A Scoping Review of Early Childhood Caries Experience Assessment Tools Used for Studies in Nigeria
by
, , , , , , , , and
Adebola Oluyemisi Ehizele
1,2,*,
Adebukunola Olajumoke Afolabi
1,3,
Ukachi Chiwendu Nnawuihe
1,4,
Omolola Titilayo Alade
1,5,
Joanne Lusher
1,6,
George Uchenna Eleje
1,7
,
Olunike Rebecca Abodunrin
1,8,
Folahanmi Tomiwa Akinsolu
1,8,
Ucheoma Nwaozuru
1,9,
Maha El Tantawi
1,10,
Morẹ́nikẹ́ Oluwátóyìn Foláyan
1,11
and
Francisca Obiageri Nwaokorie
1,12 1
Oral Health Initiative, Nigeria Institute of Medical Research, Yaba, Lagos 101212, Nigeria
2
Department of Periodontics, School of Dentistry, College of Medical Sciences, University of Benin, Benin City 300001, Nigeria
3
Department of Nursing Science, Obafemi Awolowo University, Ile-Ife 220001, Nigeria
4
Department of Preventive Dentistry, University of Medical Sciences, Ondo 351101, Nigeria
5
Department of Preventive and Community Dentistry, Faculty of Dentistry, College of Health Sciences, Obafemi Awolowo University, Ile-Ife 220001, Nigeria
6
Provost’s Group, Regent’s University London, London NW1 4NS, UK
7
Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka 420102, Nigeria
8
Department of Public Health, Faculty of Basic Medical and Health Sciences, Lead City University, Ibadan 110115, Nigeria
9
Department of Implementation Science, Wake Forest University, Winston-Salem, NC 27101, USA
10
Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria 21527, Egypt
11
Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife 220001, Nigeria
12
Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos 101212, Nigeria
*
Author to whom correspondence should be addressed.
BioMed 2023, 3(3), 400-419; https://0-doi-org.brum.beds.ac.uk/10.3390/biomed3030033
Submission received: 4 August 2023
/
Revised: 17 August 2023
/
Accepted: 23 August 2023
/
Published: 29 August 2023
Abstract
:This scoping review provides an overview of the tools used to assess for early childhood caries (ECC) in Nigeria. A search of the literature in African Journals Online, Google Scholar, Medline, and Cochrane database was conducted in June 2023 using the PRISMA-ScR guidelines. A combination of keywords related to caries risk assessment, preschool children, and evaluation tools was used for the search. Studies reported in English and assessing ECC were extracted. Descriptive statistics were used to summarise the information on study characteristics, types of caries assessment tools, and study outcome. Caries assessment tools were divided into behavioural, social, and biological. After screening 964 potential studies, 16 were included in the review. ECC assessment tools were categorised into behavioural (snacking, frequency of consumption of refined carbohydrate in-between-meals, dental service utilisation, frequency of tooth brushing, use of fluoridated toothpaste, breast and bottle feeding patterns and duration), biological (birth rank, age, sex, anthropometric measures, molecular characterisation of isolated organisms, presence of plaque), and social (socioeconomic status of the child’s household, mother’s level of education, maternal income, occupation of the father, maternal decision-making ability). Twelve studies used behavioural assessment tools, 11 used biological, and 11 used social tools. Furthermore, 11 (70.1%) used a combination of tools, four (25.0%) used only biological tools, and one (6.2%) used only behavioural tools to assess ECC experience. No study screened for the risk of caries. In conclusion, we identified the need for comprehensive studies to identify the risk indicators of ECC in Nigeria. This will support the development of a caries risk assessment tool appropriate for the country context.
1. Introduction
Despite being preventable, early childhood caries (ECC) is still one of the most prevalent diseases in children [1]. It is primarily attributed to long-term exposure to a diet rich in refined sugar, poor dental hygiene, and suboptimal oral care procedures [2]. In addition, a variety of behavioural and environmental factors make ECC risk more complex. Furthermore, the pain associated with this illness restricts chewing abilities, interferes with sleep, alters mood, and decreases productivity, which all negatively affects the child’s quality of life [1,2]. In low- and middle-income countries, ECC prevalence is still as high as 70% despite being a disease that is preventable [2]. In addition, treating caries is expensive, placing a heavy financial strain on people in countries like Nigeria where out-of-pocket healthcare payment is predominant [1,2]. Preventive interventions are essential since they are more economical than therapy given the scarce resources in places like Nigeria [3,4].
Accurate and early caries risk prediction can greatly enhance caries prevention outcomes in children, leading to timely and appropriate interventions and improved oral health results [5,6]. Caries Risk Assessment (CRA) can effectively identify children at risk of ECC and enhance the process of offering personalised preventive measures promptly [7]. CRA is the determination of the likelihood that caries will occur, or the likelihood that there will be a change in the size or activity of existing lesions during a specific period [8], and can be performed by non-dental health care providers to identify and refer high-risk children before caries development or progression occurs [8]. When the tool assesses a variety of factors, children can be categorised as low, moderate, or high risk for ECC development and managed appropriately [9].
