-2022|
Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi - 682 041, Kerala
Source of Support: None, Conflict of Interest: None
| Abstract|| |
This review was designed to assess the pooled prevalence of early childhood caries (ECC) in India. An electronic data search was done in PubMed/MEDLINE and Scopus databases in October 2020. Epidemiological surveys assessing the prevalence of ECC were included, and data on gender, geographic region, sampling strategy, feeding habits, and dmft values were extracted. The risk of bias was assessed, and a meta-analysis was performed for pooled prevalence and mean dmft values. The selection of articles, data extraction, and validity assessment were done independently by the two reviewers (ID and RV). A third reviewer (CJ) resolved any conflict between these two reviewers. A total of seventy-one studies were included for quantitative analysis. The pooled prevalence of ECC estimated from 71 studies with 69,330 participants is 46.9% (confidence interval [CI] 46.5–47.2). Males had a higher prevalence of ECC (47%, CI: 46.4–47.6,40 studies, 26,840 participants) than females (43.8%, CI: 43.2–44.2,40 studies, 24,389 participants). Region-wise analysis showed the highest number of studies (44) in southern India, with a sample size of 35,988 with a pooled prevalence of 44.6% (CI: 44–45.1). The pooled mean dmft (random effect) is 2.23 (1.97–2.48), with males having a higher proportion of 2.26 compared to 2.23 in females. The pooled prevalence of ECC was 46.9%, and the pooled mean was 2.23. The results from this study state that one in every two children in India is suffering from ECC, reflecting its public health relevance.
Keywords: Baby bottle caries, children, dmft, early childhood caries, India, prevalence Introduction
|How to cite this article:|
Devan I, Ramanarayanan V, Janakiram C. Prevalence of early childhood caries in India: A systematic review and meta-analysis. Indian J Public Health 2022;66, Suppl S1:3-11
|How to cite this URL:|
Devan I, Ramanarayanan V, Janakiram C. Prevalence of early childhood caries in India: A systematic review and meta-analysis. Indian J Public Health [serial online] 2022 [cited 2023 Jan 27];66, Suppl S1:3-11. Available from: https://www.ijph.in/text.asp?2022/66/5/3/360645
| Introduction|| |
Dental caries of primary dentition is the 12th most prevalent disease affecting about 560 million children globally. According to the United States HHS, early childhood caries (ECC) is five times as frequent as asthma and seven times more common than hay fever. The American Academy of Paediatric Dentistry defines ECC as the “presence of one or more decayed (cavitated or noncavitated), missing due to caries or filled tooth surfaces in any primary tooth in a child of age 71 months or younger.” Multiple risk factors are associated with ECC which includes distal factors like occupation, education, socio-economic conditions, access to dental care, and proximal factors such as lifestyle, dietary habits, and oral health knowledge. Untreated carious lesions can lead to problems ranging from localized pain, swelling, and abscess, causing difficulty in chewing, eating, and speaking, leading to malnutrition, gastrointestinal disorders, and difficulty attending to learning.,
Data from 44 WHO member states/countries reported the ECC prevalence ranging from 0.0% in Nigeria to 98% in Cambodia and Bosnia and Herzegovina. In Asia, especially in the Far East region, the prevalence of the disease in 3-year-old ranges from 36% to 85%; the prevalence in India has been reported in the range of 44%–49% among 8–48-month-old children.
The emotional stress associated with pain affects the overall quality of life of children and parents. School hours lost due to dental illness are estimated to be around 51 million. Poor children's restricted activity days are 12 times more than that of children from upper class families. Though there has been a general decline in the incidence of dental caries among adolescents and young adults, the same has not been observed with ECC.
ECC has been recognized as a significant public health problem. To consider a condition as a public health problem and to implement policies and programs for its prevention and control, credible nationally representative data is required to quantify its burden However, there have only been several point prevalence studies conducted in different parts of the country and also among different sub-groups of the population. There has been no national representation of data except for the solitary national oral health survey in 2002–2003 which reported the caries experience among 5-year-old children only. A recent systematic review conducted on the same topic did not report the pooled prevalence of ECC. A systematic review and meta-analysis on the prevalence of dental caries in India reports an overall prevalence of 54.16% and that of 3–18 years to be 57%. Specific information on age group between 0 and 6 years has not been reported.
