Article Data

  • Views 564
  • Dowloads 187


Open Access

Association of early childhood caries and nutritional status: a scoping review

  • Dwen-Tjin Lui1
  • Rohaya Megat Abdul Wahab1
  • Elavarasi Kuppusamy1
  • Nur Hana Hamzaid2
  • Mohd Rohaizat Hassan3
  • Farinawati Yazid1,*,

1Department of Family Oral Health, Faculty of Dentistry, National University of Malaysia, Kuala Lumpur, KL 50300, Malaysia

2Faculty of Allied Health Sciences (Nutrition & Dietetics), National University of Malaysia, Kuala Lumpur, KL 50300, Malaysia

3Department of Community Health, Faculty of Medicine, National University of Malaysia Cheras, Kuala Lumpur, KL 56000, Malaysia

DOI: 10.22514/jocpd.2023.021 Vol.47,Issue 3,May 2023 pp.11-25

Submitted: 24 November 2022 Accepted: 17 January 2023

Published: 03 May 2023

*Corresponding Author(s): Farinawati Yazid E-mail:


The most widespread non-communicable disease in the world is dental caries. Early childhood caries (ECC) is the presence of one or more decayed, missing or filled tooth surfaces in any primary tooth in children between birth and 71 months. The disease has been linked to failure to thrive, impaired speech and reduce food consumption due to pain and discomfort. Nutritional status of a child may also be affected by caries. Thus, we conducted a scoping review to review the association between ECC and nutritional status. A total of 492 articles published until December 2022 from three databases were obtained. 20 relevant articles meeting the inclusion criteria were included. From the included articles, dmft index was the most common dental assessment used, while all articles used anthropometric measurements for nutritional assessment except for two articles that used laboratory methods. Based on the results obtained, majority of the articles stated that there was an association between ECC in children with poor nutritional status, while only one study reported an association between ECC and overweight or obese children. Four papers showed no association. A more standardised and consistent study methodology, sample population and protocol in articles selected may help yield more reliable results.


Growth and development; Anthropometric measurements; Early childhood caries; Newcastle-Ottawa scale

Cite and Share

Dwen-Tjin Lui,Rohaya Megat Abdul Wahab,Elavarasi Kuppusamy,Nur Hana Hamzaid,Mohd Rohaizat Hassan,Farinawati Yazid. Association of early childhood caries and nutritional status: a scoping review. Journal of Clinical Pediatric Dentistry. 2023. 47(3);11-25.


[1] Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–016: a systematic analysis for the global burden of disease study 2016. The Lancet. 2017; 390: 1211–259.

[2] Meyer F, Enax J. Early childhood caries: epidemiology, aetiology, and prevention. International Journal of Dentistry. 2018; 2018: 1415873.

[3] American Academy of Pediatric Dentistry A. Definition of early childhood caries. 2008. Available at: (Accessed: 24 November 2022).

[4] Buhari N, Zainal Abidin FN, Mani SA, Khan IM. Oral hygiene practices and bottle feeding pattern among children with early childhood caries: a preliminary study. Annals of Dentistry University of Malaya. 2016; 23: 1–8.

[5] World Health Organization. Oral health surveys: basic methods. Biometrics. 1971; 27: 1111.

[6] Hajishengallis E, Parsaei Y, Klein MI, Koo H. Advances in the microbial etiology and pathogenesis of early childhood caries. Molecular Oral Microbiology. 2017; 32: 24–4.

[7] Bencze Z, Mahrouseh N, Andrade CAS, Kovács N, Varga O. The burden of early childhood caries in children under 5 years old in the European union and associated risk factors: an ecological study. Nutrients. 2021; 13: 455.

[8] Alazmah A. Early childhood caries: a review. The Journal of Contemporary Dental Practice. 2017; 18: 732–737.

[9] Mobley C, Marshall TA, Milgrom P, Coldwell SE. The contribution of dietary factors to dental caries and disparities in caries. Academic Pediatrics. 2009; 9: 410–414.

[10] Punitha V, Amudhan A, Sivaprakasam P, Rathanaprabu V. Role of dietary habits and diet in caries occurrence and severity among urban adolescent school children. Journal of Pharmacy and Bioallied Sciences. 2015; 7: S296–S300.

