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Young children are at the highest risk of developing dental caries as they have a lack of autonomy over their diet and oral hygiene practices. Dental caries develops over time due to demineralization of tooth substance (enamel), which results from acid production during sugar metabolism by bacteria. Early onset of dental caries often results in asymptomatic presentation, but if left untreated, it can result in severe pain, infection, and dentoalveolar abscesses. Early childhood caries (ECC) is defined as dental caries in children aged 6 years and younger and is a significant public health problem in South Africa. According to the Global Burden of Disease study, untreated dental caries of primary teeth affects 532 million children. Untreated dental caries has many detrimental effects which can affect the physical development and reduce the quality of life of affected children. Furthermore, long-term untreated dental caries can result in school absenteeism, low BMI, and poor educational outcomes.
The purpose of this study was to determine the prevalence and severity of ECC in South Africa in children under the age of 6 years.
All cross-sectional studies documenting the prevalence and severity of dental disease (decayed, missing, and filled teeth scores) will be included. Various databases will be searched for eligible studies. Only studies conducted on South African children aged 6 years and under will be included. There will be no restriction on the time or language of publication. The quality of all eligible studies will be analyzed by a risk of bias tool developed by the Joanna Briggs Institute. The results will be presented narratively, and if possible, a meta-analysis will be conducted.
The protocol is registered with PROSPERO. The literature search was initially conducted in November 2018 and was repeated in November 2020.
The results of this study will be used to advise stakeholders of the prevalence and severity of dental disease in children under 6 years of age in South Africa.
PROSPERO CRD42018112161;
DERR1-10.2196/25795
Early childhood caries (ECC) is a significant public health problem in children aged 6 years and under living in South Africa [
Untreated dental caries has many adverse effects that can affect physical development, including increased absenteeism from school [
Children are at the highest risk of developing dental caries as they are vulnerable and depend on their caregivers for their dietary needs and oral hygiene. Dental caries develops over time and is a consequence of the demineralization of tooth enamel by acids produced during the metabolism of sugars by cariogenic bacterial sugars [
Global statistics show an inconsistent prevalence of ECC between different continents and within the same country. In 2007, the prevalence of ECC in children under 5 years of age was 40% in Brazil [
The most recent prevalence rate of ECC in China was documented by Zeng et al [
African countries have also shown varying prevalence of ECC: In Burkina Faso, Mazza et al [
In South Africa, the national prevalence rate of ECC is 60% among children under 6 years or age [
For the allocation of resources necessary to manage ECC effectively, it is important to understand the demographics of South Africa. The country is inhabited by 55.7 million people, among which 10.3% are under the age of 5 years [
The purpose of this study was to determine the prevalence and severity of ECC in South Africa in children under 6 years of age. To date, this will be the first scientifically conducted systematic review on the prevalence of ECC in South Africa.
This protocol will be conducted using the PRISMA-P (Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols) guidelines [
Cross-sectional and cohort studies reporting the prevalence of ECC in healthy children aged 6 years and under living in South Africa will be included in the review. This is a prevalence/incidence study, and consequently, no interventions will be assessed. The primary outcome is the prevalence/incidence and severity of ECC. The severity of ECC will be measured using the WHO guidelines in infants and children up to the age of 6 years. The WHO criteria include dmft scores (decayed, missing, and filled teeth; lower case indicates deciduous teeth) and the percentage of children that are caries free (including noncavitated caries [white spot lesions]).
Databases such as PubMed/MEDLINE, Cochrane, Scopus, Academic Search Complete, Dentistry and Oral Science, CINAHL, and ScienceDirect will be searched. Each database will be examined using tailor-made search terms or MeSH terms: (1) “early childhood caries” OR “caries” OR “decay” OR “dmft” OR “dental” OR “oral” OR PUFA; (2) “prevalence”; (3) “children” OR “peri-natal” OR “paediatric” OR “pediatric” OR neonatal OR infant; (4) South Africa. The keywords were used in the following combinations: 1 + 2 + 3 + 4.
Scientific articles published in all South African official languages will be included in the review. Non-English articles will be translated by the Department of Foreign Languages, University of the Western Cape or a reputable translation company. To authenticate the translations, we will cross-reference the original article with the English abstract (which is usually available online) and reverse translations will be conducted to ensure its correctness.
Commentaries/letters and other gray literature will be excluded from this review.
Secondary searching (PEARLing) will be conducted (PEARLing is a search strategy where the reference lists of all the studies, whether included or excluded, are identified for possible inclusion). Manual searching will not be conducted due to the difficulty in replicating this method.
The articles will be uploaded into Rayyan [
Other reviewers will be consulted when a disagreement pertaining to the inclusion of a publication arises. The searching process will include all prevalence studies up to November 15, 2020. All eligible studies will be included, and authors will be contacted if any clarification is needed.
After reading the full-text articles, those that do not meet the inclusion criteria will be discarded and the reasons will be recorded in the “Characteristics of excluded studies” table. The reference list of all included publications will be reviewed for additional eligible studies.
Two reviewers (FK-D and TR) will independently extract data onto a standardized data extraction form (initially piloted on a small sample of studies) using Microsoft Excel (2014). Upon completion of data collection, the data will be uploaded to the University of the Western Cape’s data repository for safekeeping [
All data, irrespective of the quality of publication, will be included in the review. If details on study publications cannot be obtained, a librarian will be consulted, and if the study remains non-obtainable, it will not be included in the qualitative or quantitative analysis.
The quality assessment of studies will be conducted using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Studies Reporting Prevalence Data [
A meta-analysis will be conducted, using Stata 17, if there are studies of similar comparisons reporting the same outcomes using a random-effects model and only if there are 4 or more studies.
This review will include diverse modalities of interventions and will result in heterogeneity of the content of interventions, outcomes, and outcome measures. We will contemplate the feasibility of conducting a meta-analysis on a subgroup of included studies once the data have been extracted. Where feasible, we will assess the statistical heterogeneity in the meta-analysis by visually inspecting the scatter of effect estimates on the forest plots, Cochran test (using .10 level of significance), and by using the
Where possible, we will use multiple sources of data, including those from unpublished trials. Should a meta-analysis be conducted, we will assess publication bias according to the recommendations described in the
We will use a subgroup analysis to examine heterogeneity using Stata 17. This will include exploring the influence of factors such as participant age, province, and urban/rural status. If sufficient numbers of studies are included, a meta-analysis will be performed.
This protocol was registered with PROSPERO in October 2018, and the electronic searches were completed by November 15, 2020. The original search yielded 2247 articles.
The study aims to assess the prevalence of dental diseases and its severity in children under the age of 6. The South African government does not regularly monitor the dental disease of children or adults. The last national oral health survey was conducted in 2004 in children only and adults were excluded [
There are very few studies detailing the prevalence and severity of dental disease in young children in South Africa. It is imperative that we monitor the trends of dental disease in children to inform stakeholders of this burden. Dental disease is a noncommunicable disease, and is associated with childhood obesity and childhood diabetes. More efforts need to be made to prevent the onset of dental disease, and thus prevent the incidence of other noncommunicable diseases in the future leaders of South Africa.
early childhood caries
World Health Organization
None declared.