Appropriate public health policy programs are required to bring down the prevalence of ECC in India which in turn is dependent on the availability of relevant national data. Since an estimated pooled prevalence of ECC is lacking from the studies published so far, this systematic review and meta-analysis aims to estimate the pooled prevalence and associated factors of ECC in Indian preschool children.
| Methodology|| |
This systematic review was done and reported based on MOOSE Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies. The focused review question was as follows: What is the prevalence of ECC among preschool children in India?.
Eligibility criteria of included studies
Studies that assessed prevalence and severity of ECC (participants of age 71 months or younger using the dmft, dfs, PUFA, WHO pro forma 1997, ICDAS etc., cross-sectional studies).
Definition of outcome
The outcome considered was ECC which is defined as “the presence of 1 or more decayed (or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger.” For children below 3 years of age, the presence of any sign of smooth surface caries can be considered as severe ECC. The proportion of children who experienced ECC and mean dmft/def/dmfs were assessed.
Information sources and search
An electronic data search was done by the investigator (ID) in MEDLINE, PubMed Central and Scopus. A database customized search strategy for each database was used; MeSH terms: (prevalence) AND (”dentalcaries”) AND (”preschool children” OR “preschool children”) AND (India) (”epidemiology”[MeSH Subheading] OR “epidemiology”[All Fields]) OR “prevalence”[All Fields]) OR “prevalence”[MeSH Terms]) OR “prevalence”[All Fields]) OR “prevalence's”[All Fields]) OR “prevalences”[All Fields]) OR “prevalent”[All Fields]) OR “prevalently”[All Fields]) OR “prevalent”[All Fields]) AND “dental caries”[All Fields]) AND (”preschool children”[All Fields] OR “preschool children”[All Fields])) AND (((”India”[MeSH Terms] OR “India”[All Fields]).(prevalence) AND (”early childhood caries” OR “ECC” OR “nursing bottle caries” OR “baby bottle caries” OR “night bottle caries”) AND (India). Subsequently, based on inclusion/exclusion criteria, title and abstract screening were done. Subsequently, full-text screening was done by two reviewers (ID and RV). Only studies published in the English language were included. Any conflict was adjudicated by a third reviewer (CJ).
Data collection process and data items
Data extraction was done with the aid of a Microsoft Excel spreadsheet and the following information were extracted: bibliographic details, age group included, gender distribution, place of the study (geographic location), number of participants (sample size), technique of sample selection, number of teeth affected by ECC, dmft/deft, PUFA scores, and feeding habits.
Assessment of risk of bias
Quality assessment was done for each included study using a method proposed by Hoy et al. and was performed by two authors (ID and RV). A score of 0–9 was considered for assessing the overall risk of bias for each of the nine types of bias respectively. Any disagreement was resolved by discussion or by a third reviewer (CJ).
Synthesis of findings
Quantitative synthesis was done using a random-effects model using MetaXL developed for use with Microsoft Excel and Comprehensive Meta-analysis software. Pooled prevalence was calculated and reported with 95% confidence interval (CI).
| Results|| |
[Figure 1] shows the flow chart for study selection. 140 citations were retrieved from the database until September 2020. A comprehensive search of cross-references of these retrieved articles yielded 56 additional articles. After removing duplicates, 134 records including the National Oral Health survey was screened for title and abstract of which 55 articles were excluded. The full-text screening was done for 79 studies of which 8 did not meet the inclusion criteria due to missing data (6 studies), retracted (1 study), no full-text access (1 study). Authors were contacted through e-mail for missing data, but no response was obtained. Finally, 71 studies,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, were included for quantitative synthesis.
