Abstract Objectives To evaluate the risk factors and risk indicators associated with early childhood caries in South Africa. Design A systematic review of aetiology was performed. From 1366 papers found, 23 studies met the eligibility criteria and were included. All study designs were included. Healthy children under six who live in South Africa were eligible for the study. The study was registered with PROSPERO, registration number CRD42020216455. Data extraction Eligible studies were selected, and data extracted independently by two reviewers. Published data on socio-economic status, dietary factors, oral hygiene knowledge and practices, breastfeeding and bottle-feeding practices, oral bacterial flora and other risk indicators were collected. Two authors appraised the studies independently using the Joanna Briggs Critical Appraisal tools. Data analysis Heterogeneity was assessed using the I2 statistics, and due to heterogeneity, extracted data were mostly presented narratively. Results Meta-analysis was performed using random-effects models and concluded that parents of children who had a tertiary education had a 1.77 [1.22–2.57] odds of experiencing dental caries compared to the children of parents with a secondary education. However, the unclear risk of bias of most included cross-sectional studies precluded definitive conclusions. Conclusions More high-quality cohort studies need to be performed to evaluate actual risk factors for ECC in a South African setting. Parental/caregiver oral educational knowledge needs promoting before the emergence of their children’s teeth. The social determinants of health need to be incorporated in future studies, and suitable targeted interventions need to be developed and implemented to mitigate early childhood caries in South Africa.
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