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A scoping review on early childhood caries and inequalities using the Sustainable Development Goal 10 framework.
| BMC Oral Health | Foláyan MNO, de Barros Coelho EMR, Feldens CA, Gaffar B, Virtanen JI, Abodunrin OR, Duangthip D, Al-Batayneh OB, Vukovic A, El Tantawi M, Schroth RJ. | 25(1):219.
Caries-preventive program Social Inequalities Review
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Abstract

Background

Social inequalities contribute to health disparities. This study aimed to map evidence on early childhood caries (ECC) related to the United Nations’ Sustainable Development Goal 10 (SDG 10).

Methods

A scoping review was conducted in May 2024 following the PRISMA-ScR guidelines. A literature search was performed in PubMed, Web of Science, and CINAHL for studies published in English and addressing population level social inequalities. Studies measuring individual level of social inequalities were excluded as they were covered by other SDGs. However, studies incorporating individual measures as additional measures of population level social inequality were included. Retrieved papers were summarized, inductively analysed and a conceptual framework linking SDG 10 was developed.

Results

Of 452 studies retrieved, 42 met the inclusion criteria. Studies measured inequality among groups (deprivation, family income, indigenous communities, ethnicity, minority status) [14 studies], institutions (type of school, nursery or school facility, school poverty index, public primary health care units) [five studies], and inequality in communities (neighbourhood socio-economic status, Human Development Index, employment rate, income inequality, sanitary sewer and water supply, residents/household ratio, urban vs rural vs remote rural, accessibility index, location index, the slope index of inequality) [24 studies]. These levels of social inequalities were linked to higher prevalence of ECC; social and economic policies contributed to widening inequalities in ECC severity; and although effective interventions targeted at at-risk populations could reduce dental health disparities, study interventions differed by deprivation status. Six studies (14.3%) addressed SDG 10.1, 33 (78.6%) addressed SDG 10.2, 11 (26.2%) addressed SDG 10.3, and three (7.1%) addressed SDG 10.4. Fourteen studies (33.3%) addressed a combination of SDGs. The conceptual framework highlights the role of structural inequalities stemming from the cumulative impact of institutional decisions and systemic inequalities.

Conclusion

This scoping review underscores the profound influence of social inequality on ECC through interactions between multi-level factors. Further research is needed to explore the links between ECC and other SDG 10 targets, especially in low- and lower-middle-income countries.

Peer Review reports

Introduction

Early childhood caries (ECC) is the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to dental caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger [1]. It is a major public health problem affecting infants, toddlers, and preschool children around the world. It is estimated that 532 million children have been affected with dental caries in their primary teeth before their sixth birthday [2]. Dental caries is also the tenth most prevalent chronic disease in children [3] and it often goes untreated [4]. Untreated dental caries significantly reduces the quality of life of affected children [5], with the possibility of impacting nutritional status, health and well-being and brain development [6, 7].

In addition, various approaches have been adopted to prevent, manage, and treat dental caries in children including the use of fluoridated toothpaste [8], fluoride varnish [9], community water fluoridation, surgical interventions such as the use of pulp therapy [10, 11], restorative treatment [12,13,14], and the use of teledentistry to improve oral health access [15, 16]. These services may be difficult to obtain in communities that are socio-economically disadvantaged.

ECC, a non-communicable disease, is influenced by the social determinants of health. Thus, poor oral health is more prevalent in populations where child’s ability to address individual needs are challenged by their experience of inequalities. Inequality denotes the uneven allocation of resources due to factors like social status, including ethnicity and gender [17]. It increases the risk for ECC by influencing factors such as frequent consumption of sugar-containing drink and food [18], poor oral hygiene practices [19], limited access to preventive care, delayed dental visits for timely treatment [20], and low parental educational attainment [21].