[Table 1] describes the characteristics of the included studies. A total of 71 studies were included for quantitative synthesis which comprised of 69,330 preschool children. Most of the included studies were from South India and a majority of the studies (n = 28) were published during 2010–2015 followed by 2015–2020 (n = 21). A total of 31 studies used dmft scores for assessing ECC followed by 17 studies that used deft/def scores and 14 studies that used WHO pro forma 1997. All 71 included studies had a low risk of bias according to the assessment made by Hoy et al. criteria.
Synthesis of results
Pooled prevalence of early childhood caries by proportion
The overall prevalence of ECC estimated from 71 studies with 69,330 participants was 46.9% (95% CI: 46.5–47.2) [Figure 2]. Males had a higher proportion of ECC (47%, 95% CI: 46.4–47.6, 40 studies, 26,840 participants) than females (43.8%, 95% CI: 43.2–44.2, 40 studies, 24,389 participants). Regional analysis showed the highest number of studies conducted in Southern India with a pooled prevalence of 44.6% (95% CI: 44–45.1, 44 studies, 35,998 participants). Central India has the least number of studies but reported the highest pooled prevalence of 62.3% (95% CI: 60.2–64.3, 3 studies, 2098 participants) compared to Northern India which had a pooled prevalence of 51.6% (95% CI: 50.9–52.3, 25 studies, 19,355 participants). Eastern and Western India reported a pooled prevalence of 50.4% (95% CI: 48.9 and 51.8, 7 studies, 4464 participants) and 43.8% (95% CI: 42.6–44.97,425 participants) respectively. Sub-group analysis based on the sampling method employed for the studies showed a pooled prevalence of 48.1% (95% CI: 47–48.6, 44,355 studies participants) for random sampling and 44.7% (95% CI: 44.1–45.3, studies, 24,975 participants) for nonrandom sampling [Table 2].
| Discussion|| |
Untreated ECC has multiple consequences as it can lead to problems in eating and phonetics due to early loss of teeth and malocclusion. It ultimately affects learning as it occurs during the years of milestone development of the child. It has been observed that a malnourished child has higher odds (odds ratios 3.46, 95% CI: 1.93–6.29) of experiencing the dental caries compared to those with normal nutritional status in the tribal preschool children in India (add ref). ECC affects more than 530 million children. Underprivileged children, across cultures have greater proportion of vulnerability. Though developed countries are showing a decreasing trend in prevalence of dental caries, prevalence of ECC still remains same in both developing and developed countries. This systematic review attempted to quantify the burden of ECC in India.
The National Oral Health Survey 2002, remains India's solitary National Survey using the WHO methodology, estimating the burden of ECC. However, there exists a number of point prevalence studies estimating the ECC in India. Thus, a comprehensive review of these studies was warranted to estimate the burden of ECC in India. Previous attempts on this front had limitations of being narrative in nature and performing only a qualitative synthesis, and did not attempt to provide the pooled estimate of the prevalence of ECC in India.
According to our estimates, nearly one in two preschool children experience ECC in India. A similar prevalence of ECC was observed in Australia which is more than 50% in 6-year-old children. ECC is recognised as a major public health problem in several countries with the prevalence ranging from 11.4% in Sweden to 7%–19% in Italy to 76% and 83% in Palestine and the United Arab Emirates respectively. The national surveys from some countries, such as Greece (36%), Brazil (45.8%) and Israel (64.7%), showed inconsistent prevalence of ECC. The existing prevalence of ECC in developed countries may be attributed to its population living in slums. There are more urban slums in passive economies; and these economies are associated with higher consumption of caries-promoting diets.
Previous systematic review done in India 2016 estimated a prevalence of 49.6% compared to our observation of 46.9%. This difference could be due to the higher number of included studies and wider search strategy used in this review.
A gender wise analysis showed males have higher prevalence of ECC than females. A heterogeneity of 97%–100% was observed probably due to the variation in population and use of different indices to assess ECC. A region wise analysis revealed that most of the studies were done in Southern India, especially in Karnataka. Eastern India and Central India has very few studies and showed a high prevalence (60.2%). Further studies are needed in these areas for precise estimation of results.
