Evidence Drift in Early Childhood Caries Research: A Conceptual Six-Domain Causal-Translation Framework

Early childhood caries (ECC) is a common, preventable, and socially patterned disease, yet the literature on ECC is vulnerable not only to limitations in evidence generation but also to errors in evidence translation. This conceptual framework paper focuses on evidence translation rather than estimating a new treatment effect.

Literature and framework development were informed by targeted narrative searches of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, with an emphasis on ECC literature from 2010 onward and foundational methodological sources. Sources were purposively retained if they clarified an evidentiary domain, a cross-domain bridge, or a competing interpretation; priority was given to systematic reviews, trials, longitudinal and causal studies, natural experiments, clinical guidance, and implementation evaluations. No pooled effect estimates were produced.

Evidence drift is the movement of a finding into a stronger or different claim without adequate bridging evidence. The proposed framework comprises association, mechanism, causation, consequence, disease control, and policy implementation, with commercial and structural determinants operating as a cross-cutting upstream layer. It classifies the inference advanced rather than study design alone and permits primary and secondary domain tags. A four-question test asks whether the research question and conclusion occupy the same domain, what bridge supports the movement, and whether uncertainty is retained. Five trajectories illustrate the framework: vitamin D, dental rehabilitation under general anesthesia, oral microbiome research, silver diamine fluoride (SDF), and sugar taxation. In the SDF case, lesion-arrest evidence is explicitly separated from the still-unproven implementation hypothesis that endpoint-only pathways may create differential standards of care.

The original contribution is an integrated vocabulary, decision procedure, and validation agenda for ECC evidence appraisal. The framework generates three prespecified, testable hypotheses: (1) trained raters will classify claims with reproducible inter-rater agreement (kappa ≥ 0.70); (2) claims judged to contain evidence drift will be significantly less likely than domain-concordant claims to include an explicit bridge; and (3) using the structured framework will improve the transparency and proportionality of reviews compared with usual appraisal. Prospective testing of content and construct validity, as well as practical utility, in peer review, guideline development, education, and policy evaluation is required before standardized implementation.