{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T15:20:54Z","timestamp":1783005654676,"version":"3.54.5"},"reference-count":47,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Dental caries is the world\u2019s most common non-communicable disease with a complex etiology including social, behavioral, medical, biological and economical elements. The distribution among populations and age groups is skewed, which calls for validated clinical tools to identify those with increased caries risk. The aim of this article was therefore to review risk factors for caries development in children, based on global prospective birth cohorts, genetic proceedings and data from validated risk assessment tools. The genetic elements involve four main categories comprising enamel quality, salivary composition, dental biofilm function and taste preferences. Recent studies suggest that genes may account for 35\u201355% of the variation in caries scores in the young permanent dentition. Prospective birth cohorts have pointed out poverty, socioeconomic level, early introduction and excessive sugar intake as significant factors for a child\u2019s dental caries trajectory up into adulthood. Moreover, prolonged breastfeeding, child obesity and maternal oral conditions are linked to the caries burden later in life. In the clinic, the strongest predictors are past caries history and selected behavioral and social factors. The performance of the validated caries risk assessment models is far from perfect, but still acceptable in terms of reliability during childhood. These tools are the best clinical practice since they add objectivity, consistency and documentation to the clinical routines. In addition, the dental staff has the advantage of using the outcome of the assessment for a structured risk communication with the caregivers. The protocol should also form the basis for a personalized intervention program addressing the entire family, with particular focus on maternal oral health and sugar reduction.<\/jats:p>","DOI":"10.3390\/dj14070400","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T14:43:14Z","timestamp":1783003394000},"page":"400","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Who Gets Dental Caries? A Comprehensive Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0199-9210","authenticated-orcid":false,"given":"Svante","family":"Twetman","sequence":"first","affiliation":[{"name":"Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark"},{"name":"Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5146-4399","authenticated-orcid":false,"given":"William","family":"Papaioannou","sequence":"additional","affiliation":[{"name":"Department of Preventive and Community Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sotiria","family":"Gizani","sequence":"additional","affiliation":[{"name":"Department of Paediatric Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"17030","DOI":"10.1038\/nrdp.2017.30","article-title":"Dental caries","volume":"3","author":"Pitts","year":"2017","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1111\/idh.12494","article-title":"Impact of early childhood caries on oral health-related quality of life: A systematic review and meta-analysis","volume":"20","author":"Zaror","year":"2022","journal-title":"Int. J. Dent. Hyg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100904","DOI":"10.1016\/j.identj.2025.100904","article-title":"Global burden of dental caries from 1990 to 2021 and future projections","volume":"75","author":"Li","year":"2025","journal-title":"Int. Dent. J."},{"key":"ref_4","first-page":"197","article-title":"The 80-20 phenomenon (80:20 distribution of caries)\u2014Myth or fact","volume":"201","author":"Dugmore","year":"2006","journal-title":"Br. Dent. J."},{"key":"ref_5","first-page":"711","article-title":"Strategies and approaches in oral disease prevention and health promotion","volume":"83","author":"Watt","year":"2005","journal-title":"Bull. World Health Organ."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"E132","DOI":"10.5888\/pcd16.180641","article-title":"Current knowledge on correlations between highly prevalent dental conditions and chronic diseases: An umbrella review","volume":"16","author":"Seitz","year":"2019","journal-title":"Prev. Chronic Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1111\/jphd.12591","article-title":"Childhood caries is associated with poor health and a faster pace of aging by midlife","volume":"83","author":"Ruiz","year":"2023","journal-title":"J. Public Health Dent."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"134151","DOI":"10.1016\/j.ijcard.2025.134151","article-title":"Childhood oral health is associated with the incidence of atherosclerotic cardiovascular disease in adulthood","volume":"448","author":"Nygaard","year":"2026","journal-title":"Int. J. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1111\/jphd.12665","article-title":"Caries trajectories from childhood to adulthood associated with mental disorders in midlife","volume":"85","author":"Ruiz","year":"2025","journal-title":"J. Public Health Dent."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1038\/s41415-019-0678-8","article-title":"CariesCare practice guide: Consensus on evidence into practice","volume":"227","author":"Martignon","year":"2019","journal-title":"Br. Dent. J."