[11] Tinanoff N, Baez RJ, Diaz Guillory C, Donly KJ, Feldens CA, McGrath C, et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. International Journal of Paediatric Dentistry. 2019; 29: 238–248.

[12] Gurinović M, Zeković M, Milešević J, Nikolić M, Glibetić M. Nutritional assessment. Reference Module in Food Science. 2017; 5: 1- 14.

[13] Gibson RS. Principles of nutritional assessment. 2nd ed. Oxford University Press: New York. 2005.

[14] Ahmad I. ABCDE of community nutritional assessment. Gomal Journal of Medical Sciences. 2019; 17: 27–28.

[15] Bhattacharya A, Pal B, Mukherjee S, Roy SK. Assessment of nutritional status using anthropometric variables by multivariate analysis. BMC Public Health. 2019; 19: 1045.

[16] Frank L. Nutritional assessment. In Hickson M, Smith S (ed). Advanced nutrition and dietetics in nutrition support (pp 50–54). 1st ed. John Wiley & Sons: Hoboken. 2018.

[17] World Health Organization. Malnutrition. 2021. Available at: tab_1 (Accessed: 24 November 2022).

[18] Modéer T, Blomberg CC, Wondimu B, Julihn A, Marcus C. Association between obesity, flow rate of whole saliva, and dental caries in adolescents. Obesity. 2010; 18: 2367–2373.

[19] González-Aragón Pineda AE, García Pérez A, García-Godoy F. Salivary parameters and oral health status amongst adolescents in Mexico. BMC Oral Health. 2020; 20: 190.

[20] Magriplis E, Michas G, Petridi E, Chrousos GP, Roma E, Benetou V, et al. Dietary sugar intake and its association with obesity in children and adolescents. Children. 2021; 8: 676.

[21] van Loveren C. Sugar restriction for caries prevention: amount and frequency. which is more important? Caries Research. 2019; 53: 168–175.

[22] Ndekero TS, Carneiro LC, Masumo RM. Prevalence of early childhood caries, risk factors and nutritional status among 3–5-year-old preschool children in Kisarawe, Tanzania. PLoS One. 2021; 16: e0247240.

[23] Clarke M, Locker D, Berall G, Pencharz P, Kenny DJ, Judd P. Malnourishment in a population of young children with severe early childhood caries. Pediatric Dentistry. 2006; 28: 254–259.

[24] Norberg C, Hallström Stalin U, Matsson L, Thorngren-Jerneck K, Klingberg G. Body mass index (BMI) and dental caries in 5-year-old children from southern Sweden. Community Dentistry and Oral Epidemiology. 2012; 40: 315–322.

[25] Ribeiro CCC, Silva MCBD, Nunes AMM, Thomaz EBDAF, Carmo CDS, Ribeiro MRC, et al. Overweight, obese, underweight, and frequency of sugar consumption as risk indicators for early childhood caries in Brazilian preschool children. International Journal of Paediatric Dentistry. 2017; 27: 532–539.

[26] Lee ZL, Gan WY, Lim PY, Hasan R, Lim SY. Associations of nutritional status, sugar and second-hand smoke exposure with dental caries among 3- to 6-year old Malaysian pre-schoolers: a cross-sectional study. BMC Oral Health. 2020; 20: 164.

[27] Muhoozi GKM, Atukunda P, Skaare AB, Willumsen T, Diep LM, Westerberg AC, et al. Effects of nutrition and hygiene education on oral health and growth among toddlers in rural Uganda: follow-up of a cluster-randomised controlled trial. Tropical Medicine & International Health. 2018; 23: 391–404.

[28] Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 2005; 8: 19–32.

[29] Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implementation Science. 2010; 5: 69.

[30] Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Loso M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2014. Available at: epidemiology/oxford.asp (Accessed: 24 November 2022).

[31] Li Y, Navia JM, Bian JY. Caries experience in deciduous dentition of rural Chinese children 3–5 years old in relation to the presence or absence of enamel hypoplasia. Caries Research. 1996; 30: 8–15.

[32] Petti S, Cairella G, Tarsitanl G. Rampant early childhood dental decay: an example from Italy. Journal of Public Health Dentistry. 2000; 60: 159–166.

