2.1

Eligibility criteria

The PICO (participants, interventions, comparators and outcomes) question for this review was “What are the parent related characteristics that influence dental caries levels in permanent dentitions of 6–12 year old children”. All the cross-sectional, longitudinal and experimental studies that were published in English from 2000 to March 2015 were considered for inclusion. Reviews, personal opinions and letters were excluded. Suitability of the studies was based on the predetermined inclusion criteria of (1) the study population comprised children aged 6–12 years; and (2) caries was assessed in the permanent dentition. For study populations with mixed age groups of children and adolescents, abstracts were only considered for inclusion when the results for each age category were presented separately. Abstracts that did not state anything about socio-economic status and parental characteristics were excluded.

2.2

Search strategy

Databases searched in April 2015 were PubMed, Medline via OVID and CINAHL Plus via EBSCO. The search was restricted to scientific articles using filters of language (English) and time (from year 2000 to March 2015). The search strategy used is shown in Table 1 . A truncation for the term “child” was used. A manual search for literature was not attempted.

2.3

Study selection

Two authors (SK and JT) screened the titles and abstracts independently. When the information in the abstract was inconclusive, to decide on its suitability for inclusion (for instance, age of the study sample has not been provided), it was considered for full text review. There was no disagreement between the reviewers on determining the suitability of articles for inclusion.

2.4

Data collection

Data extraction was done using piloted data extraction sheets by two authors (SK and JT). Data collected was rechecked for accuracy by the senior authors (JK and NWJ). Data on study design and setting, sample size, age, parental characteristics, statistical tests, findings on association of dental caries with parental characteristics, caries diagnosis criteria and caries outcome measure were extracted from each study. Studies included exhibited clinical heterogeneity as they differed widely in design, method of caries diagnosis, participants, parental characteristics assessed and the measure of dental caries used as outcome. Therefore, no single effect size estimates could be calculated. Quantitative systematic review with single effect size estimates (Meta-analysis) of all the studies was not possible as the parent characteristics were diverse, ranging from education to home environment. Moreover, subgroup analysis with respect to each parent characteristic (e.g. education) was also not possible due to non-uniform definition of the characteristic and its categorisation. Further, the definition of the outcome measure (e.g. prevalence of decayed teeth, total decayed teeth, and total caries count) was different between the studies.

2.5

Quality assessment criteria

Quality assessment criteria for the articles included were adopted from a previous systematic review . Scoring was done for each article on three different criteria:

(1) Caries diagnosis: based on the method of caries diagnosis used in the study, caries at the pre-cavity level was given a score of 1 and those at cavity level and subject/parent reported caries were scored 2 and 3 respectively.

(2) Representativeness of the study sample: samples collected from random clusters or strata of countries or provinces were scored 1 while those on towns and cities were scored 2. Studies on convenience samples that were randomly chosen were scored 3 and those on convenience samples with no randomisation were scored 4.

(3) Statistical adjustment: studies that statistically adjusted for the effect of confounders when evaluating the influence of independent variables on dental caries were scored 1 while those lacking statistical adjustment were scored 2.

A fourth criteria on study design was added to these where a score of 1 was allocated to longitudinal studies or studies that used a life course approach, while a score of 2 was allocated to cross-sectional studies.

2.1

Eligibility criteria

The PICO (participants, interventions, comparators and outcomes) question for this review was “What are the parent related characteristics that influence dental caries levels in permanent dentitions of 6–12 year old children”. All the cross-sectional, longitudinal and experimental studies that were published in English from 2000 to March 2015 were considered for inclusion. Reviews, personal opinions and letters were excluded. Suitability of the studies was based on the predetermined inclusion criteria of (1) the study population comprised children aged 6–12 years; and (2) caries was assessed in the permanent dentition. For study populations with mixed age groups of children and adolescents, abstracts were only considered for inclusion when the results for each age category were presented separately. Abstracts that did not state anything about socio-economic status and parental characteristics were excluded.

2.2

Search strategy

Databases searched in April 2015 were PubMed, Medline via OVID and CINAHL Plus via EBSCO. The search was restricted to scientific articles using filters of language (English) and time (from year 2000 to March 2015). The search strategy used is shown in Table 1 . A truncation for the term “child” was used. A manual search for literature was not attempted.

2.3

Study selection

Two authors (SK and JT) screened the titles and abstracts independently. When the information in the abstract was inconclusive, to decide on its suitability for inclusion (for instance, age of the study sample has not been provided), it was considered for full text review. There was no disagreement between the reviewers on determining the suitability of articles for inclusion.