The alleviation of social inequality is, therefore, an ethical imperative before individuals can aspire to lead healthy lives. For this reason and more, the United Nations prioritizes the reduction and elimination of social inequalities through the Sustainable Development Goal 10 (SDG10), which is inextricably linked to other goals including reduction of poverty, decent jobs and economic growth and responsible production and consumption [22]. Inequality is unjust as the disadvantaged and vulnerable are often left behind as reflected in the skewed expenditure on oral health to countries, leaving low-income nations and marginalized communities with limited access to care [23]. Such inequities perpetuate poor oral health outcomes and widen the gap in healthcare access.

Dental caries is increasingly acknowledged as a condition stemming from social disparities. Racial inequities and societal imbalances, which amplify exposure to environmental toxins, lack of access to fluoridated water, and barriers to oral health care, all combine to elevate the likelihood and severity of dental caries [24, 25]. Indigenous communities, culturally and linguistically diverse minority individuals, geographic remoteness and area deprivation (areas in need of targeted interventions) are societal factors identified to possibly contribute to inequalities that increase the risk of ECC [26].

It is, therefore, important to address the challenge of social inequalities in every country, especially in the developing countries to effectively tackle childhood non-communicable diseases like ECC. Studies are also beginning to explore the pathways linking social inequalities to the risk of ECC [24] because of the harm to the health, including oral health, of entire groups of people [27]. The increasing advocacy to address ECC through the lens of social justice, health equity and human rights [28, 29] makes it an imperative to understand how ECC and social inequality intersect.

The framework in Fig. 1 shows how various factors—structural, institutional, family, and individual—contribute to disparities in ECC and align with SDG 10’s targets. At the structural level, barriers like cost, healthcare access, and discrimination create unequal access to resources, such as dental care, with the most disadvantaged being the most impacted [30], while policies promoting equitable distribution of resources can benefit individuals across this spectrum [31]. At the institutional level, factors like school type, economic conditions, and geographic location mediate access to preventive care and dental services, affecting people along the social gradient [32]. At the family-level, health inequalities increase among ethnic minorities, those living in indigenous communities and families with lower socioeconomic status because of barriers related to education, employment, income, and oral health behaviours [33]. At the child level, factors such as sugar consumption, access to topical fluoride, oral hygiene and dental services utilization impact oral health, with children from lower socioeconomic backgrounds less likely to receive preventive services or adopt protective oral health behaviours [34]. The framework illustrates that health inequalities are multiple [35]; and that addressing these multiple factors is essential to reducing inequalities.

Fig. 1
figure 1

Conceptual framework on the association between social inequality and ECC

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This scoping review aims to map the publications linking ECC with social inequalities, validate the developed conceptual framework on the links between ECC and social inequalities, identify the gaps in the literature on the plausible links between ECC and the SDG 10.

Methods

This scoping review was performed in accordance with the Joanna Briggs Institute methodology guidelines [36] and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines (PRISMA-ScR) [37].

Research questions

Broadly, the review was based on the Population, Concept and Context (PCC) framework, where the population was children younger than 72 months, the concept was inequalities as risk factors for ECC, and the context was SDG 10. This scoping review was guided by the following questions: (i) What is the existing evidence on the association between social inequality and ECC? (ii) What are the SDG 10 social inequality-related factors (lack of basic amenities, poor social, economic and political inclusion; discriminatory laws, policies and practices; and low development assistance and financial flows to developing countries) associated with ECC? (iii) what is the conceptual framework on the link between ECC and social inequalities based on the study findings?

Identifying relevant articles

One author (OA) performed a search in May 2024 in three databases namely, PubMed, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Web of Science. The search terms can be found in Appendix 1.

The search included the scientific databases listed above and was complemented by searching the grey literature (theses retrieved from accessible online university repositories). The reference lists and bibliographies of relevant studies were also hand-searched for further references.

Articles identified through the three databases were exported to RAYYAN Software where duplicates were removed by the “Remove Duplicates” function. Two authors ran the search separately and lists of retrieved articles were then shared with all and screened for eligibility. Authors and institutions were not consulted for additional resources.