[33] Karvonen HM, Nuutinen O, Uusitalo U, Sorvari R, Ihanainen M. Child nutrition and oral health in Ulaanbaatar. Nutrition Research. 2003; 23: 1165–1176.

[34] Oliveira LB, Sheiham A, Bönecker M. Exploring the association of dental caries with social factors and nutritional status in Brazilian preschool children. European Journal of Oral Sciences. 2008; 116: 37–43.

[35] Sood S, Ahuja V, Chowdhry S. Reconnoitring the association of nutritional status with oral health in elementary school-going children of Ghaziabad City, North India. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2014; 32: 197–201.

[36] Janakiram C, Antony B, Joseph J. Association of undernutrition and early childhood dental caries. Indian Pediatrics. 2018; 55: 683–685.

[37] Shim S, Han D, Khang Y. Association between dental caries and delayed growth in Korean children. Caries Research. 2018; 52: 71–77.

[38] Olatosi OO, Alade AA, Naicker T, Busch T, Oyapero A, Li M, et al. Dental caries severity and nutritional status of Nigerian preschool children. JDR Clinical & Translational Research. 2022; 7: 154–162.

[39] Cuong DH, Tam VV, Tinh HQ, Do LT, Nghia NT, Anh HC. Research on nutrition, dental caries status using novel methods, and related factors to preschool children in rural areas of Vietnam. Journal of Analytical Methods in Chemistry. 2022; 2022: 1–6.

[40] Aung YM, Jelleyman T, Ameratunga S, Tin Tin S. Body mass index and dental caries in New Zealand pre-school children: a population-based study. Journal of Paediatrics and Child Health. 2021; 57: 1432–1437.

[41] Schroth RJ, Levi JA, Sellers EA, Friel J, Kliewer E, Moffatt ME. Vitamin D status of children with severe early childhood caries: a case-control study. BMC Pediatrics. 2013; 13: 174.

[42] Alvarez JO, Caceda J, Woolley TW, Carley KW, Baiocchi N, Caravedo L, et al. A longitudinal study of dental caries in the primary teeth of children who suffered from infant malnutrition. Journal of Dental Research. 1993; 72: 1573–1576.

[43] Silva MJ, Kilpatrick NM, Craig JM, Manton DJ, Leong P, Ho H, et al. A twin study of body mass index and dental caries in childhood. Scientific Reports. 2020; 10: 568.

[44] Renggli EP, Turton B, Sokal-Gutierrez K, Hondru G, Chher T, Hak S, et al. Stunting malnutrition associated with severe tooth decay in cambodian toddlers. Nutrients. 2021; 13: 290.

[45] WHO Multicentre Growth Reference Study Group. WHO child growth standards based on length/height, weight and age. Acta Paediatrica. Supplement. 2006; 450: 76–85.

[46] de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization. 2007; 85: 660–667.

[47] World Health Organization. Oral health surveys: basic methods. 4th ed. World Health Organization: Geneva, Switzerland. 1997.

[48] Khamis AH. Re-visiting the decay, missing, filled teeth (DMFT) index with a mathematical modeling concept. Open Journal of Epidemiology. 2016; 06: 16–22.

[49] Dimaisip-Nabuab J, Duijster D, Benzian H, Heinrich-Weltzien R, Homsavath A, Monse B, et al. Nutritional status, dental caries and tooth eruption in children: a longitudinal study in Cambodia, Indonesia and Lao PDR. BMC Pediatrics. 2018; 18: 300.

[50] Lee TT, Norimah AK, Safiah MY. Development of healthy eating inder (HEI) for Malaysian adults. 26th Scientific Conference and Annual General Meeting of the Nutrition Society of Malaysia. Kuala Lumpur, Malaysia and 24–25 March 2011. Nutrition Society of Malaysia: Kuala Lumpur. 2011.

[51] Ardenghi TM, Sheiham A, Marcenes W, Oliveira LB, Bönecker M. Maxillary anterior caries as a predictor of posterior caries in the primary dentition in preschool Brazilian children. Journal of Dentistry for Children. 2008; 75: 215–221.