2.4

Data collection

Data extraction was done using piloted data extraction sheets by two authors (SK and JT). Data collected was rechecked for accuracy by the senior authors (JK and NWJ). Data on study design and setting, sample size, age, parental characteristics, statistical tests, findings on association of dental caries with parental characteristics, caries diagnosis criteria and caries outcome measure were extracted from each study. Studies included exhibited clinical heterogeneity as they differed widely in design, method of caries diagnosis, participants, parental characteristics assessed and the measure of dental caries used as outcome. Therefore, no single effect size estimates could be calculated. Quantitative systematic review with single effect size estimates (Meta-analysis) of all the studies was not possible as the parent characteristics were diverse, ranging from education to home environment. Moreover, subgroup analysis with respect to each parent characteristic (e.g. education) was also not possible due to non-uniform definition of the characteristic and its categorisation. Further, the definition of the outcome measure (e.g. prevalence of decayed teeth, total decayed teeth, and total caries count) was different between the studies.

2.5

Quality assessment criteria

Quality assessment criteria for the articles included were adopted from a previous systematic review . Scoring was done for each article on three different criteria:

(1) Caries diagnosis: based on the method of caries diagnosis used in the study, caries at the pre-cavity level was given a score of 1 and those at cavity level and subject/parent reported caries were scored 2 and 3 respectively.

(2) Representativeness of the study sample: samples collected from random clusters or strata of countries or provinces were scored 1 while those on towns and cities were scored 2. Studies on convenience samples that were randomly chosen were scored 3 and those on convenience samples with no randomisation were scored 4.

(3) Statistical adjustment: studies that statistically adjusted for the effect of confounders when evaluating the influence of independent variables on dental caries were scored 1 while those lacking statistical adjustment were scored 2.

A fourth criteria on study design was added to these where a score of 1 was allocated to longitudinal studies or studies that used a life course approach, while a score of 2 was allocated to cross-sectional studies.

3.1

Background characteristics

Ten studies were conducted in Brazil , three each from Australia , India and a collaboration across Germany and Ireland . There were two articles each from Iran , Japan , Thailand , Greece , Russia and Norway . There were nineteen single country papers. The majority of the studies were cross-sectional in design and one article presented data from previous studies . Two studies were longitudinal and there was one each of experimental , cohort and retrospective design .

3.2

Quality of the articles

Quality of each study in constituent criteria is presented in Table 3 . Most of the studies diagnosed caries at cavity level. Only seven studies were conducted on randomly selected clusters of the country or provinces. Nineteen studies statistically controlled the effect of confounders when evaluating the influence of independent variables on dental caries. There were only five studies that were longitudinal or used a life course approach.

3.3

Socio-economic status (SES)

SES-related parental characteristics studied were a composite scale of SES, household income, parents’ education, parents’ occupation, house ownership, family health insurance coverage, owning a car, money regularly spent on sweets and daily pocket money for snacks. A composite SES scale based on parents’ education and employment level was used in five studies , all of which observed an inverse relation between SES and caries (i.e. people belonging to poor SES exhibited greater caries). Table 2 presents the significant parental characteristics and their direction of relation with dental caries in all the included studies.

Table 2

Background characteristics, significant parental characteristics and the direction of relation of the parental characteristics with the outcome variable (dental caries) in the studies reviewed.