Eligibility and selection

The selected articles included only those published in English, where the patients or participants in the study were children younger than 72 months, the study outcome was ECC as defined by non-cavitated and cavitated lesion on tooth surfaces of children younger than 72 months [1]. Indicators of ECC included the presence of ECC experience, the presence of untreated ECC, and ECC severity. The studies also had to have one or more measures of social inequality (socioeconomical issues, racial and ethnicity issues, and geographical/residential locations). Studies of any design or publication date were included. There was no limitation placed on the year of publication.

Studies reporting on the individual and household measures of poverty status like household income and socioeconomic status (SDG1), parental educational status (SDG4), and studies focusing on other childhood diseases were excluded. In addition, studies with variables measuring the characteristics of migrants and refugees (SDG15), and those that addressed urban and rural differences (SDG11) were excluded. Prior publications by the team had reported on these links. However, when the measures of other SDGs are used in conjunction with the measures of social inequality, the publication was retained. Furthermore, studies that included preschool children but without clinical data for this age group were excluded. Publications with no full text available were also excluded.

Data charting

Documents that cleared the initial screening underwent full-text retrieval, and essential details were extracted using Microsoft Excel 2019 (Microsoft Corporation, United States). The data extraction form and items to extract were established through collaborative discussions among co-authors, and a pilot test was carried out to calibrate the data extraction process. The following information were extracted from the selected publications for this review: author name(s), publication year, type of journal in which the article was published, study location defined as the country in which the study was conducted, study design, sample size, study aim, measures for ECC and indicators of social inequality, and main study findings. Table 1 contains the extracted information from all included publications.

Table 1 Summary of included studies (N?=?42)
Full size table

Data analysis

There were two steps for data synthesis. First a quantitative analysis was conducted. A descriptive analysis of the publications included in the review was done. The publication year were grouped into decades, and the countries were grouped using the World Health Organization region into Americas region (AMR); Eastern Mediterranean Region (EMR); African region (AFR), European region (EUR); South East Asian region (SEAR) and the Western Pacific region (WPR). The countries were also grouped by income level (low-income countries (LICs), lower middle-income countries (LMICs), upper middle-income countries (UMICs) and high-income countries (HICs)) based on the World Bank 2022–23 classification [79].

The design of the study was extracted and classified as cross-sectional, ecological, case control, cohort, randomized clinical trial, protocols of any of the above, narrative reviews, systematic reviews, scoping reviews, and opinions pieces.

The measures of ECC and the social inequality indicator were extracted. Social inequality was measured using the following variables: residential area, community, school, and country income levels. In addition, an analysis was conducted on the SDG 10 indicators that each of the study addressed. Gaps in assessment of the SDG 10 were also identified.

Second, a qualitative analysis was conducted using inductive coding to identify key themes, and concepts, that capture the main ideas emanating from the study findings [80]. The findings were used to develop a conceptual framework that could guide future empirical studies on the links between social inequality and ECC. Next, we conducted a grounded theory analysis by developing axial coding to organize the concepts into categories, and then integrated and refine the categories to form a cohesive theory.

Role of the funding source

There was no funding for the study. The study design selection, data collection, data analysis, data interpretation and writing of the report were free from any form of influence. All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Results

As Fig. 2 indicates, the initial search from 470 reports yielded 404 potentially relevant articles. Overall, 297 publications were excluded based on the pre-identified exclusion criteria leaving 107 reports for full screening. On full screening of the full manuscript, 42 manuscripts [24, 38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78] met the inclusion criteria.