CRA tools also help to enhance objectivity, documentation, and motivation for caries management for preschool children [10]. They are developed for different populations [5] and often include several socio-demographic, behavioural, and clinical factors that are assessed jointly to decide about the caries risk status of the children. Some examples of globally tested tools are the Caries Management by Risk Assessment (CAMBRA), the American Dental Association Caries Risk Assessment, the American Academy of Paediatric Dentistry Caries Risk Assessment, and the computer-based assisted CRA methods (e.g., Cariogram) [11]. These tools have, however, only been used for the screening of ECC in high-income countries like the United States and Europe [12,13]. We did not find any study that screened for ECC using any of CRA in Africa.
Despite the low prevalence but high burden of ECC in Nigeria [4], little is known about the CRA tools used for ECC risk assessment and the consistency of their application [10]. The absence of a validated and accurate CRA tool to assess the risk of ECC in children in Nigeria limits the comparison of data between studies, and the application of evidence-based clinical management of ECC [14]. In addition, the absence of a validated CRA tool for the country makes it challenging to develop a national ECC risk profile with identified geographical areas and sub-populations more affected by inequalities associated with ECC that require special attention to reduce their risk for ECC [15]. This scoping review, therefore, aimed to map the existing literature on the tools used to assess ECC in Nigeria and to highlight the strengths and gaps in the use of these tools to assess the risk of ECC in children.
2. Materials and Methods
The method for this review was developed using the Population/participants, Concept and Context (PCC) framework [16], where the population of interest is preschool children, the concept is the CRA tools, and the context is Nigeria. The methodology was based on the Joanna Briggs Institute (JBI) scoping review methodology [17] to provide a systematic and transparent search strategy to identify relevant studies.
2.1. Research Questions
This review was guided by the research questions: (i) what are the CRA tools used for assessing the risks of ECC among preschool children in Nigeria? (ii) what are the strengths and weaknesses of the CRAs used for assessing the risks of ECC among preschool children in Nigeria?
2.2. Relevant Studies
A systematic search of the literature, from inception till June 2023, on MEDLINE [PubMed], African Journals Online, Google Scholar, and Cochrane Library [CENTRAL] was conducted using the terms shown in Appendix A. A search of related citations and references was also carried out. Non-English articles were excluded if no English translation was available.
2.3. Study Selection
Publications identified through the search strategy were downloaded into Endnote, imported into Rayyan, and duplicates were removed. Three researchers performed title and abstract screening independently using pre-defined inclusion and exclusion criteria. Studies were included if there was an agreement between two or all the reviewers. The same three researchers completed the full-text review. Uncertainty regarding whether publications met the inclusion criteria was resolved via consensus among the three researchers.
2.4. Inclusion Criteria
Peer reviewed full length articles focusing on CRA tools for preschool children in Nigeria, published in English, were included in this review. There was no restriction on study design or date of publication.
2.5. Exclusion Criteria
Letters to the editor, commentaries on studies, and studies whose full lengths cannot be accessed were excluded. In addition, retrieved documents without data on children <72 months of age were excluded. Other data sources, such as websites or books, were excluded.
2.6. Data-Charting Process
A data-charting form was developed by two authors (AOE and AOA) to extract relevant variables. All authors independently extracted data and continuously updated the data-charting form. Each study’s data were extracted by two separate authors blinded to each other’s results to ensure accurate data extraction. Authors charted variables related to literature characteristics (e.g., authors, year of publication), study design, sample size, category of tool, population characteristics (e.g., part or region of the country), and variables related to the research questions (e.g., ECC risk factors, ECC protective factors). The range of behavioural, social, and biological assessment tools used for caries assessment was also charted.
2.7. Expert Consultation
The developed chart was shared with experts in the field of ECC (MET and MOF) and a Cochrane-trained expert on systematic review, meta-analysis, and scoping review (GUE) to validate the process and to ensure the extracted data were comprehensive.
2.8. Data Analysis
The results of the scoping review were reported according to the Preferred Reporting Items for Systematic reviews and Meta Analyses extension for Scoping Reviews (PRISMA-ScR) checklist [18]. The tools used for caries risk assessment were classified into tools using biological, behavioural, and social indicators. In addition, the Joanna Briggs Institute Critical Appraisal Checklist for analytical cross-sectional studies, case-control studies, and cohort studies [19] was used for critical appraisal of the quality of all included studies. The extent to which the studies addressed the possibility of bias in eight areas of study design, conduct, and analysis was analysed. Each of the eight domains received a score from 0 (poor quality) to 2 (high quality), and a total quality score was calculated by summing the individual domain scores. Total scores ranged from 0 to 16, with higher scores indicating higher quality. Three researchers independently assessed each included publication and any uncertainty regarding the quality of publications was resolved through discussion among the team.
3. Results
The search resulted in 1040 records, which were downloaded into Endnote and imported into Rayyan. After de-duplication, 964 records remained. After reviewing titles and abstracts, and screening, 33 articles were eligible for full-text screening. On screening the full articles, 17 articles were excluded either because the data were not specific to the study group of interest or they were not specific to Nigeria, leaving 16 articles [20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35] for this review. Figure 1 shows the flow diagram of the publication screening process.
Table 1 shows that the 16 extracted articles were conducted among preschool children in the south-west geopolitical zone of Nigeria: seven (43.8%) in Ile-Ife [20,23,25,28,30,31,32], seven (43.8%) in Lagos [21,24,27,29,34,35], one (6.2%) in Enugu [26], and one (6.2%) in Benin [33]. Two (12.5%) studies analysed urban and rural differences in the prevalence of ECC [22,35].