Study design	Study sample	Study location	Age	Sample size	Parental characteristics studied	Significant parental characteristics in uni or bivariate analysis	Significant parental characteristics in multivariable analysis	Direction of relation	Outcome variable	Reference
CSS	School children	West Baghdad, Iraq	12	391	Mother’s education Father’s education	Mother’s education	Mother’s education	Caries experience greater in children of highly educated mothers	DMFT	Ahmed et al.
CSS	School children	Jeddah, Saudi Arabia	9	880	Father’s education Mother’s education Family income Type of home Home ownership Receipt of government monetary support Medical insurance coverage Dental insurance coverage	Father’s education Mother’s education Home ownership	None	Children of parents with less than high school education and those owning a home had higher caries prevalence.	‘D’ of DMFT	Al Agili et al.
CSS	School children	Porto Alegre, Brazil	12	1528	Brazilian socio-economic classification (based on education level of head of family and purchase power of family)	SES	SES	Greater caries prevalence and experience in lower SES children	DMFT	Alves et al.
CSS	School children	Lithgow, New south wales, Australia	10–12	257	Living in a single parent household Education level of female parent/guardian Education level of male parent/guardian Occupation of female parent/guardian Occupation of male parent/guardian Family income	Occupation of male parent/guardian	Occupation of male parent/guardian	Children whose male parent/guardian was a pensioner, a laborer, or unemployed had greater extent of caries than those children whose male parent/guardian was manager or had a professional occupation	DMFT	Arora and Evans
CSS	School children	Piracicaba city, Brazil	12	724	Monthly family income Number of people living in the household Mother’s educational level Fathers’ educational level Home ownership	Monthly family income Father’s education Mother’s education	Monthly family income	Children of parents earning less income were at greater risk than those earning more Caries was less prevalent in children of parents with higher education than their counterparts	DMFT	Benazzi et al.
CSS	School children	Sassari, Sardinia (Italy)	12	403	Socio-economic category and status of the family Age of the mother	Socio-economic category and status of the family	None	Children belonging to higher socio-economic level had lower caries levels	DMFT DMFS	Campus et al.
CSS	School children	Vienna, Austria	12	736	Migration background of parents Parent’s education (parent with highest level of education was considered)	Migration background of parents Parent’s education	Migration background of parents	Children with a migration background are at high risk of dental caries and children of parents with low educational level experienced greater caries levels.	DMFT	Cvikl et al.
CS	School children	Yazd and Hadi-Shahr cities, Iran	12	1223	Parents’ job Parents’ Educational level (no information about which parent it was)	None	None	–	DMFT	Daneshkazemi and Davari
CSS	School children	Thiruvananthapuram, Kerala	12	838	Mother’s education	None	None	–	DMFT	David et al.
Data from two previous CSS	Children who attended school dented service	South Australia and Queensland	6–12	7875	Equivalized household income (based on Household size and income)	Equivalized household income	Equivalized household income	Children of lowest income category more risk at caries	DMFS	Do et al.
CSS	School children	Clermont-Ferrand, France	10	427	Family status Number of children in the family Birth order of the child Mother’s employment Father’s employment Country of origin of the parents Basic dental insurance	Number of children in the family Mother’s employment Father’s employment Country of origin of the parents Basic dental insurance	Number of children in the family Father’s employment Country of origin of the parents	Greater caries in families with more children Children of jobless parents had greater caries Children of one or both immigrant parents had greater caries Children with state aid insurance had more caries than those with private insurance	DMFT	Enjary et al.
CSS	School children	Montserrat(Bristish overseas territory)	12	32	Fathers occupation	No inferential statistics done	No inferential statistics reported	–	DMFT	Fergus
CSS	School children	Nairobi west and Mathira west districts, Kenya	12	639	Mother’s education	Not conducted	Mother’s education in Nairobi west district	Children of illiterate mothers more prone for dental caries than those whose mothers were educated	DMFT	Gathecha et al.
CSS	School children	Benghazi, Libya	12	2662	Father’s education Mother’s education	Father’s education	Father’s education	Children of less educated fathers had greater caries	DMFT DMFS	Huew et al.
CSS data from a LS	School children	National representative sample of Australia	6–7	4464	Socio-economic position (SEP) (derived from combined annual household income, parents’ years of education and occupation)	Not conducted	SEP	Lower SEP was associated with higher odds of parent-reported caries	Parent reported caries levels	Kilpatrick et al.