Fig. 2
figure 2

A Flowchart showing the process of studies selection

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Characteristics of included studies

The year of publication of the 42 manuscripts ranged from 1995 to 2024. Figure 3 shows the number of articles published at each 5-year interval. Between 1995 and 2009 the number of articles varied from 4 to 5 every 5 years (mean: approximately 1 article per year) [38, 39, 49,50,51,52,53,54,55, 63,64,65, 74]. From 2010 onwards, there has been a significant increase in the number of articles published that include data on the link between ECC and SDG 10, with a mean of approximately 2 articles per year, which has remained stable since then [24, 40,41,42,43,44,45,46,47,48, 56,57,58,59,60,61,62, 66,67,68,69,70,71,72,73, 75,76,77,78].

Fig. 3
figure 3

Distribution of studies included in the current scoping review by year of publication

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Table 1 shows that of the 42 studies analyzed, the majority (N?=?14, 33.3%) were conducted in Europe, comprising nine from UK [49,50,51, 53, 54, 56, 57, 60, 62], one from Denmark [52], Scotland [55], and France [58] respectively, one from a combination of Scotland, England and Wales [59], and one from England, Wales and Northern Ireland [61]. In addition, there were 12 (28.6%) studies from the WPR, which included Australia [24, 64, 66,67,68, 71], New Zealand [63, 69, 70], Japan [65, 72], and Hong Kong [73]. There were also 11 (26.2%) studies conducted in the AMR, which included six from Brazil [38, 41, 42, 45, 47, 48], three from the United States [40, 43, 46], and two from Canada [39, 44]. Studies conducted in AFR were only two (4.8%), with one conducted in South Africa [74] and one in Ghana [75]. In addition, there were three (7.1%) global studies [76,77,78]. There were no studies from SEAR or EMR.

The 42 studies were conducted in 15 countries: 13 (86.6%) countries are in HICs, one (6.7%) in a UMIC, and one (6.7%) in a LMIC. There was no study conducted in a LICs. Thirty-four of the 42 studies reported data of 2,955,923 participants ranging from 93 [75] to 995,003 [72]. There were 29 cross-sectional [24, 38, 39, 41,42,43, 45, 47,48,49, 52, 53, 55,56,57,58,59,60,61, 64,65,66,67,68,69,70, 72, 74, 75], and three cohort [44, 54, 63] studies. There were four narrative reviews [40, 46, 50, 71], three ecological studies [50, 62, 76], two meta-analyses [73, 77], and one scoping reviews [78].

Assessment of dental caries

Dental caries was assessed clinically in 36 (85.7%) studies using indices such as decayed and filled teeth (dft) [51, 72], decayed teeth (dt) [41], decayed, extracted and filled teeth (def) [40], decayed, missing and filled teeth (dmft) [24, 38, 40,41,42,43, 45, 47,48,49,50, 53,54,55, 57,58,59,60,61,62,63,64,65, 67,68,69, 73, 75,76,77], decayed, missing and filled surfaces (dmfs) [39, 52], Wyne’s ECC classification [74], care index [56], significant caries index [59, 75], and specific affected dental caries index [75]. Non-tactile assessment of dental caries was by visual inspection [44, 70]. In addition, one study used non-clinical assessment of ECC by parental report [66]. Three studies did not report ECC measures [46, 71, 78] and five studies used two or more measures for ECC [39, 40, 56, 59, 75].

Assessment of social inequality

Social inequality indicators were used singly or in combination. The diverse measures of social inequalities in the studies were divided into measures at the level of:

  1. 1.Groups: deprivation, family income, Indigenous communities, ethnicity, minority status [24, 39, 46, 47, 51, 55, 60,61,62,63,64,65,66,67,68,69,70,71, 74, 77].
  2. 2.Institution: type of school, nursery or school facility, school poverty index, public primary health care units [38, 43, 45, 58, 75].
  3. 3.Community: neighbourhood socio-economic status, Human Development Index, employment rate, income inequality, sanitary sewer and water supply, residents/household ratio, urban vs rural vs remote rural, accessibility index, location index, the slope index of inequality [24, 42, 44, 45, 47, 49,50,51, 53, 54, 56, 57, 59, 60, 62, 64,65,66, 68, 69, 72,73,74, 76].