More number of included studies compared to previous the systematic review and meta-analysis using both proportion and mean deft/dmft/dfs are the strengths of our study, which makes for a more comprehensive quantitative synthesis of ECC prevalence in India. Representativeness of our results are reasonable for two reasons, one the included studies were from 13 (geographical) out of 30 Indian states and one nationally representative data and second, the number of included studies is large (n = 71) which reflects a close estimate of prevalence of ECC. Despite the strengths of the study, the study findings need to be interpreted with caution because of the possible fallacies associated with included cross-sectional studies and variation in the indices used to measure the ECC may underestimate the pooled value.
With a high burden of ECC in India, it is imperative to adopt measures to control and prevent the same. The World Health Organization expert consultation on public health interventions against ECC outlines few strategies which include caries risk assessment, brushing with fluoride toothpaste, fluoride varnish applications, and certain behavioral interventions that affect preventive self-care. Early and periodic dental visits could contribute to its prevention. The World Health Assembly also recommends a shift from curative approach to preventive approach beginning from family, schools and workplaces including comprehensive and inclusive care within the primary health-care system for improving oral health.
| Conclusion|| |
Results from this study indicate that one in every two preschool children in India is suffering from ECC reflecting its social relevance. This data would be useful for planning and policy making.
The authors wish to thank Dr. Vineetha Karuveetil (Department of Public Health Dentistry, Amrita School of Dentistry, Kerala) for her valuable inputs in the preparation of this article.
Financial support and sponsorship
This study is a part of the Indian Council of Medical Research Nurturing Clinical Scientist fellowship awarded to Dr. Induja Devan for which contingency is being availed.
Conflicts of interest
There are no conflicts of interest.
| References|| |
GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388:1545-602.
Bagramian RA, Garcia-Godoy F, Volpe AR. The global increase in dental caries. A pending public health crisis. Am J Dent 2009;22:3-8.
Council on Clinical Affairs. Definition of Early Childhood Caries (ECC). Chicago: American Academy of Pediatric Dentistry; 2008.
Ganesh A, Sampath V, Sivanandam BP, Sangeetha H, Ramesh A. Risk factors for early childhood caries in toddlers: An institution-based study. Cureus 2020;12:e7516.
Anil S, Anand PS. Early childhood caries: Prevalence, risk factors, and prevention. Front Pediatr 2017;5:157.
Phantumvanit P, Makino Y, Ogawa H, Rugg-Gunn A, Moynihan P, Petersen PE, et al.
WHO global consultation on public health intervention against early childhood caries. Community Dent Oral Epidemiol 2018;46:280-7.
Harris NO, Garcia-Godoy F. Primary Preventive Dentistry. New Jersey, United States: Prentice Hall PTR; 1999. p. 680.
Bali RK, Mathur VB, Talwar PP, Chanana HB. National Oral Health Survey and Fluoride Mapping 2002-03. Dental Council of India, New Delhi; 2004.
Ganesh A, Muthu MS, Mohan A, Kirubakaran R. Prevalence of early childhood caries in India – A systematic review. Indian J Pediatr 2019;86:276-86.
Pandey P, Nandkeoliar T, Tikku AP, Singh D, Singh MK. Prevalence of dental caries in the Indian population: A systematic review and meta-analysis. J Int Soc Prev Community Dent 2021;11:256-65.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al.
Meta-analysis of observational studies in epidemiology: A proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283:2008-12.
Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, et al.
Assessing risk of bias in prevalence studies: Modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol 2012;65:934-9.
World Health Organization. Oral Health Surveys: Basic Methods. 4th
ed. Geneva: World Health Organization; 1997. p. 66.
Singh A, Purohit B, Sequeira P, Acharya S. Oral health status of 5-year-old aborigine children compared with similar aged marginalised group in South Western India. Int Dent J 2011;61:157-62.
Agarwal D, Sunitha S, Reddy CV, Machale P. Early childhood caries prevalence, severity and pattern in 3-6 year old preschool children of Mysore city, Karnataka. Brazilian Research in Pediatric Dentistry and Integrated Clinic 2012;12:561-5.