CSS	School children	Arkhangelsk, North West Russia; Tromso, Northern Norway	12	590-Russian; 264-Norwegian	Family economy Family status Money spent on sweets per week Parental education Parents self-evaluated oral health Oral health problems in the past 2 years Last dental attendance Adequate help obtained during last visit to dentist Number of teeth	Self-evaluated oral health Oral health problems in the past 2 years, Adequate help obtained during last visit to dentist	Oral health problems in the past 2 years	Children were more at caries risk if their parents evaluated their oral health as moderate/bad, and had oral problems in the last 2 years and have not received adequate help in last dental visit	DMFT	Koposova et al.
CSS	School children	Arkhangelsk, North West Russia; Tromso, Northern Norway	12	48-North west Russia; 36-Tromso, Norway	Family status Money spent on sweets per week Parental education Self-evaluated oral health condition Oral health problems in the past 2 years Number of teeth Time since last visit to dentist	Parental education Self-evaluated oral health Oral problems during the past 2 years Time since last visit to dentist	Parental education Time since last visit to dentist	Children more at risk of caries if parents had <12 years of education, bad self-evaluated oral health and oral health problems during the last 2 years No information given on the direction of relation of caries with parents’ time since last dental visit	DMFT	Koposova et al.
CSS	Children selected from citizen registry	Subsample of Thailand National oral health survey	12	1063	Daily pocket money for snacks	Daily pocket money for snacks	Daily pocket money for snacks	Children receiving pocket money of >10 bahts had greater caries than those receiving 0-10 baht	DMFT	Krisdapong et al.
RS	Children attending Ylivieska Public Health Center	Ylivieska district, Finland	10	93 (xylitol), 55 (F or CHX) and 359 (none)	Mothers’ receiving preventive intervention (three groups; xylitol chewing gum, fluoride or CHX varnish treatments , no intervention	None	None	–	DMFT	Laitala et al.
CSS	School children	Berisso city, Buenos Aires province, Argentina	6	804	Socio-economic position (from father’s or mother’s occupation)	Socio-economic position	Not conducted	Children of manual workers had greater caries experience than those whose parents were managers, professionals and employees	DMFT DMFS	Llompart et al.
CSS	School children	City of Sao Paulo, Brazil	12	4249	House crowding Mother’s education Father’s education Family income Owning a car	House crowding Mother’s education Father’s education Family income Owning a car	House crowding Family income	Greater caries in children living in over-crowded houses Children of less educated parents had more caries Greater caries in children with less family income More caries in children of families with no car	Untreated caries (D of DMFT)	Lopes et al.
CSS	School children	Na Klang district, Nongbua Lampoo province, Thailand	12	111	Father’s education Mother’s education Family income	Family income	Family income	Children belonging to families with more income were at greater risk for caries	DMFT	Lueangpiansamut et al.
CSS	School children	Parkala and Udupi towns, India	12	200	Social class based on per capita income	None	Not performed	–	DMFT SIC	Mahalakshmi et al.
CSS	School children	Belo Horizonte, Minas Gerais, Brazil	8–10	1204	Household income Number of residents in the home Caregivers’ schooling	Household income Caregivers’ schooling	None	Children of caregiver with lesser education and less household income had greater caries experience and severity	DMFT	Martins et al.
CSS	School children (Autistic and non-autistic)	From three districts of Istanbul, Turkey	6–12	363 (62-autistic, 301-non-autistic)	Mother’s education Father’s education Family income	Family income	Family income	Children from low income families had more caries	DMFT	Namal et al.
CSS	Mothers and children attending Hiroshima University Dental Hospital	Hiroshima city, Japan	8–11	117	Mother’s gingival health and oral hygiene level (measured by Oral rating index) Mothers oral health behaviour	Mother’s gingival health and oral hygiene level	Mother’s gingival health and oral hygiene level	Mothers with better gingival health and oral hygiene had children with lower caries	DFT	Okada
CSS	School children	Hiroshima, Japan	7–12	296	Parent’s oral health behaviour	Parent’s oral health behaviour on decayed teeth (DT) only	Parent’s oral health behaviour on DT	Children of parents with better oral health behavior had less caries	DT FT	Okada
CSS	School children	Greece	12	1224	Father’s education Mother’s education	Father’s education Mother’s education	Father’s education Mother’s education	Children of mother or father with higher education had lower caries experience	DMFT DMFS	Oulis et al.
CSS	School children	Piracicaba city, Sao Paulo, Brazil	12	1001	Family monthly income Number of residents living in the house Mother’s education Father’s education Home ownership	DMFS and DMFS + WL Family income Residents in house Mother’s education Father’s education WL: Family income Residents in house Fathers education	DMFS and DMFS + WL Family income Residents in house Father’s education WL: Family income	Children from high income families had less caries Children in houses with more residents had greater caries Children of father or mother with greater education had less caries	DMFS DMFS + WL WL (non cavitated active caries lesion)	Pardi et al.
CSS	School children	Piracicaba city, Sao Paulo, Brazil	12	929	Monthly family income Number of people living in the household Father’s education Mother’s education Car ownership Home ownership	Monthly income , Father’s education Mother’s education Car ownership	Monthly income Father’s education	Children in families with more income had less caries Children of father or mother with better education had less caries Children in families with more number of cars had less caries	DMFT	Pereira et al.