Sustainable Development Goal 10 targets

The SDG 10 has 10 targets [81]. The studies included in this scoping review addressed four of the 10 targets: six (14.3%) addressed SDG 10.1 [38, 44, 45, 65, 73, 76], 33 (78.6%) addressed SDG 10.2 [24, 39,40,41,42,43,44,45,46,47,48, 50,51,52,53,54,55,56,57,58,59,60,61, 64, 66,67,68,69,70,71,72,73,74], 11 (26.2%) addressed SDG 10.3 [39, 43, 49, 55, 66, 68,69,70,71, 74, 75] and three (7.1%) addressed SDG 10.4 [62, 63, 76]. Fourteen studies (33.3%) addressed a combination of SDG 10 targets: 10 addressed a combination of SDG 10.2 and 10.3 [39, 43, 48, 55, 66, 68,69,70,71, 74], three addressed a combination of SDG 10.1 and 10.2 [44, 45, 73], and one addressed a combination of SDG 10.1 and 10.4 [76].

Inductive analysis of the study findings

  1. A.Ethnic minority groups and Indigenous communities: Racial and ethnic disparities in ECC are evident, with ethnic minority children (e.g., Turkish, Pakistani, Albanian, Somali, Arabian) showing higher prevalence than Danish children [52, 55]. Among kindergarteners, disparities between White and Black children were larger in non-poor schools compared to poor schools [43]. Indigenous children, including Aboriginal, M?ori, and other groups, experience significantly higher rates of untreated ECC and poor oral health than their non-Indigenous peers [24, 48, 66,67,68,69,70,71], often due to structural barriers such as cost, access, and provider discrimination [71].
  2. B.Impact of institutions: Children attending public schools have a significantly higher prevalence of ECC than those in private schools, where untreated decay is more common in public schools and filled teeth in private schools [38, 41]. Poor accessibility to dental care in certain areas was linked to higher prevalence of ECC among preschool children [72].
  3. C.Impact of community factors: The prevalence of ECC is influenced by community factors, including water supply and sugar consumption. Lower water fluoride levels and higher per capita sugar expenditure increase ECC risk [74]. Children in municipalities with lower incomes and limited access to fluoridated water experience higher ECC prevalence and severity, while those in higher-income neighbourhoods are more likely to receive treatment [42, 45]. ECC levels are notably higher in deprived areas, reflecting strong geographic inequalities [59, 60]. Rural children generally have better oral health than urban counterparts, but rural Indigenous children face poorer outcomes compared to non-Indigenous peers [56, 64].
  4. D.Influence of health policies: Social and economic policies contributed to widening ethnic and socioeconomic inequalities in ECC severity [63]. Water fluoridation reduced the risk of ECC and the divide in the prevalence of ECC between the rich and the poor [49, 50].
  5. E.Health interventions and education: Persistent disparities in oral health underscore the need for targeted efforts addressing social determinants of health [58]. Effective interventions for at-risk populations are crucial. Children from poorer backgrounds more often receive oral hygiene instruction, while affluent children are more likely to access preventive treatments like fluoride varnish [40, 53]. Postal provision of high-fluoride toothpaste benefits children across socioeconomic statuses, though its impact varies with deprivation levels [54].

Conceptual framework for studying early childhood caries using the SDG10

From the inductive analysis, three key social inequality factors linked to ECC risk were identified: (1) socioeconomic status (poverty, deprivation, education), (2) health access (availability of healthcare and educational institutions), and (3) geographical disparities (urban vs. rural settings, water, and sanitation infrastructure). These factors shape ECC risk through socioeconomic and environmental influences, with institutional and community inequalities exacerbating vulnerabilities for marginalized groups and rural populations with limited resources.