[52] Pinni J, Avula JSS, Bandi S. Association of dental caries with sociodemographic and nutritional factors among school children in Guntur district of Andhra Pradesh, India. Pediatric Dental Journal. 2019; 29: 111–115.

[53] Asli PM, Beyza BA, Tugha E. Relationship between socioeconomic status, body mass index and dental caries of children. Advances in Dentistry & Oral Health. 2017; 4: 1–4.

[54] Rajput N, Tuohy P, Mishra S, Smith A, Taylor B. Overweight and obesity in 4–5-year-old children in New Zealand: results from the first 4 years (2009–2012) of the B4School Check programme. Journal of Paediatrics and Child Health. 2015; 51: 334–343.

[55] Turck D, Michaelsen KF, Shamir R, Braegger C, Campoy C, Colomb V, et al. World Health Organization 2006 child growth standards and 2007 growth reference charts: a discussion paper by the committee on nutrition of the European society for pediatric gastroenterology, hepatology, and nutrition. Journal of Pediatric Gastroenterology & Nutrition. 2013; 57: 258–264.

[56] Mei Z, Grummer-Strawn LM. Standard deviation of anthropometric Z- scores as a data quality assessment tool using the 2006 WHO growth standards: a cross country analysis. Bulletin of the World Health Organization. 2007; 85: 441–448.

[57] Wang Y, Chen H. Use of percentiles and Z-scores in anthropometry. Handbook of Anthropometry. 2012; 11: 29–48.

[58] Must A, Anderson SE. Body mass index in children and adolescents: considerations for population-based applications. International Jour-nal of Obesity. 2006; 30: 590–594.

[59] Koo W, Walyat N. Vitamin D and skeletal growth and development. Current Osteoporosis Reports. 2013; 11: 188–193.

[60] Hujoel PP. Vitamin D and dental caries in controlled clinical trials: systematic review and meta-analysis. Nutrition Reviews. 2013; 71: 88–97.

[61] Alkarimi HA, Watt RG, Pikhart H, Sheiham A, Tsakos G. Dental caries and growth in school-age children. Pediatrics. 2014; 133: e616–e623.

[62] Pollitt E. Developmental sequel from early nutritional deficiencies: conclusive and probability judgements. The Journal of Nutrition. 2000; 130: 350S–353S.

[63] Hooley M, Skouteris H, Boganin C, Satur J, Kilpatrick N. Body mass index and dental caries in children and adolescents: a systematic review of literature published 2004 to 2011. Systematic Reviews. 2012; 1: 57.

[64] Gerdin EW, Angbratt M, Aronsson K, Eriksson E, Johansson I. Dental caries and body mass index by socio-economic status in Swedish children. Community Dentistry and Oral Epidemiology. 2008; 36: 459–465.

[65] Chen D, Zhi Q, Zhou Y, Tao Y, Wu L, Lin H. Association between dental caries and BMI in children: a systematic review and meta-analysis. Caries Research. 2018; 52: 230–245.

[66] Wulaerhan J, Abudureyimu A, Bao X, Zhao J. Risk determinants associated with early childhood caries in Uygur children: a preschool-based cross-sectional study. BMC Oral Health. 2014; 14: 136.

[67] Huebner CE, Riedy CA. Behavioral determinants of brushing young children’s teeth: implications for anticipatory guidance. Pediatric Dentistry. 2010; 32: 48–55.

[68] American Academy of Pediatric Dentistry. Policy on early childhood caries (ECC): classifications, consequences and preventive strategies. The Reference Manual of Pediatric Dentistry (pp 79–81). 7th ed. American Academy of Pediatric Dentistry: Chicago, IL. 2016.

[69] González-Valero L, Montiel-Company JM, Bellot-Arcís C, Almerich-Torres T, Iranzo-Cortés JE, Almerich-Silla JM. Association between passive tobacco exposure and caries in children and adolescents. A systematic review and meta-analysis. PLoS One. 2018; 13: e0202497.

[70] Liu S, Wu T, Zhou X, Zhang B, Huo S, Yang Y, et al. Nicotine is a risk factor for dental caries: an in vivo study. Journal of Dental Sciences. 2018; 13: 30–36.