Four (25.0%) of the studies were hospital-based [21,28,33,35], one (6.2%) was school-based [21], and 11 (68.8%) were population-based [20,22,23,24,25,27,29,30,31,32,35]. All the studies were cross-sectional, and all but two [20,31] assessed ECC at the cavitated level.
Altogether, 34 tools were used to assess ECC risk in the 16 studies. These were 12 tools using behavioural indicators, 11 tools using social indicators, and 11 tools using biological indicators. Furthermore, 11 (70.1%) of the studies used a combination of tools, four (25.0%) used only biological indicators [25,29,32,34], and one (6.2%) used only behavioural indicators [31].
Table 1 shows that the behavioural indicators were associated with ECC risk: Frequency of sugar consumption [23,28,35], long duration of breastfeeding [21,23,33], exclusive breastfeeding [24], sleeping with bottle in the mouth [21], and supervised tooth brushing [21]. On the contrary, the following behavioural indicators were not associated with ECC experience: tooth brushing frequency [21,22,23,26,27,33,35], night feeding [23,24,33,35], frequency of sugar consumption [20,26,33], duration and content of bottle feeding [20,23,27], use of toothpaste [19,21,22], form of breast feeding [23,28], dental service utilisation [20,26], duration of breast feeding [28,35], supervised tooth brushing [22], tooth cleaning tool [27], onset of tooth cleaning [21], tooth brushing method [27], and oral rehydration therapy [31]. The only behavioural indicator found to be protective against ECC was tooth brushing more than once a day [20].
Table 2 shows the behaviour indicators used for caries risk assessment among preschool children in Nigeria. Of the 11 studies that assessed the relation between ECC risk and behaviour, eight explored tooth brushing frequency [20,21,22,23,26,27,33,35], six explored sugar consumption [20,23,26,28,33,34], five explored breast feeding duration [21,24,28,33,35], five explored night feeding [21,22,24,32,35], four explored forms of breast feeding (exclusive, partially exclusive or non-exclusive) [21,23,24,28], three explored the use of toothpaste [20,22,23], two explored bottle feeding [24,28], dental service utilisation [20,26], two tooth cleaning tools [25,32], and supervised tooth brushing [21,22] each, and one explored tooth cleaning methods [27] and oral rehydration therapy [31].
Table 3 shows the range of social indicators used for ECC risk assessment in Nigeria. Of the 11 studies that assessed the relation between ECC risk and social factors, nine explored age [20,21,22,23,24,27,28,33,35], seven explored sex [22,23,24,27,28,33,35], four explored socioeconomic status [23,26,27,35], three explored birth rank [23,27,28], two explored residential location [22,35], and one explored maternal psychosocial factors [30], maternal decision-making abilities [30], maternal education, [30], maternal income [30], maternal employment status [30], and maternal knowledge [23], respectively.
Table 1 shows the social factors associated with ECC risk were older age [20,21,22,26,27,28], and higher socioeconomic status [26,35]. Age [23,24,33,35], sex [22,24,27,28,33,35], residential location [22,35], socioeconomic status [23,27], birth rank [23,27,28], maternal psychosocial factors [30], maternal decision-making abilities [30], maternal education, [30], maternal income [30], maternal employment status [33], and maternal age [23,24] were not associated with ECC risk. The two protective social factors were being female [23] and maternal oral health knowledge [23].
Table 4 shows the biological indicators used for ECC risk assessment in Nigeria. Of the 12 studies, five explored plaque score [23,25,26,27,35], three explored anthropometric variables [25,29,33], and one explored enamel defects [24], maternal caries status [30], maternal illness [21], use of medication [21], CD4 count [32], HIV exposure [32], spontaneous membrane rupture during delivery [32], S. mutans count [34], and S. sobrinus count [34].
Table 1 shows the biological indicators associated with ECC risk were plaque score [22,23,27], wasting [29], overweight [32], birth weight [21], enamel defects [29], maternal caries status [30], HIV infected [32], low CD4 count [32], and S. sobrinus count [34]. Biological indicators not associated with ECC were plaque [35], stunting [32], underweight [32], wasting [32], medical illness [21], use of medication [21], and S. mutans count [34]. In addition, children with fair oral hygiene had lower risk for ECC [24].
Table 5 shows the outcome of the critical appraisal of the quality of studies included in the review. All the studies described the study participants and setting in detail, used objective, standardised criteria to measure ECC, and used appropriate statistical analysis to reach their conclusions. However, only 15 (93.8%) of the 16 studies included information on the eligibility criteria of the study participants, and 15 (93.8%) had information about how the exposure variables were measured validly. In addition, of the 15 epidemiological studies that needed to adjust for confounders, only three (20.0%) studies clearly defined their confounding variables and six (40.0%) identified strategies to deal with confounding variables.
4. Discussion
This scoping review reveals that the assessment of ECC risk was only carried out in two of the six geopolitical zones in Nigeria. These assessments were conducted using cross-sectional studies that were mainly population-based. Various indictors were utilised to assess ECC risk, including behavioural indicators such as snacking habits, frequency of refined carbohydrate consumption between meals, dental service utilisation, tooth brushing frequency, use of fluoridated toothpaste, breastfeeding and bottle-feeding patterns, and duration. Additionally, biological indicators like birth rank, age, sex, dental defects, anthropometric measures, molecular characterisation of isolated organisms, and plaque accumulation were used. Social indicators such as the child’s socioeconomic status, mother’s education level, maternal income, father’s occupation, and maternal decision-making ability were also used, either individually or in combination.