Figure 4, adapted from the WHO framework on social determinants of health [31], illustrates the structural, intermediary, and individual determinants of ECC within a health equity context, aligned with SDG10. Structural factors include governance, macroeconomic and social policies, and cultural values, forming the foundation of health inequalities. Community-level inequalities include socioeconomic status, Human Development Index, and sanitation access (N?=?24 studies); institutional factors include school types and public healthcare availability (N?=?5 studies); and group-level inequalities include income, indigenous status, ethnicity, and minority status (N?=?14 studies).

Fig. 4
figure 4

Conceptual framework on the association between social inequality and ECC

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Figure 4 also indicates that social cohesion and capital mediate structural and individual determinants. At the individual level, material circumstances, biological characteristics, behaviors, and psychosocial factors shape oral health and ECC susceptibility. The health system further influences access and equity in oral healthcare services.

Discussion

This current scoping review presents an overview of studies focusing on ECC and social inequality. Most studies were conducted in HICs, with no publication from LICs. Most studies were cross-sectional and they used dmft related measures. There were multiple social inequality indicators often used in combination. The findings indicated that the lack of basic amenities, poor social, economic and political inclusion, and discriminatory laws, policies and practices were associated with ECC. We did not find evidence on the relationship between development assistance and financial flows to developing countries and ECC risk.

Findings from this scoping review underscore the impact of socioeconomic factors, racial disparities, and geographical location on dental health outcomes, particularly among vulnerable populations. The study conclusions focused on tailored interventions addressing access to fluoridated water, dental care, and community-level interventions to reduce oral health disparities acknowledging the need to address the structural determinants of ECC to achieve equitable oral health.

This is the first attempt to assess the link between ECC and the SDG 10. It included a large number of studies with many participants, making it robust. The scoping review also combined qualitative and quantitative analysis strengthening our methodological approach and supporting the conclusions and making the development of a conceptual framework feasible and objective.

The restriction of the study to those only published in English and to three databases may have, however, selectively excluded other studies with the risk of under-reporting the number of eligible publications, the scope of social inequality explored, and the number of SDG targets addressed. In addition, a limitation of the review is the focus on the term “inequalities,” which may have influenced the included studies. While we used terms such as “disparities,” “inequities,” and “differentials” in our search, the primary framing around “inequalities” aligned with SDG 10 might have inadvertently excluded some studies that used alternate terminologies. Although an iterative approach was adopted to ensure a broad capture of relevant literature, there remains the possibility that the emphasis on certain terms may have constrained the comprehensiveness of our findings. Despite these limitations, the study had several valuable findings.

The conceptual framework emphasizes the role of structural inequalities stemming from institutional decisions and systemic inequalities [82]. It also provides an understanding of the multifaceted nature of oral health disparities and highlights the need for targeted, context-specific interventions to address these disparities. Low socioeconomic status, a reflection of poverty [83, 84] and low parental education [12], are risk factors for limited access to preventive dental care [85, 86], nutritious diets [87], resources for oral hygiene practices [88, 89], and higher levels of parental stress [90]. These are known pathways for ECC. Similarly, marginalized ethnic groups often face systemic barriers to dental care resulting from limited access to dental insurance, discrimination where clinics may not serve underserved communities, and cultural or language differences that hinder effective communication and trust between providers and patients [77, 91, 92]. In addition, rural and underserved areas often lack adequate infrastructure, including fluoridated water and dental clinics further exacerbating geographic disparities [93]. Social disparity also contributes to chronic stress and poor mental health outcomes which are linked to immune system dysregulation with higher susceptibility to diseases, including ECC [94,95,96].

While structural barriers (cost, access, discrimination) and health policies (water fluoridation, socioeconomic policies) shape the broader context within which oral health disparities manifest, school type, and household economic conditions, seem to serve as mediating factors that influence the extent of oral health disparities. Effective health interventions and education programs targeting at-risk populations can mitigate disparities and promote equitable oral health by addressing systemic challenges and individual-level factors influencing oral health behaviours [97, 98]. Furthermore, although the WHO’s Global Oral Health Action Plan has highlighted the relevance of monitoring the impact of out-of-pocket spending on oral health care to achieve Universal Health Coverage by 2030, this topic remains a gap in studies on inequalities and ECC [99]. Further studies, guided by the conceptual framework, are warranted to validate the suggested pathway regarding the link between ECC and SDG 10. In addition, investigations are needed to explore the potential connections between ECC and other SDG targets.