Cohort	Children of Pelotas, brazil	Pelotas, brazil	12	339	Social class at birth (employment status) Family income at birth Father’s schooling at birth Mother’s schooling at birth Family economic level at age 12	Mother’s schooling at birth	None	Children of less educated mothers had greater caries	DMFT	Peres et al.
CSS	School children	City of Santa Maria, Brazil	12	792	Household income Mother’s schooling Father’s schooling Mother’s occupation Father’s occupation	DMFT prevalence: Household income Mother’s schooling Father’s schooling Mother’s occupation DMFT mean: Household income Father’s schooling SiC: Household income Father’s schooling	DMFT prevalence: Household income DMFT mean : Household income SiC: Household income	Children of mother or father with less education had more caries Children of unemployed mothers had more caries	DMFT prevalence DMFT mean SiC	Piovesan et al.
CSS	School children	Jordan	12	2560	Parents’ level of education	Not conducted	Parents’ level of education	Children of parents with low education had greater caries experience and were at greater risk	DMFT	Rajab et al.
LS	School children	Belo Horizonte, Brazil	9–11	224	Family income Mother´s education	None	None	–	Incidence of carious lesion on the occlusal surface of 1 st permanent molars	Rossete Melo et al.
CSS	School children	Frielburg, Germany	12	322	Parents education	Parents education	Not done	Children with parents with greater education had less caries	DMFT	Sagheri et al.
CSS	School children	Freiburg, Germany and Dublin, Ireland	12	699	Social class (based on parents’ educational level and parents’ employment)	Social class in both cities	Not performed	Children belonging to lower social class had more caries but in Freilburg, caries was poorest in middle social class followed by low and high	DMFT	Sagheri et al.
CSS	School children	North-west Dublin, Ireland	12	332	Family’s medical card status (available to low income individuals and families)	None	Not performed	–	DMFT	Sagheri et al.
CSS	School children	Dublin, Ireland and Freiburg, Germany	12	567	Social class (based on parents’ educational level and parents’ employment)	Social class	Social class	Children belonging to lower social class had more caries but in Dublin, caries was poorest in middle social class followed by low and high	DMFT	Sagheri et al.
CSS	School chidren	Tehran, Iran	9	409	Parent’s education (highest of either of the parents)	Parent’s education (only on Decayed component)	Not performed	Children of low education parents had greater decayed teeth	D DMFT	Saied-Moallemi et al.
CSS	School children	Davangere city, India	6	765	SES (based on percapita family income)	SES	Not performed	Children belonging to lower SES had more caries	DMFT	Sakeenabi et al.
CSS	School children	Galiza, Spain	12	1217	Mother’s education	Mother’s education	Mother’s education	Children of mothers with higher education had less caries	DMFT	Smyth and Caamano
CSS	School children	South Belfast area, Ireland	11–12	230	Parental employment status (no information about which parent it was)	Parental employment status	Parental employment status	No information on direction	Untreated caries “D” of DMFT	Sweeney and Kinirons
CSS	School children	Southland provinvce, New Zealand	9	443	New Zealand Socio-economic Index (based on the occupation of the parent with higher occupation)	None	SES (only in unadjusted analysis)	Children belonging to families with higher SES had less caries	DMFS	Thomson and Mackay
ES	Children	Varberg city, Sweden	10	405	Mothers MS levels at 18 months of child’s age Mothers’ chewing gums (four groups: xylitol, CHX + Xyl + sorbitol, F + Xyl + Sorb & non chewing group) when child was of 6-18 months age	Mothers MS levels	Not conducted	Mothers MS levels positively correlated with caries experience in children	DS (cavitated and non-cavitated lesion)	Thorlid et al.
CSS	School children	Municipality of Curitibanos, Brazil	12	253	Father’s education Mother’s education	Father’s education Mother’s education	Father’s education Mother’s education	Children of father or mother with greater education had less caries	DMFT	Traebert et al.
CSS	School children	Bangladesh	12	631	Social class (based on father’s education)	None	None	–	DMFT	Ullah et al.
CSS	Children	Greece	12	1224	Mother’s education Father’s education	Not conducted	Mother’s education Father’s education	Children of father or mother with greater education had less caries	DMFS	Vadiakas et al.
CSS	School children	Guangdong province, China	12	1576	Parents’ education	Not conducted	None	–	DMFT	Wong et al.

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

1. Longevity of direct restorations in Dutch dental practices. Descriptive study out of a practice based research network
2. Quantitative characterization and micro-CT mineral mapping of natural fissural enamel lesions
3. Relationship between enamel fluorosis severity and fluoride content
4. Randomized controlled trial to study plaque inhibition in calcium sodium phosphosilicate dentifrices
5. The effect of air-abrasion on the susceptibility of sound enamel to acid challenge
6. Electromagnetic interference of endodontic equipments with cardiovascular implantable electronic device

Stay updated, free dental videos. Join our Telegram channel

Join