This scoping review showed that there was no consensus on behavioural indicators that were associated with an increased risk of ECC, except brushing more than once a day, which was identified as a protective indictor. Similarly, dental services utilisation was not associated with the risk of ECC in the two studies that included it as a risk indicator. Moreover, no consensus was reached on the social indictors that were risks for ECC, while being female and having maternal knowledge of oral health were found to be protective indicators. On the other hand, biological indicators like HIV exposure, low CD4 count, high S. sobrinus count, and enamel defects were identified as risk indicators for ECC. The association between malnutrition, oral hygiene, and ECC risk was not clearly established across most studies. Furthermore, most of the studies lacked clear definitions of their confounding factors, and did not propose strategies to address potential confounding factors, compromising the robustness of the analysis.
One strength of this study is that it highlights a critical gap in ECC management in Nigeria. Despite having a low prevalence of ECC in Nigeria [37,38], the burden of untreated caries remains high [39], especially considering the large population of infants, toddlers, and preschool children in the country [40]. Therefore, there is an urgent need for an effective CRA tool that can be utilised by adjunct dental staff to prevent and diagnose ECC. Countries like Canada [9], the UK [41], India [42], and others [43,44] are promoting the use of context-specific CRA tools by laypersons to ensure early access to oral examinations by the age of one. Early intervention for ECC management is crucial, as the risk significantly increases by the age of 2 and becomes even higher in the 3–5-year age group [38]. This study also highlighted that the risk of ECC increases with age in Nigeria, emphasizing the need for the development of an appropriate CRA tool for the country.
The data generated in Nigeria regarding the indicators associated with ECC contribute to ongoing debates in the public sphere. Like findings from other studies, it was observed that prolonged breastfeeding combined with poor oral hygiene practices can increase the risk of ECC [23,39]. Conversely, effective plaque control disrupts the bacterial biofilm, reduces substrate availability for cariogenic bacteria, minimises acid production, and lowers the risk of ECC [11,22]. An effective CRA tool will consider factors such as diet, fluoride exposure, salivary flow, previous caries experience, and the presence of cariogenic bacteria [11]. However, in Nigeria, there is limited information on the association between fluoride exposure and the risk of ECC, as well as limited information on cariogenic bacteria that are risk indicators for ECC. There are also no studies on the association between ECC and salivary flow. In addition, the evidence for the link between ECC and the frequency of daily sugar consumption is contradictory. While the two studies that showed links between maternal knowledge of oral health, maternal caries status, dental defects, and the risk of ECC are supported by existing evidence [45,46,47], the non-significant association between S. mutans count and ECC is contentious, as prior studies had shown this link [48]. Also contentious is the finding that fair oral hygiene is protective against ECC. These are some of the reasons why robust evidence is needed to objectively identify ECC risk and protective factors in Nigeria.
The development of a CRA tool for Nigeria requires a strong foundation of research-based evidence, like the process followed in the development of the Canadian CRA [9,49]. However, at present, the country-specific evidence needed to support the development of a CRA is limited. The robustness of the studies conducted have been majorly limited by the studies not defining their confounders nor identifying strategies to adjust their study findings for the effect of confounders. It is crucial to strategically address this data analysis gap and facilitate the conduct of research that provides high-quality evidence to support the development of a cost-effective and easy to use CRA tool. Such research should explore the use of digital risk assessment tools and artificial intelligence-based models and algorithms [50,51].
The development of a national CRA for ECC screening should be based on shifting the task of screening for ECC to community healthcare workers working based on the national task shifting and task sharing policy for essential healthcare services in Nigeria [52]; and the need to promote minimum intervention dentistry based on the draft National Policy on Mercury phase down. The successful application of the minimum intervention dentistry strategy to manage ECC relies heavily on caries risk assessment [53,54,55]. It also contributes to achieving the sustainable development goals (SDG 3) [56].
5. Conclusions
This scoping review demonstrated that ECC risk assessment in Nigeria has been limited to only two regions in the country and assessment has relied on the use of behavioural, biological, and social indicators. No standardised CRA tool was used in any of the studies. In addition, consensus is lacking on the factors that are associated with risk for ECC, though suggestive protective behaviours and social indicators were identified. Additionally, the associations of the frequency of sugar consumption, duration of breastfeeding, forms of breastfeeding, night feeding, malnutrition, and oral hygiene with the risk of ECC were inconclusive. There is the need for studies using more comprehensive, and standardised tools with nationally representative samples and proper consideration of confounding factors to enhance the understanding of risk factors for ECC and improve its preventive strategies.
Author Contributions
Conceptualisation, A.O.E., A.O.A., U.C.N. and F.O.N.; methodology, A.O.E., A.O.A., U.C.N. and F.O.N.; software, F.T.A., O.R.A., A.O.E., A.O.A., U.C.N. and F.O.N.; validation, F.T.A., O.R.A., A.O.E., A.O.A., U.C.N. and F.O.N.; formal analysis, A.O.E., A.O.A., U.C.N. and O.T.A.; investigation, A.O.E., A.O.A., U.C.N.; resources, F.T.A., O.R.A., A.O.E., A.O.A., U.C.N., F.O.N., G.U.E. and M.O.F.; data curation, A.O.E., M.O.F., M.E.T., G.U.E., J.L. writing—original draft preparation, A.O.E.; writing—review, A.O.A., U.C.N., F.O.N., O.T.A., J.L., U.N., G.U.E. and M.O.F.; visualisation, A.O.E., A.O.A., U.C.N. O.R.A. and F.T.A.; supervision, F.O.N., O.T.A., J.L, U.N., G.U.E. and M.O.F.; project administration, F.T.A., F.O.N., O.T.A. and M.O.F.; funding acquisition, F.T.A. and M.O.F. All authors have read and agreed to the published version of the manuscript.