The conceptual framework for the risk factors for ECC using the SDG 10 as a framework, reflects a conflation of multiple theories such as the social determinants of health theory [100, 101] that emphasizes how socioeconomic factors influence health outcomes, including oral health; the ecological systems theory [102] that highlights the interaction between individual, institutional, and community factors in shaping child development and health outcomes; the fundamental cause theory [103] that suggests that social factors, such as socioeconomic status, are fundamental causes of health disparities; the health inequity framework [104] that focuses on how structural inequalities and social determinants lead to differential health outcomes across populations; the life course theory [105] that examines how early life experiences and exposures to socioeconomic factors influence health trajectories over time; and the theory of agency and structuration [106] which reflects on how humans interact with systems created through biopolitics [107]. Findings from this scoping review highlight the dynamic interplay between individual actions, social structures, and broader policy contexts. Understanding these interactions may help address the inequalities that drive the risk for ECC.

The publication distribution over time observed in the current scoping review may illustrate the changing landscape of ECC research and its link with social inequality. The rise in publications between 2011 and 2020, along with recent studies from 2021 to 2024, indicates a growing interest and ongoing efforts to tackle health inequalities. This increasing attention is significant, particularly given current discussions framing ECC as a justice and rights issue, as those most impacted are individuals with limited ability to mitigate their risk [108].

Mitigating disparities to decrease the risk of ECC among social minority groups requires a comprehensive approach that recognizes and tackles the underlying social determinants of health recognising that those who face social disparity hold less social power or influence to change their society [109]. As identified in the current study, tailored interventions addressing access to fluoridated water, dental care, and community-level interventions are needed to reduce oral health disparities. This entails efforts to dismantle barriers to dental care, enhance access to preventive services, address socioeconomic disparities, promote culturally sensitive oral health education, and confront systemic discrimination within healthcare systems. Moreover, community-based interventions that empower minority groups to advocate for their oral health needs and address the social and environmental determinants of health can play a pivotal role in reducing ECC. In addition, prioritizing oral health research, and leveraging technological advancements such as teledentistry are imperative actions for effective responses to social disparities contributing to ECC risk.

Research can also foster inclusive and sustainable development for all. The strongest research focus on the on the SDG 10 was on target 2 which is about promoting equity in the access of children to oral health care and ECC risk reduction interventions. This topic is also embedded in the SDG 3. Thus, using an interconnected approach between SDGs for designing ECC control programs recognizes that ECC is not just a biological state but an existential condition influenced by socio-political structures that results in inequalities. Interventions must therefore transcend clinical approaches, incorporating policies that tackle underlying social inequalities. Further studies of the link between social inequalities and ECC in low- and middle-income countries is needed.

Capacity-building for researchers is needed to acquire the agency to generate needed empirical evidence for action. This is in view of scoping review findings that four of the ten SDG 10 targets were addressed in ECC/SDG 10 research. We found no studies on development assistance and financial flows to low income countries although they can significantly address systemic disparities and financing gaps [110]. Effective utilization of international funding provided through development assistance and investments in health infrastructure can enhance access to dental care, preventive measures, and education. However, the lack of publications on ECC development assistance limits our understanding of and responding to ECC challenges in LICs. Bridging this knowledge and funding gap is essential to support equitable oral health interventions and the achievement of the SDGs.