Ali YA, Chandranee NJ, Khan A, Khan ZH. Prevalence of dental caries in nursery school children of Akola city. J Indian Soc Pedod Prev Dent 1998;16:21-5.
] [Full text]
Anandakrishna L, Bhargav N, Hegde A, Chandra P, Gaviappa D, Shetty AK. Problematic eating and its association with early childhood caries among 46-71-month-old children using Children's Eating Behavior Questionnaire (CEBQ): A cross sectional study. Indian J Dent Res 2014;25:602-6.
] [Full text]
Chawla HS, Gauba K, Goyal A. Trend of dental caries in children of Chandigarh over the last sixteen years. J Indian Soc Pedod Prev Dent 2000;18:41-5.
Dash JK, Sahoo PK, Bhuyan SK, Sahoo SK. Prevalence of dental caries and treatment needs among children of Cuttack (Orissa). J Indian Soc Pedod Prev Dent 2002;20:139-43.
] [Full text]
Sachin D, Uma D, Deshpande SJ. Association between oral-health related factors and early childhood caries in children between age 36 and 72 months from rural North Karnataka. J Indian Assoc Public Health Dent 2012;10:48-55. [Full text]
Dixit S, Chaudhary M, Singh A. Molluscum contagiosum and dental caries: A pertinent combination. J Indian Soc Pedod Prev Dent 2009;27:197-201.
] [Full text]
Dogra S, Rao R, Singh G, Mohan S, Patel A. Early childhood caries in preschool children of gram panchayat Anoo, Hamirpur, Himachal Pradesh. Indian J Dent Sci 2018;10:11. [Full text]
Gaidhane AM, Patil M, Khatib N, Zodpey S, Zahiruddin QS. Prevalence and determinant of early childhood caries among the children attending the Anganwadis of Wardha district, India. Indian J Dent Res 2013;24:199-205.
] [Full text]
Goel P, Sequeira P, Peter S. Prevalence of dental disease amongst 5-6 and 12-13 year old school children of Puttur municipality, Karnataka State-India. J Indian Soc Pedod Prev Dent 2000;18:11-7.
] [Full text]
Gopal S, Chandrappa V, Kadidal U, Rayala C, Vegesna M. Prevalence and predictors of early childhood caries in 3-to 6-year-old South Indian Children – A cross-sectional descriptive study. Oral Health Prev Dent 2016;14:267-73.
Gopinath VK, Barathi VK, Kannan A. Assessment and treatment of dental caries in semi-urban school children of Tamilnadu (India). J Indian Soc Pedod Prev Dent 1999;17:9-12.
Goyal A, Gauba K, Chawla HS, Kaur M, Kapur A. Epidemiology of dental caries in Chandigarh school children and trends over the last 25 years. J Indian Soc Pedod Prev Dent 2007;25:115-8.
] [Full text]
Gupta D, Momin RK, Mathur A, Srinivas KT, Jain A, Dommaraju N, et al.
Dental caries and their treatment needs in 3-5 year old preschool children in a rural district of India. N Am J Med Sci 2015;7:143-50.
Henry JA, Muthu MS, Saikia A, Asaithambi B, Swaminathan K. Prevalence and pattern of early childhood caries in a rural South Indian population evaluated by ICDAS with suggestions for enhancement of ICDAS software tool. Int J Paediatr Dent 2017;27:191-200.
Jaidka R, Jaidka S, Sunil MK, Singh DJ, Singh S, Sharma M. An assessment of the oral health status of 5 year old government school children in Meerut, Uttar Pradesh, India. J Indian Assoc Public Health Dent 2011;9 17 Suppl 2:503-8.
Jose B, King NM. Early childhood caries lesions in preschool children in Kerala, India. Pediatr Dent 2003;25:594-600.
Kaikure KM. The prevalence of early childhood caries (ECC) and its associated risk factors among immigrant Tibetan pre-school children in Bylakuppe, Mysore, India. Sci J Public Health 2015;3:384.
