Insufficient Sleep and Incidence of Dental Caries in Deciduous Teeth among Children in Japan: A Population-Based Cohort Study

Effect of sleep on oral health: A scoping review

Sleep is a vital biological process that facilitates numerous vital functions integral to mental and physical restoration of the body. Sleep deprivation or poor sleep quality not only affects physical health but may also affect oral health. This scoping review aims to collate existing evidence related to the impact of sleep duration and/or quality on oral health. A systematic search strategy using PubMed, Embase, Scopus and CINAHL databases was performed to identify studies that assessed the association between sleep quality or duration and oral health or hygiene. Two researchers independently screened and extracted the data. Eligible studies were critically appraised using the NIH quality assessment tool for observational cohort and cross-sectional studies checklist. The search identified 18,398 studies, from which 14 fulfilled the inclusion criteria. Of the 14 papers, four papers were associated with effect of sleep on caries, 8 papers described the effect of sleep on gingival and periodontal health, and two papers described the effect of sleep on general oral health and oral disease symptoms. This review found a direct link between sleep and dental decay in children, and short sleep duration was associated with an increased risk of periodontitis adults.

Measuring hair cortisol concentration, insomnia symptoms and quality of life in preschool children with severe early childhood caries - a case-control pilot study

OBJECTIVE

This study aimed to 1) investigate the relationships between hair cortisol concentration (HCC), insomnia symptoms, Health-Related Quality of Life (HRQoL) and Oral Health-Related Quality of Life (OHRQoL) in preschool children with severe early childhood caries, 2) compare HCC, insomnia symptoms, HRQoL and OHRQoL in preschool children with severe early childhood caries with these factors in children without clinical signs of dental caries, and 3) explore correlations between caries scores and HCC, insomnia symptoms, HRQoL and OHRQoL.

MATERIAL AND METHODS

A case-control pilot study, including 12 children with severe early childhood caries and 28 controls, aged 3-5 years. Dental examination was performed and hair samples for cortisol were taken. Parents filled out questionnaires about their child's insomnia symptoms, HRQoL and OHRQoL. Interpreters were used in families with language difficulties.

RESULTS

The key findings in this pilot study were tendencies that children with severe early childhood caries had more insomnia symptoms, and poorer OHRQoL than the controls. Caries scores was correlated with insomnia symptoms and OHRQoL.

CONCLUSIONS

Dentists should include questions about the child's sleep when they see the child, as insomnia related to dental caries may lead to several physical, mental, and social problems.

Problematic media use is associated with poor oral health in Turkish school-age children: a pilot cross-sectional study

OBJECTIVES

In the recent years, problematic media use (PMU) has become a serious health concern for children. The precisely defined effects of PMU on children's oral health are unknown. It was aimed to investigate the relationship between the PMU and oral health and oral habits in school-age children.

METHODS

In this cross-sectional study, mothers and their healthy children aged 6-11 years who applied to pediatric dentistry outpatient clinic were enrolled. PMU was assessed using the parent-reported Problematic Media Use Measure Short Form (PMUM-SF). PMUM-SF scores were divided into 3 groups from the lowest to the highest tertile. Multivariable logistic regressions for PMU (moderate-high vs. low) were used to predict the odds of having good and parafunctional oral habits, poor oral hygiene, gingivitis and caries.

RESULTS

Totally 153 mother-child pairs participated in this study. Plaque index, gingival index, ICDAS-II (International Caries Detection and Evaluation System), DMFT and DMFS [decayed (D), missing (M), filled (F) tooth (T) /surfaces (S)] scores were significantly higher in children with moderate-high PMU (P < 0.05). After adjusting for potential confounders, moderate-high PMU decreased the probability of good oral habit of daily toothbrushing [Odds (95% CI) = 0.43 (0.20-0.94)] while it increased the risk of oral parafunctional habit of object sucking/biting [Odds (95% CI) = 3.34 (1.27-8.74)]. Moderate-high PMU increased the risk of moderate-severe gingivitis, moderate-extensive caries and the presence of DMFT [Odds (95% CI) = 2.13 (1.01-4.50); 4.54 (1.11-18.54) and 2.16 (1.07-4.36), respectively].