Investments in targeted, low-cost oral health interventions, such as the provision of fluoride toothpaste and school-based oral hygiene education and supervised toothbrushing, are feasible and impactful [111]. Community-level approaches, including parental education and engagement in children’s oral health care, are also feasible [112]. These approaches rely on human resources rather than expensive infrastructure, have lower financial demands and have incremental implementation potential making them scalable. The programs can leverage local health workers, school networks, and community health workers to facilitate innovative delivery models in underserved areas [113]. Tailoring education and advocacy to local beliefs and practices can further enhance acceptance and effectiveness of health promotion programs [114]. However, ensuring consistent fluoride product supply would be a challenge for many LICs where there is little or no local production of fluoride dentifrices.

To enhance scalability and feasibility, ECC prevention efforts should be incorporated into existing maternal and child health programs to optimize resource utilization [115]. For infrastructure-intensive interventions like teledentistry in LICs, international funding and multilateral support are crucial to address the needs of remote areas with limited access to dental professionals, especially as digital connectivity continues to improve. Public–private partnerships can also play a critical role in scaling interventions such as subsidized dental care services or oral health product distribution, provided there are clear agreements aligning public health goals with private sector contributions. It is therefore important to also scale policies to address systemic socioeconomic disparities, but this needs robust governance and cross-sector collaboration. Research and pilot programs specifically targeting LICs are crucial to evaluate and optimize these interventions in resource-constrained settings.

In conclusion, this scoping review underscored the significant impact of socioeconomic factors, racial disparities, and geographic location on ECC. The conceptual framework emphasizes the complex interplay between behaviours, social structures, and policy contexts in shaping oral health outcomes by committing to reducing social inequalities and recognizing that the health of marginalized children is an urgent ethical and existential issue. More research representation from LICs exploring the links between ECC and other SDG targets is needed to advance efforts to reduce social disparities in the oral health of preschool children.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

AFR:
African region
AMR:
Americas region
dmft:
Decay, missing, filled teeth index
ECC:
Early Childhood Caries
EMR:
Eastern Mediterranean Region
EUR:
European region
HICs :
High-Income Countries
LICs:
Low-Income Countries
LMICs:
Lower Middle-Income Countries
PRISMA-ScR :
Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines
SDG:
Sustainable Development Goal
SEAR:
South East Asian region
UMICs :
Upper Middle-Income Countries
WPR:
Western Pacific region

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Funding

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Author information

Authors and Affiliations

  1. Early Childhood Caries Advocacy Group, Winnipeg, Canada

    Mor??nik?? Oluwátóyìn Foláyan, Carlos Alberto Feldens, Balgis Gaffar, Jorma I. Virtanen, Duangporn Duangthip, Ola B. Al-Batayneh, Ana Vukovic, Maha El Tantawi & Robert J. Schroth

  2. Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria

    Mor??nik?? Oluwátóyìn Foláyan

  3. Department of Pediatric Dentistry, Pontifical University of Rio Grande Do Sul, Porto Alegre, Brazil

    Elisa Maria Rosa de Barros Coelho

  4. Federal University of Rio Grande Do Sul, Porto Alegre, Brazil

    Carlos Alberto Feldens

  5. Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia

    Balgis Gaffar

  6. Faculty of Medicine, University of Bergen, Bergen, Norway

    Jorma I. Virtanen

  7. Department of Public Health, Faculty of Basic Medical and Health Sciences, Lead City University, Ibadan, Oyo, Nigeria

    Olunike Rebecca Abodunrin

  8. Nanjing Medical University, Nanjing, China

    Olunike Rebecca Abodunrin

  9. College of Dentistry, The Ohio State University, Columbus, OH, USA

    Duangporn Duangthip

  10. Department of Preventive Dentistry, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan

    Ola B. Al-Batayneh

  11. Department of Orthodontics, Pediatric and Community Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates

    Ola B. Al-Batayneh

  12. Clinic for Pediatric and Preventive Dentistry, School of Dental Medicine, University of Belgrade, Belgrade, Serbia

    Ana Vukovic

  13. Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt

    Maha El Tantawi

  14. Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada

    Robert J. Schroth

FULL-TEXT STUDY ONLINE AT https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-025-05587-1