},{"key":"ref_11","first-page":"230","article-title":"Dentists\u2019 use of caries risk assessment in children: Findings from the Dental Practice-Based Research Network","volume":"58","author":"Riley","year":"2010","journal-title":"Gen. Dent."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1111\/j.1600-0528.2011.00626.x","article-title":"Dentists\u2019 use of caries risk assessment and individualized caries prevention for their adult patients: Findings from The Dental Practice-Based Research Network","volume":"39","author":"Riley","year":"2011","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1007\/s00784-022-04694-5","article-title":"Caries risk assessment-related knowledge, attitude, and behaviors among Chinese dentists: A cross-sectional survey","volume":"27","author":"Fang","year":"2023","journal-title":"Clin. Oral Investig."},{"key":"ref_14","first-page":"500","article-title":"Caries risk assessment by dental students and dentists in the Netherlands: A survey study to assess knowledge and implementation","volume":"59","author":"Volgenant","year":"2025","journal-title":"Caries Res."},{"key":"ref_15","first-page":"71","article-title":"Risk factors for dental caries in young children: A systematic review of the literature","volume":"21","author":"Harris","year":"2004","journal-title":"Community Dent. Health"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Canova, C., and Cantarutti, A. (2020). Population-based birth cohort studies in epidemiology. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17155276"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1007\/s00127-015-1048-8","article-title":"The Dunedin Multidisciplinary Health and Development Study: Overview of the first 40 years, with an eye to the future","volume":"50","author":"Poulton","year":"2015","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1177\/00220345211062475","article-title":"Scoping review of oral health-related birth cohort studies: Toward a global consortium","volume":"101","author":"Peres","year":"2022","journal-title":"J. Dent. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1177\/0022034520942208","article-title":"Oral health birth cohort studies: Achievements, challenges, and potential","volume":"99","author":"Peres","year":"2020","journal-title":"J. Dent. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1159\/000520766","article-title":"Individual susceptibility to dental caries: The Vipeholm study","volume":"30","author":"Vieira","year":"2021","journal-title":"Monogr. Oral Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S181","DOI":"10.4103\/jpbs.jpbs_1758_24","article-title":"Genetics in dentistry: A review of advances and implications","volume":"17","author":"Singh","year":"2025","journal-title":"J. Pharm. Bioallied. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"635","DOI":"10.4149\/BLL_2024_98","article-title":"Genetic factors affecting susceptibility to dental caries","volume":"125","author":"Slobodnikova","year":"2024","journal-title":"Bratisl. Med. J."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Bouaita, I., Peixoto, A., Mascarenhas, P., and Manso, C. (2025). Tooth decay: Genetic and epigenetic insights driving the development of anti-caries vaccines. Genes, 16.","DOI":"10.3390\/genes16080952"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1159\/000314676","article-title":"Genes and their effects on dental caries may differ between primary and permanent dentitions","volume":"44","author":"Wang","year":"2010","journal-title":"Caries Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e2000314","DOI":"10.1002\/bies.202000314","article-title":"How does the early life environment influence the oral microbiome and determine oral health outcomes in childhood?","volume":"43","author":"Adler","year":"2021","journal-title":"Bioessays"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Fol\u00e1yan, M.O., Gaffar, B., Feldens, C.A., Schroth, R.J., Ramos-Gomez, F., Virtanen, J.I., Lee, H., Adeniyi, A., and El Tantawi, M. (2025). The first 1,000 days of life and early childhood caries: Closing the global data gap. Front. Oral Health, 6.","DOI":"10.3389\/froh.2025.1701839"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"104007","DOI":"10.1016\/j.identj.2025.104007","article-title":"Biological validation of the PSC-MCAT: Analyzing dental plaque microbiota across caries risk levels in preschoolers","volume":"76","author":"Jiang","year":"2026","journal-title":"Int. Dent. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s40368-019-00480-2","article-title":"A systematic review of risk assessment tools for early childhood caries: Is there evidence?","volume":"21","author":"Twetman","year":"2020","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e088253","DOI":"10.1136\/bmjopen-2024-088253","article-title":"Risk prediction models for dental caries in children and adolescents: A systematic review and meta-analysis","volume":"15","author":"Wang","year":"2025","journal-title":"BMJ. Open"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1186\/s13643-023-02298-y","article-title":"Multivariable prediction models of caries increment: A systematic review and critical appraisal","volume":"12","author":"Havsed","year":"2023","journal-title":"Syst. Rev."