The global prevalence of early childhood caries: A systematic review with meta-analysis using the WHO diagnostic criteria

Int J Paediatr Dent. 2021 Nov;31(6):817-830. doi: 10.1111/ipd.12783. Epub 2021 Apr 30.


Aim: To estimate the global prevalence of early childhood caries using the WHO criteria.

Design: Systematic review of studies published from 1960 to 2019.

Data sources: PubMed, Google Scholar, SciELO, and LILACS. Eligibility criteria were articles using: dmft-WHO diagnostic criteria with calibrated examiners, probability sampling, and sample sizes.

Study selection: Two reviewers searched, screened, and extracted information from the selected articles. All pooled analyses were based on random-effects models. The protocol is available on PROSPERO 2014 registration code CRD42014009578.

Results: From 472 reports, 214 used WHO criteria and 125 fit the inclusion criteria. Sixty-four reports of 67 countries (published 1992-2019) had adequate data to be summarised in the meta-analysis. They covered 29 countries/59018 children. Global random-effects pooled prevalence was (percentage[95% CI]) 48[43, 53]. The prevalence by continent was Africa: 30[19, 45]; Americas: 48 [42, 54]; Asia: 52[43, 61]; Europe: 43[24, 66]; and Oceania: 82[73, 89]. Differences across countries explain 21.2% of the observed variance.

Conclusions: Early childhood caries is a global health problem, affecting almost half of preschool children. Results are reported from 29 of 195 countries. ECC prevalence varied widely, and there was more variance attributable to between-country differences rather than continent or change over time.

Keywords: early childhood caries; epidemiology; oral health; preschool children; systematic review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Child, Preschool
  • Dental Caries Susceptibility*
  • Dental Caries* / diagnosis
  • Dental Caries* / epidemiology
  • Europe
  • Humans
  • Prevalence
  • World Health Organization