[71] Chugh VK, Sahu KK, Chugh A. Prevalence and risk factors for dental caries among preschool children: a cross-sectional study in Eastern India. International Journal of Clinical Pediatric Dentistry. 2018; 11: 238-243.

[72] Colak H, Dülgergil CT, Dalli M, Hamidi MM. Early childhood caries update: a review of causes, diagnoses, and treatments. Journal of Natural Science, Biology and Medicine. 2013; 4: 29–38.

[73] Kuppusamy E, Yazid F, Marizan Nor M, Goo CL, Rosli MSA, Megat Abdul Wahab R, et al. Encouraging correct tooth brushing habits among children in the B40 community through gamification. Advances in Visual Informatics. 2019; 65: 488–497.

[74] Acs G, Shulman R, Ng MW, Chussid S. The effect of dental rehabilitation on the body weight of children with early childhood caries. Pediatric Dentistry. 1999; 21: 109–113.

[75] Sheiham A. Dental caries affects body weight, growth and quality of life in pre-school children. British Dental Journal. 2006; 201: 625–626.

[76] Parisotto TM, Stipp R, Rodrigues LKA, Mattos-Graner RO, Costa LS, Nobre-dos-Santos M. Can insoluble polysaccharide concentration in dental plaque, sugar exposure and cariogenic microorganisms predict early childhood caries? A follow-up study. Archives of Oral Biology. 2015; 60: 1091–1097.

[77] Ireland R, Yeung CA. A dictionary of dentistry. 2nd ed. Oxford University Press: Oxford. 2020.

[78] Renton C. Management of residual and recurrent caries in adoles-cents. BDJ Team. 2015; 2: 15093.

[79] Stephan RM. Intra-oral hydrogen-ion concentrations associated with dental caries activity. Journal of Dental Research. 1944; 23: 257–266.

[80] Olatosi OO, Sote EO. Association of early childhood caries with breastfeeding and bottlefeeding in southwestern Nigerian Children of preschool age. Journal of the West African College of Surgeons. 2014; 4: 31–53.

[81] Sheiham A, James WPT. Diet and dental caries: the pivotal role of free sugars reemphasized. Journal of Dental Research. 2015; 94: 1341–1347.

[82] Chao HC. Association of picky eating with growth, nutritional status, development, physical activity, and health in preschool children. Frontiers in Pediatrics. 2018; 6: 22.

[83] Dubois L, Farmer A, Girard M, Peterson K, Tatone-Tokuda F. Problem eating behaviors related to social factors and body weight in preschool children: a longitudinal study. International Journal of Behavioral Nutrition and Physical Activity. 2007; 4: 9.

[84] Anik AI, Rahman MM, Rahman MM, Tareque MI, Khan MN, Alam MM. Double burden of malnutrition at household level: a comparative study among Bangladesh, Nepal, Pakistan, and Myanmar. PLoS One. 2019; 14: e0221274.

[85] Macek MD, Mitola DJ. Exploring the association between over-weight and dental caries among US children. Pediatric Dentistry. 2006; 28: 375–380.

[86] Sheller B, Churchill SS, Williams BJ, Davidson B. Body mass index of children with severe early childhood caries. Pediatric Dentistry. 2009; 31: 216–221.

[87] Hayden C, Bowler JO, Chambers S, Freeman R, Humphris G, Richards D, et al. Obesity and dental caries in children: a systematic review and meta-analysis. Community Dentistry and Oral Epidemiology. 2013; 41: 289–308.

[88] Ahmad R, Rahman NA, Hasan R, Yaacob NS, Ali SH. Oral health and nutritional status of children with cerebral palsy in northeastern peninsular Malaysia. Special Care in Dentistry. 2020; 40: 62–70.

[89] Pham MT, Rajić A, Greig JD, Sargeant JM, Papadopoulos A, McEwen SA. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Research Synthesis Methods. 2014; 5: 371–385.

[90] Manohar N, Hayen A, Fahey P, Arora A. Obesity and dental caries in early childhood: a systematic review and meta-analyses. Obesity Reviews. 2020; 21: e12960.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

PubMed (MEDLINE) PubMed comprises more than 35 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full text content from PubMed Central and publisher web sites.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time