Funding
This research was funded by the Oral Health Initiative, Nigeria Institute of Medical Research, Nigeria, grant number [OHI/COH2023/0001]. The Article Processing Charge (APC) was funded by the Institutional Open Access Program (Wake Forest School of Medicine).
Institutional Review Board Statement
Not applicable.
Informed Consent Statement
Not applicable.
Data Availability Statement
The data presented in this study are openly available in Medline, Cochrane Library, and African Journals Online.
Conflicts of Interest
The authors declare no conflict of interest.
Appendix A
Search strategy
The search strategy for PubMed, which was altered appropriately using specific terms for the other databases, is as follows:
1. Medline (PUBMED) (940 results)
• #1- (Dental Cavity[Title/Abstract) OR (Dental Decay[Title/Abstract)) OR (Dental Cavities[Title/Abstract)) OR (Cavities, Dental[Title/Abstract)) OR (Cavity, Dental[Title/Abstract)) OR (Carious Lesions[Title/Abstract)) OR (Carious Lesion[Title/Abstract)) OR (Lesion, Carious[Title/Abstract)) OR (Lesions, Carious[Title/Abstract)) OR (Decay, Dental[Title/Abstract)) OR (Carious Dentin[Title/Abstract)) OR (Carious Dentins[Title/Abstract)) OR (Dentin, Carious[Title/Abstract)) OR (Dentins, Carious[Title/Abstract)) OR (Dental White Spot[Title/Abstract)) OR (Spot, Dental White[Title/Abstract)) OR (Spots, Dental White[Title/Abstract)) OR (White Spot, Dental[Title/Abstract)) OR (White Spots, Dental[Title/Abstract)) OR (Dental White Spots[Title/Abstract)
• #2- (risk assess[Title/Abstract] OR risk assessed[Title/Abstract] OR risk assessment[Title/Abstract] OR risk assessing[Title/Abstract] OR risk, assessment[Title/Abstract] OR risk, assessments[Title/Abstract] OR risk, assessments[Title/Abstract] OR risk assessor[Title/Abstract] OR risk assessors[Title/Abstract] OR risk management[Title/Abstract] OR risk managing[Title/Abstract)
• #3- (children[Title/Abstract] OR preschool children[Title/Abstract)
• #4- (Nigeria [Title/Abstract] OR Federal republic of Nigeria[Title/Abstract)
#1 AND #2 AND #3 NOT #4 --- (n = 1040)
2. Cochrane Library (n = 10)
ID Search
#1 caries
#2 carious lesion
#3 dental caries
#4 dental cavities
#5 carious lesions
#6 dental cavity
#7 dental decay
#8 risk
#9 risk assessment
#10 tool
#11 indices
#12 methods
#13 children
#14 Early childhood
#15 Nigeria
#16 #1OR#2OR3OR#4OR#5OR#5OR#6OR#7
#17 #8OR#9
#18 #10OR#11OR#12
#19 #13OR#14
#20 #15AND#16AND#17AND#18AND#19 (n = 10)
3. African Journals Online (AJOL) (n = 74)
Search term: Risk assessment tool for early childhood caries in Nigeria
4. Grey Literature (n = 2)
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Figure 1.
Flow diagram of studies included in scoping review [36]. * Only these databases were used for this study; ** Studies were excluded for the following reasons: Wrong population (n = 540), Wrong outcome (n = 327), Wrong publication type (n = 52), Publication in foreign language (n = 12).
Figure 1.
Flow diagram of studies included in scoping review [36]. * Only these databases were used for this study; ** Studies were excluded for the following reasons: Wrong population (n = 540), Wrong outcome (n = 327), Wrong publication type (n = 52), Publication in foreign language (n = 12).
Table 1.
Characteristics of included studies.