CONCLUSIONS

Turkish school-age children with a remarkable PMU were significantly more likely to have poor oral health and exhibit oral parafunctional habits Oral health screening seems to be needed for Turkish children experiencing PMU.

Association between sleep duration and dental caries in a nationally representative U.S. population

BACKGROUND

Dental caries is considered one of the most prevalent chronic diseases worldwide despite all dental public health efforts. Short sleep duration has been established as a risk factor for several medical conditions. In this study, we aimed to examine the relationship between sleep duration and dental caries.

METHODS

Data were collected from the 2017-2018 cycle of the National Health and Nutrition Examination Survey, a nationally representative health survey conducted in the United States. Participants who completed sleep questionnaires were examined by dentists using standardized clinical criteria. Analysis was limited to Individuals aged ≥ 16 years with complete clinical oral examination data and who completed the sleep questionnaire (N = 5,205). The data were weighted to provide a national estimate, and multiple potential covariates were included in the analysis to account for the complex sample design. The main outcomes of the study were untreated dental caries and dental caries experience. The main predictor variables were average sleep hours/night and a binary variable with 7 h/night as a cut off. Multiple weighted Poisson and logistic regression analyses were conducted to test the hypothesis that people with short sleep duration are more likely to exhibit dental caries.

RESULTS

This study showed a statistically significant negative relationship between sleep duration and dental caries amongst all weighted adjusted analyses conducted. For a one hour increase in average sleep hours, the Adjusted Odds Ratio (AOR) of having a dental caries experience might decrease by 0.86 (AOR = 0.86, 95% CI = 0.75-0.98, P < 0.05). Individuals who reported an average sleep of ≥ 7 h were less likely to have a dental caries experience compared to individuals who reported an average sleep of < 7 h (AOR = 0.52, 95% CI = 0.33-0.82, P < 0.05). For a one hour increase in average sleep hours, the Adjusted Mean Ratio (AMR) of having a dental caries experience might decrease by 0.97 (AMR = 0.97, 95% CI = 0.96-0.99, P < 0.05), and was lower for those who reported sleeping ≥ 7 h/night than individuals who reported sleeping < 7 h/night (AMR = 0.92, 95% CI = 0.87-0.99, P < 0.05).

CONCLUSION

Findings of this cross-sectional representative study of the U.S. population revealed a statistically significant negative association between sleep duration and dental caries. In this study, individuals who slept < 7 h/night were more likely to exhibit dental caries.

The Relationship between Sleep, Chronotype, and Dental Caries-A Narrative Review

This article provides an overview of how sleep and circadian rhythm disturbances mutually influence the occurrence of dental caries and how it is possible to reduce the risk of circadian rhythm disturbances, sleep, and associated adverse effects. Dental caries is a global problem worldwide that contributes to sociological limitations. Numerous factors influence the occurrence of dental caries, from socioeconomic factors to cariogenic bacteria, dietary habits, and oral hygiene. However, sleep disorders and circadian rhythm disturbances represent a new approach in the fight against the increasing prevalence of dental caries worldwide. Bacteria in the oral cavity and the oral microbiome are mainly responsible for the development of caries, and saliva plays an important role in their regulation. The circadian rhythm regulates numerous physiological functions, including sleep and saliva production. Disturbances in sleep and circadian rhythms affect saliva production, which impacts the development of dental caries, as saliva is necessary for regulating and maintaining oral health, especially for controlling oral infections. A person's preference for a particular time of day depends on the circadian rhythm called chronotype. Individuals with an evening chronotype have a less healthy lifestyle that can lead to a higher caries risk than individuals with a morning chronotype. Because circadian rhythms are critical to maintaining sleep homeostasis and oral health, sleep disturbances can disrupt circadian rhythms and lead to a vicious cycle.

Effect of sleep on development of early childhood caries: a systematic review

PURPOSE

To investigate the impact of sleep on the development of early childhood caries (ECC).

METHODS

Seven electronic databases and grey literature were searched with various keyword combinations. Two reviewers independently selected studies, extracted data, and assessed the risk of bias using the Newcastle-Ottawa Scale. The studies were included if they evaluated the impact of sleep parameters on the caries experience or severity of ECC in children under 6 years of age.