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1016\/j.jdent.2015.10.011","article-title":"Diagnostic accuracy of different caries risk assessment methods. A systematic review","volume":"43","author":"Senneby","year":"2015","journal-title":"J. Dent."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1177\/154405910808700112","article-title":"Trajectory patterns of dental caries experience in the permanent dentition to the fourth decade of life","volume":"87","author":"Broadbent","year":"2008","journal-title":"J. Dent. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"103664","DOI":"10.1016\/j.jdent.2021.103664","article-title":"Assessment of predictive performance of caries risk assessment models based on a systematic review and meta-analysis","volume":"110","author":"Su","year":"2021","journal-title":"J. Dent."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1111\/ipd.13140","article-title":"A systematic review of caries risk in children <6 years of age","volume":"34","author":"Khan","year":"2024","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_35","unstructured":"(2026, June 17). IAPD Foundational Articles and Consensus Recommendations: Caries Risk Assessment and Care Pathways, Foundational Articles and Recommendations. Available online: https:\/\/iapdworld.org\/wp-content\/uploads\/2022\/08\/2022_13_caries-risk-assessment-and-care-pathways.pdf."},{"key":"ref_36","unstructured":"American Academy of Pediatric Dentistry (2025). Caries-risk assessment and management for infants, children, and adolescents. The Reference Manual of Pediatric Dentistry, American Academy of Pediatric Dentistry. Available online: http:\/\/www.aapd.org\/media\/Policies_Guidelines\/BP_CariesRiskAssessment.pdf."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e70069","DOI":"10.1111\/eos.70069","article-title":"Use of the oral microbiota as screening test to identify children at risk for caries development. A systematic review of longitudinal studies","volume":"134","author":"Santos","year":"2026","journal-title":"Eur. J. Oral Sci."},{"key":"ref_38","first-page":"385","article-title":"Artificial intelligence in early childhood caries detection and prediction: A systematic review and meta-analysis","volume":"15","author":"Rokhshad","year":"2024","journal-title":"Pediatr. Dent."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Karam\u00fcft\u00fco\u011flu, N., \u00dc\u00e7punar, B.Y., Birben, \u0130., Altunda\u011f, A.E., Mullao\u011flu, K.\u00d6., and Bal, C. (2026). Artificial intelligence in pediatric dentistry: A systematic review and meta-analysis. Children, 13.","DOI":"10.3390\/children13010152"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Twetman, S. (2024). Why is caries prevention in children so difficult? A narrative opinion. Int. J. Environ. Res. Public Health, 21.","DOI":"10.3390\/ijerph21101316"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1126\/science.adn5421","article-title":"Exposure to sugar rationing in the first 1000 days of life protected against chronic disease","volume":"386","author":"Gracner","year":"2024","journal-title":"Science"},{"key":"ref_42","unstructured":"WHO (2015). Guideline: Sugars Intake for Adults and Children, World Health Organization. Available online: http:\/\/www.who.int\/nutrition\/publications\/guidelines\/sugars_intake\/en\/."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1177\/00220345251340040","article-title":"Birth cohort study identifies Candida albicans as a risk factor for dental caries","volume":"104","author":"Alkhars","year":"2025","journal-title":"J. Dent. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"104876","DOI":"10.1016\/j.archoralbio.2020.104876","article-title":"Candida and dental caries in children, adolescents and adults: A systematic review and meta-analysis","volume":"119","author":"Eidt","year":"2020","journal-title":"Arch. Oral Biol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"103324","DOI":"10.1016\/j.jdent.2020.103324","article-title":"A methodological study to assess the measurement properties (reliability and validity) of a caries risk assessment tool for young children","volume":"95","author":"Christian","year":"2020","journal-title":"J. Dent."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1177\/0022034515620779","article-title":"Predicting dental caries outcomes in children: A \u201crisky\u201d concept","volume":"95","author":"Divaris","year":"2016","journal-title":"J. Dent. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1080\/00016357.2023.2275032","article-title":"What is risk? The challenge of defining \u2018risk\u2019 in caries risk assessment","volume":"83","author":"Senneby","year":"2024","journal-title":"Acta Odontol. Scand."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/7\/400\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T15:11:01Z","timestamp":1783005061000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/7\/400"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":47,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["dj14070400"],"URL":"https:\/\/doi.org\/10.3390\/dj14070400","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]}}}