Supplementary Material for: Candida albicans and Early Childhood Caries: A Systematic Review and Meta-Analysis

<p>Oral <i>Candida albicans</i> has been detected in children with early childhood caries (ECC) and has demonstrated cariogenic traits in animal models of the disease. Conversely, other studies found no positive correlation between <i>C. albicans</i> and caries experience in children, while suggesting it may have protective effects as a commensal organism. Thus, this study aimed to examine whether oral <i>C. albicans</i> is associated with ECC. Seven electronic databases were searched. The data from eligible studies were extracted, and the risk of bias was evaluated. A fixed effects model (Mantel-Haenszel estimate) was used for meta-analysis, and the summary effect measure was calculated by odds ratio (OR) and 95% confidence interval (CI). Fifteen cross-sectional studies were included for the qualitative assessment and 9 studies for meta-analysis. Twelve studies revealed higher oral <i>C. albicans</i> prevalence in ECC children than in caries-free children, while 2 studies indicated an equivalent prevalence. A pooled estimate, with OR = 6.51 and 95% CI = 4.94-8.57, indicated a significantly higher ECC experience in children with oral <i>C. albicans</i> than those without <i>C. albicans</i> (<i>p</i> < 0.01). The odds of experiencing ECC in children with <i>C. albicans</i> versus children without <i>C. albicans</i> were 5.26 for salivary, 6.69 for plaque, and 6.3 for oral swab samples. This systematic review indicates that children with oral <i>C. albicans</i> have >5 times higher odds of having ECC compared to those without <i>C. albicans</i>. Further prospective cohort studies are needed to determine whether <i>C. albicans </i>could be a risk factor for ECC, and whether it is dependent on different sample sources (saliva/plaque).</p>