RESULTS

Four cross-sectional studies and two longitudinal studies were included. Children who had irregular bedtimes had a 66-71% higher chance of developing ECC. Children who slept after 11 pm might have a 74-85% higher chance of developing ECC. Children who slept less than 8 h during the night had a 30% increased risk of caries than children who slept more than 11 h.

CONCLUSION

Irregular or late bedtime and fewer sleeping hours could be an independent risk factor for ECC. The risk of ECC might be related inversely in a dose-response manner to the number of sleep hours.

Association between sleep patterns and early childhood caries in 3-4-year-old children: A cross-sectional study

Aim

The aim of this study was to assess the sleep practices of children and their association with early childhood caries (ECC) at three different age periods.

Methodology

A cross-sectional study was conducted to assess the sleep practices, feeding practices, and oral hygiene practices of children during nighttime from 0 to 2 years of age. A survey among 550 mothers of children aged 3-4 years with ECC (n = 275) and without ECC (n = 275) was conducted using a pretested and validated questionnaire. The three practices (sleep practices, feeding practices, and oral hygiene practices) of children at 0-3 months, 4-11 months, and 1-2 years of age were recorded and analyzed.

Results

Risk factors associated with ECC at 0-3 months of age were gender (odds ratio [OR]: 0.59, 0.36-0.98), no previous dental visit (OR: 2.30, 1.15-4.59), bedtime (OR: 3.54, 2.01-6.25), and intentional feeding practice at night (OR: 1.83, 1.0-3.35). At 4-11 months of age, no previous dental visit (OR: 3.28, 1.66-6.49), mother's education (OR: 0.42, 0.23-0.76), frequent night wakes (OR: 5.98, 1.89-19.21), and intentional feeding practice at night (OR: 111.09, 32.25-382.68) and, at 1-2 years of age, no previous dental visit (OR: 2.37, 1.45-3.88), intentional feeding practice at night (OR: 19.12, 9.09-40.21), and breastfeeding for more than 2 years (OR: 14.56, 7.17-29.56) were associated with ECC.

Conclusion

Lack of previous dental visit and intentional feeding at night were the common risk factors associated with ECC in children.

Parental and Child Outlook on the Impact of ECC on Oral Health-related Quality of Life: A Prospective Interventional Study

AIM

To evaluate the perspectives of parents and children on the impact of early childhood caries (ECC) on the oral health-related quality of life (OHQoF).

MATERIALS AND METHODS

About 400 children aged 3-5 years were recruited for the study. About 200 children who were caries-free were the controls for the study. The remaining 200 consisted of children who were diagnosed with ECC and required dental rehabilitation under general anesthesia. Oral health-related quality of life was recorded at baseline and 6 months after intervention using the Michigan oral health-related quality of life scale. Data were analyzed and evaluated using Statistical Package for Social Sciences (SPSS) Version 25.0.

RESULTS

Children with ECC were found to have a significantly lower oral health-related quality of life compared with caries-free children, and a statistically significant difference was seen between both groups. The main concern for both parents and children at baseline was pain at the first visit when the evaluation was done. After the intervention, a significant improvement in the oral health-related quality of life was seen.

CONCLUSION

Early childhood caries was found to have detrimental effects on the oral health-related quality of life. Full-mouth rehabilitation under general anesthesia was found to bring a significant improvement in the oral health-related quality of life. The perspectives of both parents and children were found to be similar.

CLINICAL SIGNIFICANCE

Early childhood caries has an impact on the lives of children and their parents. Oral health-related quality of life was low with children suffering from ECC. Full-mouth rehabilitation under general anesthesia can significantly improve the OHRQoL of children. Continuous monitoring of the children with regular follow-ups and parental education should be enforced to prevent the relapse of ECC.

Fluoride and calcium release from peppermint-flavored fluoride varnish containing dicalcium-phosphate-dihydrate coated with xylitol

Bakground: Fluoride varnish with high initial fluoride and calcium release can help patients with high-risk caries. Ample quantities of free fluoride and calcium ions in the oral cavity can enhance enamel remineralization. This study aimed to investigate the effect of dicalcium phosphate dihydrate coated with xylitol (DCPD-xylitol), in fluoride varnish, on the release of fluoride and calcium ions in the oral cavity.

