A scoping review of early childhood caries, poverty and the first sustainable development goal

Poverty is a well-known risk factor for poor health. This scoping review (ScR) mapped research linking early childhood caries (ECC) and poverty using the targets and indicators of the Sustainable Development Goal 1 (SDG1).

We searched PubMed, Web of Science, and Scopus in December 2023 using search terms derived from SDG1. Studies were included if they addressed clinically assessed or reported ECC, used indicators of monetary or multidimensional poverty or both, and were published in English with no date restriction. We excluded books and studies where data of children under 6 years of age could not be extracted. We charted the publication year, study location (categorized into income levels and continents), children age, sample size, study design, measures of ECC, types and levels of poverty indicators and adjusted analysis. The publications were also classified based on how the relation between poverty and ECC was conceptualized.

In total, 193 publications were included with 3.4 million children. The studies were published from 1989 to 2023. Europe and North America produced the highest number of publications, predominantly from the UK and the US, respectively. Age-wise, 3-5-year-olds were the most studied (62.2%). Primary studies (83.9%) were the majority, primarily of cross-sectional design (69.8%). Non-primary studies (16.1%) included reviews and systematic reviews. ECC was mainly measured using the dmf indices (79.3%), while poverty indicators varied, with the most common used indicator being income (46.1%). Most studies measured poverty at family (48.7%) and individual (30.1%) levels. The greatest percentage of publications addressed poverty as an exposure or confounder (53.4%), with some studies using poverty to describe groups (11.9%) or report policies or programs addressing ECC in disadvantaged communities (11.4%). In addition, 24.1% of studies requiring adjusted analysis lacked it. Only 13% of publications aligned with SDG1 indicators and targets.

The ScR highlight the need for studies to use indicators that provide a comprehensive understanding of poverty and thoroughly examine the social, political, and economic determinants and impact of ECC. More studies in low and middle-income countries and country-level studies may help design interventions that are setting- and economic context-relevant.