| s/n | Authors, Date (Location) | Study Design | Sample Size | Variable Assessed | Category of Tool | Age Range | ECC Risk Indictors | ECC Protective Indicators | Indicators Not Associated with ECC |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Folayan et al., 2021 [20] (Ile-Ife) | Cross-sectional Population-based | 1549 | Cavitated and non-cavitated caries Age Tooth brushing frequency Sugar consumption frequency Use of fluoridated toothpaste Dental service utilisation in 12 months | Social Behavioural Behavioural Behavioural Behavioural | 6–71 months | dmft and dmfs highest among the 24–35-months-olds SiC score highest among the 12–23-months-olds | Tooth brushing frequency (more than once per day) | Sugar consumption frequency Use of fluoridated toothpaste Dental service utilisation in 12 months |
| 2 | Olatosi et al., 2015 [21] (Lagos) | Cross-sectional Hospital-based | 302 | Cavitated caries Sugar consumption Duration of breastfeeding Breastfeeding at night On demand breast feeding Duration of bottle feeding Sleep with bottle Sugarmate drinks Method of tooth cleaning Onset of tooth cleaning Frequency of tooth cleaning Tooth cleaning supervisor Birth weight of child Medical illness Use of medication Socioeconomic status Age, sex | Behavioural Behavioural Behavioural Behavioural Behavioural Behavioural Behavioural Behavioural Behavioural Behavioural Behavioural Biological Biological Social Social Social | 6–71 months | Age Duration of breastfeeding Sleep with bottle Sugarmate drinks Sugar consumption Tooth cleaning supervisor Method of tooth cleaning | NA | Breastfeeding at night On demand breast feeding Duration of bottle feeding Onset of tooth cleaning Tooth cleaning frequency Birth weight of child Medical illness Use of medication Socioeconomic status Age, sex |
| 3 | Adeniyi et al., 2009 [22] (Lagos) | Cross-sectional Population-based | 404 | Cavitated caries Age Sex Residence (Rural vs. urban) Plaque score Toothpaste (Children vs. adult) Tooth brusher (Child vs. caregiver) Tooth-brushing frequency | Social Social Social Biological Behavioural Behavioural Behavioural | 18–60 months | Age Plaque score | NA | Sex Residence (Rural vs. urban) Toothpaste (Children vs. adult) Tooth brusher (Child vs. caregiver) Tooth-brushing frequency |
| 4 | Folayan et al., 2015 [23] (Ile-Ife) | Cross-sectional Population-based | 497 | Cavitated caries Age, sex, birth rank Socioeconomic status Maternal age at childbirth Maternal knowledge of oral health Tooth brushing frequency Sugar consumption frequency Use of fluoridated toothpaste Night feeding Forms of breastfeeding (exclusive, almost exclusive or mixed) Plaque score | Social Social Social Social Behavioural Behavioural Behavioural Behavioural Behavioural Biological | 6–71 months | Sugar consumption frequency Plaque score | Female Maternal knowledge of oral health | Age Socioeconomic status Use of fluoridated toothpaste Birth rank Night feeding Tooth brushing frequency Forms of breastfeeding (exclusive, almost exclusive, or mixed) Maternal age at childbirth |
| 5 | Folayan et al., 2010 [24] (Lagos) | Cross-sectional Population-based | 396 | Cavitated caries Age and sex Forms of breastfeeding (exclusive, almost exclusive or mixed) Duration of breastfeeding Night feeding habits Duration and content of bottle feeding | Social Behavioural Behavioural Behavioural Behavioural | 6–71 months | Breastfeeding longer than 18 months Exclusively breastfeeding | NA | Age and sex Night feeding habits Duration and content of bottle feeding |
| 6 | Folayan et al., 2020 [25] (Ile-Ife) | Cross-sectional Population-based | 1549 | Cavitated caries Anthropometric variables (stunting, wasting underweight) Enamel defects | Biological Biological | 0–5 years | 0–2-year-olds
Amelogenesis imperfecta Fluorosis 3–5-year-olds Enamel hypoplasia Amelogenesis imperfecta Fluorosis 0–5-year-olds Enamel hypoplasia fluorosis | NA | Anthropometric variables (stunting, wasting underweight) |
| 7 | Onyejaka et al., 2015 [26] (Enugu) | Cross-sectional School-based | 429 | Cavitated caries Socioeconomic status Dental service utilisation Tooth brushing frequency Sugar consumption frequency Plaque score | Social Behavioural Behavioural Behavioural Biological | 3–5 years | Age High socioeconomic status | Fair oral hygiene | Dental service utilisation Tooth brushing frequency Sugar consumption frequency |
| 8 | Sowole et al., 2007 [27] (Lagos) | Cross-sectional Population-based | 389 | Cavitated caries Socioeconomic status, age, sex, birth rank Tooth cleansing methods Tooth brushing frequency Tooth cleansing tool Plaque score | Social Behavioural Behavioural Behavioural Biological | 6–71 months | Age Plaque score | NA | Socioeconomic status, sex, birth rank Tooth cleansing methods Tooth brushing frequency Tooth cleansing tool |
| 9 | Folayan et al., 2012 [28] (Ile-Ife) | Cross-sectional study Hospital-based | 205 | Cavitated caries Age, sex, birth rank Duration of breast and bottle feeding Forms of breastfeeding (exclusive, almost exclusive or mixed) Frequency of daily sugar consumption Duration of bottle feeding | Social Behavioural Behavioural Behavioural Behavioural | 1–16 years | Age Frequency of daily sugar consumption | NA | Sex Birth rank Duration of breast and bottle feeding Forms of breastfeeding (exclusive, almost exclusive, or mixed) |
| 10 | Olatosi et al., 2021 [29] (Lagos) | Cross-sectional School-based | 273 | Cavitated caries Anthropometric variables (stunting, wasting, underweight, BMI) | Biological | 1–6 years | Wasting | NA | NA |