Kalita C, Choudhary B, Saikia AK, Sarma PC. Caries prevalence of school-going boys and girls according to cleaning methods and soft drink-taking frequency in different localities, in and around Guwahati City. J Indian Soc Pedod Prev Dent 2016;34:249-56.
] [Full text]
Karunakaran R, Somasundaram S, Gawthaman M, Vinodh S, Manikandan S, Gokulnathan S. Prevalence of dental caries among school-going children in Namakkal district: A cross-sectional study. J Pharm Bioallied Sci 2014;6:S160-1.
Barjatya K, Nayak UA, Vatsal A. Association between early childhood caries and feeding practices among 3-5-year-old children of Indore, India. J Indian Soc Pedod Prev Dent 2020;38:98-103.
] [Full text]
Koya S, Ravichandra KS, Arunkumar VA, Sahana S, Pushpalatha HM. Prevalence of early childhood caries in children of West Godavari district, Andhra Pradesh, South India: An epidemiological study. Int J Clin Pediatr Dent 2016;9:251-5.
Krishnaswamy S, Purushotham J, Bhat K. Early childhood caries and oral hygiene practices among preschool children in Mangaluru city. Int J Community Med Public Health 2019;6:4494.
Mahesh Kumar P, Joseph T, Varma RB, Jayanthi M. Oral health status of 5 years and 12 years school going children in Chennai city – An epidemiological study. J Indian Soc Pedod Prev Dent 2005;23:17-22.
Kuriakose S, Joseph E. Caries prevalence and its relation to socio-economic status and oral hygiene practices in 600 pre-school children of Kerala-India. J Indian Soc Pedod Prev Dent 1999;17:97-100.
Kuriakose S, Prasannan M, Remya KC, Kurian J, Sreejith KR. Prevalence of early childhood caries among preschool children in Trivandrum and its association with various risk factors. Contemp Clin Dent 2015;6:69-73.
] [Full text]
Kakanur M, Nayak M, Patil SS, Thakur R, Paul ST, Tewathia N. Exploring the multitude of risk factors associated with early childhood caries. Indian J Dent Res 2017;28:27-32.
] [Full text]
Mahejabeen R, Sudha P, Kulkarni SS, Anegundi R. Dental caries prevalence among preschool children of Hubli: Dharwad city. J Indian Soc Pedod Prev Dent 2006;24:19-22.
] [Full text]
Ghanghas M, Kumar A, Manjunath B, Narang R, Goyal A, Kundu H. Prevalence of early childhood caries in 3-to 5-year-old preschool children in Rohtak City, Haryana. J Indian Assoc Public Health Dent 2017;15:344. [Full text]
Mandal KP, Tewari AB, Chawla HS, Gauba KD. Prevalence and severity of dental caries and treatment needs among population in the Eastern states of India. J Indian Soc Pedod Prev Dent 2001;19:85-91.
] [Full text]
Mangla RG, Kapur R, Dhindsa A, Madan M. Prevalence and associated risk factors of severe early childhood caries in 12-to 36-month-old children of Sirmaur District, Himachal Pradesh, India. Int J Clin Pediatr Dent 2017;10:183-7.
Meghashyam B, Nagesh L, Ankola A. Dental caries status and treatment needs of children of fisher folk communities, residing in the coastal areas of Karnataka region, South India. West Indian Med J 2007;56:96-8.
Mehta A, Gupta J, Bhalla S, Arora R, Bal IS. Prevalence of dental caries among 3-17 year old children studying in various government and private schools at Chandigarh. J Indian Assoc Public Health Dent 2011;9:89-93. [Full text]
Mittal M, Chaudhary P, Chopra R, Khattar V. Oral health status of 5 years and 12 years old school going children in rural Gurgaon, India: An epidemiological study. J Indian Soc Pedod Prev Dent 2014;32:3-8.
] [Full text]
Shazia N, Kavikumar V, Tahir A. Incidence and prevalence of early childhood caries in pre-school children-our experience. Eur J Biomed Pharm Sci 2018;5:253-5.
