Early Childhood Caries and Maternal Education: Systematic Review and Meta-Analysis

To review and synthesise the available evidence on the association between maternal education and early childhood caries (ECC).

A comprehensive search strategy was employed to identify relevant studies published up to September 2025. Databases searched were PubMed, Scopus, Web of Science, and EMBASE. Authors of selected studies were contacted for additional information and to search for unpublished studies. A rigorous screening of publications was conducted, and data were extracted independently by two reviewers. All analytical study designs were included without language or year of publication restriction. The risk of bias was assessed using the Newcastle-Ottawa guidelines. Random-effects stratified meta-analyses were conducted to estimate the pooled odds ratio (OR). Meta-regression was carried out to assess potential factors associated with heterogeneity, such as study design, diagnostic criteria, sample characteristics, community fluoridation programmes, country economic indicators, and social policies.

The search retrieved 5562 unique articles and 155, conducted in 44 different countries, were included after full-text reading. The majority were cross-sectional (n = 124), followed by cohort (n = 24) and case-control (n = 7). The diagnostic criteria for dental caries varied across studies: 116 reported cavitated lesions, 39 included noncavitated lesions. The pooled effect showed that children of mothers with lower education had significantly higher chances of developing ECC compared to those of mothers with higher education: OR = 1.82 (95% CI 1.65-2.02 I²: 88.8%). Neither study characteristics nor country of dataset were able to significantly explain heterogeneity (p > 0.05), although the association was stronger among High-Income countries (OR = 1.92) than among Lower-Middle-Income countries (OR = 1.61) and among the highest tertile of social spending (OR = 1.98) than the lowest tertile (OR = 1.63). Social spending explained 3% of heterogeneity, all other explained less than 1% or nearly zero.

Maternal education is a consistent risk factor for ECC regardless of study characteristics.