| 11 | Alade et al., 2021 [30] (Ile-Ife) | Cross-sectional Population-based | 1549 | Cavitated caries Maternal psychosocial factors (dental anxiety, general anxiety, sense of coherence, parenting stress, fatalism, social support, depressive symptoms, and executive dysfunction), Maternal decision-making abilities Maternal education Maternal income Maternal caries status | Social Social Social Social Biological | 6–71 months | Maternal caries status | NA | Maternal psychosocial factors (dental anxiety, general anxiety, depressive symptoms, sense of coherence, fatalism, parenting stress, social support, and executive dysfunction), Maternal decision-making abilities Maternal education Maternal income |
| 12 | Folayan et al., 2023 [31] (Ile-Ife) | Cross-sectional Population-based | 1564 | Cavitated and non-cavitated caries Oral rehydration therapy | Behavioural | 6 month–5 year | NA | NA | Oral rehydration therapy |
| 13 | Folayan et al., 2019 [32] (Ile-Ife) | Cross-sectional Population-based | 370 | Cavitated caries Anthropometric variables (stunting, wasting, overweight, underweight) | Biological | 6–71 month | Overweight | Stunting Underweight | Wasting |
| 14 | Coker et al., 2018 [33] (Benin) | Cross-sectional Hospital-based | 335 | Cavitated caries Age and sex Maternal age, education and employment status CD4 count HIV exposure (HIV infected; HIV exposed but uninfected; and HIV unexposed and uninfected) Spontaneous membrane rupture during delivery Duration of breastfeeding Tooth cleaning frequency Sugar consumption Sleeping with bottle or breast | Social Social Biological Biological Behavioural Behavioural Behavioural Behavioural | 6–72 months | HIV infected Low CD4 count Older age Longer duration of breastfeeding Spontaneous membrane rupture during delivery. | NA | Sex Maternal age, education and employment status Tooth cleaning frequency Sugar consumption Sleeping with bottle or breast |
| 15 | Oluwo et al., 2021 [34] (Lagos) | Cross-sectional study Hospital-based | 80 | Cavitated caries Streptococcus mutans count Streptococcus sobrinus count | Biological Biological | 1–5 years | S. sobrinus count | NA | S. mutans count |
| 16 | Folayan et al., 2012 [35] (Lagos) | Cross-sectional study Population-based | 369 | Cavitated caries Age, sex Socioeconomic status Residential location Duration of breast feeding Night feeding practice Frequency of tooth cleaning Plaque score | Social Social Social Behavioural Behavioural Behavioural Biological | 6–71 months | Higher with higher socioeconomic status Night feeding practice | NA | Age, sex Residential location Duration of breast feeding Tooth cleaning frequency Plaque score |
dmft: decay, missing, filled tooth. dmfs: decay, missing, filled surface; SiC: significant Index of Caries.
Table 2.
Behavioural indicators used for early childhood caries risk assessment among preschool children in Nigeria.
Table 2.
Behavioural indicators used for early childhood caries risk assessment among preschool children in Nigeria.
| s/n | Authors, Date (Location) | Use of Toothpaste | Supervised Tooth Brushing | Tooth Cleaning Method | Tooth Cleaning Tools | Tooth Brushing Frequency | Oral Rehydration Therapy | Sugar Consumption | Breast Feeding Duration | Forms of Breast Feeding | Night Feeding | Bottle Feeding | Dental Service Utilisation |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Folayan et al., 2021 [20] | X | - | - | - | X | - | X | - | - | - | - | X |
| 2 | Olatosi et al., 2015 [21] | - | X | - | X | X | - | X | X | X | X | - | - |
| 3 | Adeniyi et al., 2009 [22] | X | X | - | - | X | - | - | - | - | - | - | - |
| 4 | Folayan et al., 2015 [23] | X | - | - | - | X | - | X | - | X | X | - | - |
| 5 | Folayan et al., 2010 [24] | - | - | - | - | - | - | - | X | X | X | X | - |
| 6 | Onyejaka et al., 2015 [26] | - | - | - | - | X | - | X | - | - | - | - | X |
| 7 | Sowole et al., 2007 [27] | - | - | X | X | X | - | - | - | - | - | - | - |
| 8 | Folayan et al., 2012 [28] | - | - | - | - | - | - | X | X | X | - | X | - |
| 9 | Folayan et al., 2023 [31] | - | - | - | - | - | X | - | - | - | - | - | - |
| 10 | Coker et al., 2018 [33] | - | - | - | - | X | - | X | X | - | X | - | - |
| 11 | Folayan et al., 2012 [35] | - | - | - | - | X | - | - | X | - | X | - | - |
Table 3.
Social indicators used for ECC risk assessment among preschool children in Nigeria.
| s/n | Authors, Date (Location) | Age | Sex | Residential Location | Socioeconomic Status | Birth Rank | Maternal Knowledge of Oral Health | Maternal Psychosocial Factors | Maternal Decision Making | Maternal Education | Maternal Income | Maternal Employment Status |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Folayan et al., 2021 [20] | X | - | - | - | - | - | - | - | - | - | - |
| 2 | Olatosi et al., 2015 [21] | X | - | - | - | - | - | - | - | - | - | - |
| 3 | Adeniyi et al., 2009 [22] | X | X | X | - | - | - | - | - | - | - | - |
| 4 | Folayan et al., 2015 [23] | X | X | - | X | X | X | - | - | - | - | - |
| 5 | Folayan et al., 2010 [24] | X | X | - | - | - | - | - | - | - | - | - |
| 6 | Onyejaka et al., 2015 [26] | - | - | - | X | - | - | - | - | - | - | - |
| 7 | Sowole et al., 2007 [27] | X | X | - | X | X | - | - | - | - | - | - |
| 8 | Folayan et al., 2012 [28] | X | X | - | - | X | - | - | - | - | - | - |
| 9 | Folayan et al., 2023 [31] | - | - | - | - | - | - | X | X | X | X | - |
| 10 | Coker et al., 2018 [33] | X | X | - | - | - | - | - | - | X | - | X |
| 11 | Folayan et al., 2012 [35] | X | X | X | X | - | - | - | - | - | - | - |
Table 4.