Nagarajappa R, Satyarup D, Naik D, Dalai RP. Feeding practices and early childhood caries among preschool children of Bhubaneswar, India. Eur Arch Paediatr Dent 2020;21:67-74.
Narang R, Saha S, Jagannath GV, Kumari M, Mohd S, Saha S. The maternal socioeconomic status and the caries experience among 2-6 years old preschool children of Lucknow city, India. J Clin Diagn Res 2013;7:1511-3.
Padma M, Kumar R, Prathap KV, Mallika P, Naidu GM. Early childhood caries and feeding habits of preschool children in Guntur city in Andhra Pradesh. J Indian Assoc Public Health Dent 2011;1 Suppl 2:854-7.
Prabhu P, Rajajee KT, Sudheer KA, Jesudass G. Assessment of caries prevalence among children below 5 years old. J Int Soc Prev Community Dent 2014;4:40-3.
Prakash P, Subramaniam P, Durgesh BH, Konde S. Prevalence of early childhood caries and associated risk factors in preschool children of urban Bangalore, India: A cross-sectional study. Eur J Dent 2012;6:141-52.
Priyadarshini HR, Hiremath SS, Puranik M, Rudresh SM, Nagaratnamma T. Prevalence of early childhood caries among preschool children of low socioeconomic status in Bangalore city, India. J Int Soc Prev Community Dent 2011;1:27-30.
Retnakumari N, Cyriac G. Childhood caries as influenced by maternal and child characteristics in pre-school children of Kerala-an epidemiological study. Contemp Clin Dent 2012;3:2-8.
] [Full text]
Sachdeva A, Punhani N, Bala M, Arora S, Gill GS, Dewan N. The prevalence and pattern of cavitated carious lesions in primary dentition among children under 5 years age in Sirsa, Haryana (India). J Int Soc Prev Community Dent 2015;5:494-8.
Sankeshwari RM, Ankola AV, Tangade PS, Hebbal MI. Association of socio-economic status and dietary habits with early childhood caries among 3-to 5-year-old children of Belgaum city. Eur Arch Paediatr Dent 2013;14:147-53.
Saravanan S, Madivanan I, Subashini B, Felix JW. Prevalence pattern of dental caries in the primary dentition among school children. Indian J Dent Res 2005;16:140-6.
] [Full text]
Saravanan SP, Lokesh S, Polepalle T, Shewale A. Prevalence, severity and associated factors of dental caries in 3-6 year old children – A cross sectional study. Int J Dent Sci Res 2014;2:5-11.
Sarumathi T, Kumar BS, Datta M, Hemalatha VT, Nisha VA. Prevalence, severity and associated factors of dental caries in 3-6 year old children. J Clin Diagn Res 2013;7:1789-92.
Shankar S, Naveen N, Kruthika M, Vinay S, Shaikh H. Comparison of def index with Nyvad's new caries diagnostic criteria among three to six years old children in a school at Bangalore city. Indian J Dent Res 2012;23:135-9. [Full text]
Rathod SB, Nimbal AV, Padmashree S, Khanagoudra S, Bagoji IB, Hadimani GA. Early childhood caries and its prevalence among the preschool children's attending the anganwadi's at Ukkali Vijayapura district, Karnataka India. Indian J Public Health Res Dev 2020;11:856.
Sharma KR, Bhardwaj VK. Prevalence of dental caries and its pattern among five year old school going children in Shimla City, Himachal Pradesh. J Indian Assoc Public Health Dent 2011;1 17 Suppl 2:539-43.
Sharma K, Gupta KK, Gaur A, Sharma AK, Pathania V, Thakur VB. A cross-sectional study to assess the prevalence of early childhood caries and associated risk factors in preschool children in district Mandi, Himachal Pradesh. J Indian Soc Pedod Prev Dent 2019;37:339-44.
] [Full text]
Manjunath C, Ramakrishna T, Shilpashree K. Risk factors for predicting early childhood caries in anganwadi children in Bangalore city: A cross-sectional study. J Indian Assoc Public Health Dent 2016;14:160.
Prakasha Shrutha S, Vinit GB, Giri KY, Alam S. Feeding practices and early childhood caries: A cross-sectional study of preschool children in Kanpur district, India. ISRN Dent 2013;2013:275193.
Simratvir M, Moghe GA, Thomas AM, Singh N, Chopra S. Evaluation of caries experience in 3-6-year-old children, and dental attitudes amongst the caregivers in the Ludhiana city. J Indian Soc Pedod Prev Dent 2009;27:164-9.
] [Full text]
Singh A, Bharathi MP, Sequeira P, Acharya S, Bhat M. Oral health status and practices of 5 and 12 year old Indian tribal children. J Clin Pediatr Dent 2011;35:325-30.
Singh S, Vijayakumar N, Priyadarshini HR, Shobha M. Prevalence of early childhood caries among 3-5 year old pre-schoolers in schools of Marathahalli, Bangalore. Dent Res J (Isfahan) 2012;9:710-4.
Chandramohan S, Mandava P. Prevalence of early childhood caries (ECC) among anganwadi school children in rural areas of Thiruvallur district. Indian Streams Res J 2014;4:1-4.
Stephen A, Krishnan R, Ramesh M, Kumar VS. Prevalence of early childhood caries and its risk factors in 18-72 month old children in Salem, Tamil Nadu. J Int Soc Prev Community Dent 2015;5:95-102.
Sujlana A, Pannu PK. Family related factors associated with caries prevalence in the primary dentition of five-year-old children. J Indian Soc Pedod Prev Dent 2015;33:83-7.
] [Full text]
Suma BS, Hiremath SS. A study of feeding habits and its relation to early childhood caries experience in young children of 1-3 years age in Bangalore city. J Indian Assoc Public Health Dent 2010;8:13-9. [Full text]
Sunitha S, Chandu GN, Pushpanjali K, Jayashree SH, Shafiulla M. Feeding habits and Early Childhood Caries (ECC) among pre-school children of Davangere City, Karnataka. J Indian Assoc Public Health Dent 2016;4:39.
Bhayade SS, Mittal R, Chandak S, Bhondey A. Assessment of social, demographic determinants and oral hygiene practices in relation to dental caries among the children attending anganwadis of Hingna, Nagpur. J Indian Soc Pedod Prev Dent 2016;34:124-7.
] [Full text]
Tewari S, Tewari S. Caries experience in 3-7 year-old children in Haryana (India). J Indian Soc Pedod Prev Dent 2001;19:52-6.
] [Full text]
Tyagi R. The prevalence of nursing caries in davangere preschool children and its relationship with feeding practices and socioeconomic status of the family. J Indian Soc Pedod Prev Dent 2008;26:153-7.
] [Full text]
Venugopal T, Kulkarni VS, Nerurker RA, Damle SG, Patnekar PN. Epidemiological study of dental caries. Indian J Pediatr 1998;65:883-9.
Chugh VK, Sahu KK, Chugh A. Prevalence and risk factors for dental caries among preschool children: A cross-sectional study in Eastern India. Int J Clin Pediatr Dent 2018;11:238-43.
Virdi M, Bajaj N, Kumar A. Prevalence of severe early childhood caries in pre-school children in Bahadurgarh, Haryana, India. Internet J Epidemiol 2010;8:1-4.
Yadav PK, Saha S, Jagannath GV, Singh S. Prevalence and association of developmental defects of enamel with, dental- caries and nutritional status in pre-school children, Lucknow. J Clin Diagn Res 2015;9:ZC71-4.
Yashoda R, Anuradha KP, Baskar DJ, Hiremath SS. Dental caries prevalence and treatment needs among davangere preschool children. J Indian Assoc Public Health Dent 2011;9:193-201. [Full text]
World Health Organization. WHO Expert Consultation on Public Health Intervention against Early Childhood Caries: Report of a Meeting, Bangkok, Thailand, 26-28 January 2016 (WHO/NMH/PND/17.1). World Health Organization; 2016.
[Figure 1], [Figure 2]
[Table 1], [Table 2]