Biological indicators used for ECC risk assessment among preschool children in Nigeria.
| s/n | Authors, Date (Location) | Plaque Score | Anthropometry | Enamel Defect | Maternal Caries Status | Medical Illness | Use of Medication | CD4 Count | S. mutans Count | S. sobrinus Count | HIV Exposure | Spontaneous Membrane Rupture during Delivery |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Olatosi et al., 2015 [21] | - | - | - | - | X | X | - | - | - | - | - |
| 2 | Adeniyi et al., 2009 [22] | X | - | - | - | - | - | - | - | - | - | - |
| 3 | Folayan et al., 2015 [23] | X | - | - | - | - | - | - | - | - | - | - |
| 4 | Folayan et al., 2020 [25] | - | X | X | - | - | - | - | - | - | - | - |
| 5 | Onyejaka et al., 2015 [26] | X | - | - | - | - | - | - | - | - | - | - |
| 6 | Sowole et al., 2007 [27] | X | - | - | - | - | - | - | - | - | - | - |
| 7 | Olatosi et al., 2021 [29] | - | X | - | - | - | - | - | - | - | - | - |
| 8 | Alade et al., 2021 [30] | - | - | - | X | - | - | - | - | - | - | - |
| 9 | Folayan et al., 2019 [32] | - | X | - | - | - | - | - | - | - | - | - |
| 10 | Coker et al., 2018 [33] | - | - | - | - | - | - | X | - | - | X | X |
| 11 | Oluwo et al., 2021 [34] | - | - | - | - | - | - | - | X | X | - | - |
| 12 | Folayan et al., 2012 [35] | X | - | - | - | - | - | - | - | - | - | - |
Table 5.
Critical appraisal of included studies.
| s/n | Authors, Date | Were the Criteria for Inclusion in the Sample Clearly Defined? | Were the Study Participants and the Setting Described in Detail? | Was the Exposure Measured in a Valid and Reliable Way? | Were Objective, Standard Criteria Used for Measurement of the Condition? | Were Confounding Factors Identified? | Were Strategies to Deal with Confounding Factors Stated? | Were the Outcomes Measured in a Valid and Reliable Way? | Was Appropriate Statistical Analysis Used? |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Folayan et al., 2021 [20] | Yes | Yes | Yes | Yes | Unclear | No | Yes | Yes |
| 2 | Olatosi et al., 2015 [21] | No | Yes | No | Yes | No | No | Yes | Yes |
| 3 | Adeniyi et al., 2009 [22] | Yes | Yes | Yes | Yes | No | No | Yes | Yes |
| 4 | Folayan et al., 2015 [23] | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes |
| 5 | Folayan et al., 2010 [24] | No | Yes | Yes | No | No | No | Yes | Yes |
| 6 | Folayan et al., 2020 [25] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| 7 | Onyejaka et al., 2015 [26] | Yes | Yes | Yes | Yes | No | No | Yes | Yes |
| 8 | Sowole et al., 2007 [27] | No | Yes | Yes | Yes | No | No | Yes | Yes |
| 9 | Folayan et al., 2012 [28] | Yes | Yes | Yes | Yes | No | No | Yes | Yes |
| 10 | Olatosi et al., 2021 [29] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| 11 | Alade et al., 2021 [30] | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| 12 | Folayan et al., 2023 [31] | Yes | Yes | Yes | Yes | No | No | Yes | Yes |
| 13 | Folayan et al., 2019 [32] | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes |
| 14 | Coker et al., 2018 [33] | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes |
| 15 | Oluwo et al., 2021 [34] | Yes | Yes | Yes | Yes | Not applicable | Not applicable | Yes | Yes |
| 16 | Folayan et al., 2012 [35] | Yes | Yes | Yes | Yes | No | No | Yes | Yes |
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Ehizele, A.O.; Afolabi, A.O.; Nnawuihe, U.C.; Alade, O.T.; Lusher, J.; Eleje, G.U.; Abodunrin, O.R.; Akinsolu, F.T.; Nwaozuru, U.; Tantawi, M.E.; et al. A Scoping Review of Early Childhood Caries Experience Assessment Tools Used for Studies in Nigeria. BioMed 2023, 3, 400-419. https://0-doi-org.brum.beds.ac.uk/10.3390/biomed3030033
AMA Style
Ehizele AO, Afolabi AO, Nnawuihe UC, Alade OT, Lusher J, Eleje GU, Abodunrin OR, Akinsolu FT, Nwaozuru U, Tantawi ME, et al. A Scoping Review of Early Childhood Caries Experience Assessment Tools Used for Studies in Nigeria. BioMed. 2023; 3(3):400-419. https://0-doi-org.brum.beds.ac.uk/10.3390/biomed3030033
Chicago/Turabian StyleEhizele, Adebola Oluyemisi, Adebukunola Olajumoke Afolabi, Ukachi Chiwendu Nnawuihe, Omolola Titilayo Alade, Joanne Lusher, George Uchenna Eleje, Olunike Rebecca Abodunrin, Folahanmi Tomiwa Akinsolu, Ucheoma Nwaozuru, Maha El Tantawi, and et al. 2023. "A Scoping Review of Early Childhood Caries Experience Assessment Tools Used for Studies in Nigeria" BioMed 3, no. 3: 400-419. https://0-doi-org.brum.beds.ac.uk/10.3390/biomed3030033