Materials and methods

DCPD powder with xylitol was synthesized by preparing a 60% xylitol solution and mixed it with DCPD solution. The mixture was stirred for 1 h at room temperature and dried at 80 °C for 18 h to reduce the water content. Then, the powder was used in the formulation of peppermint-flavored fluoride varnish as an active agent. The amounts of fluoride and calcium ion released in deionized water at 37 °C for 6 h were assessed with an ion-selective electrode. The cumulative fluoride and calcium ion release data were analyzed using one-way analysis of variance (ANOVA) and the post hoc Tukey test with α = 0.05.

Results

The results showed that the addition of DCPD coated with xylitol provided better bioavailability of the ions than DCPD without coating. Peppermint-flavored fluoride varnish (PFFV) with DCPD-xylitol 1% gave the highest fluoride ion release (296.90 mg/L) compared to the varnishes with other xylitol concentrations and the positive control. In contrast, PFFV DCPD-xylitol 5% afforded the highest calcium ion release at 111.20 mg/L.

Conclusions

This study concluded that xylitol affects the bioavailability of free fluoride and calcium ions in varnishes. However, the efficacy of fluoride and calcium uptake in enamel and under different in vitro media conditions requires further investigation.

Association between Insufficient Sleep and Dental Caries among Preschoolers in Japan: A Cross-Sectional Multicentre Study

Recently, sleeping status has attracted attention for its relationship with oral health. In the present study, we have investigated the association between early childhood caries and sleeping status. A multicentre observational cross-sectional study was conducted among 332 preschoolers (aged 3–6 years) and their parents in Chitose, Japan. Dental caries and sleeping status were assessed in the children and the sleep quality and health literacy of the parents were also assessed. Univariate and multivariate regression analyses were used in order to investigate the effect of the sleeping status of the parents and their children on dental caries. Among the children, the prevalence of dental caries experience was 12.7%. The children without caries slept significantly longer and their parents had a better Pittsburgh Sleep Quality Index (PSQI) score than those with caries experience. The sleeping status and the numbers of caries in the children were significantly correlated. Health literacy was better in those without caries experience. Parents’ PSQI was significantly positively correlated with the numbers of caries in the children (r = 0.19, p = 0.0004). The children’s sleep durations, screen time, and parental smoking status were independently associated with early childhood caries. Poor sleeping status of children and their parents is related to dental caries among preschoolers.

Relationship between Insufficient Sleep and Bad Breath in Korean Adolescent Population

This cross-sectional study sought to evaluate the association between insufficient sleep and bad breath among Korean adolescent population. It was based on the 13th Korea Youth Risk Behavior Web-Based Survey (2017). From 64,991 participants (aged 13-18 years), the final participation rate in the survey was 95.8% (62,276 participants; 31,624 boys and 30,652 girls). A complex sample logistic regression was performed to identify the relationship between insufficient sleep and halitosis, after adjusting for all covariates. In Model II for estimating the adjusted odds ratio (AOR) for general characteristics, students who answered "not at all sufficient", indicating insufficient sleep, were at higher risk of bad breath than those who answered "completely sufficient" (AOR = 2.09, 95% confidence interval, CI = 1.91-2.30). In Model III, for estimating the AOR adjusted for all covariates, students who answered "not at all sufficient", indicating insufficient sleep, were at higher risk of bad breath than those who answered "completely sufficient" (AOR = 1.47, 95% CI = 1.33-1.83). It is necessary for families and schools to have health education lessons that recognize insufficient sleep among adolescents may be a cause of bad breath and therefore optimal sleeping habits and oral health behaviors should be promoted.

Association of short sleep duration and long media use with caries in school children

BACKGROUND

Individual lifestyle factors are associated with dental caries in children. The aim of this study was to investigate comprehensively the association between dental caries in elementary school children and lifestyle factors of the children and their parents.

METHODS

Children from five elementary schools in Takaoka city, Toyama Prefecture, Japan (1,699: 848 boys, 851 girls, age range 6-12 years) participated in a survey conducted in March 2016. Questions on socioeconomic status (SES) and lifestyle factors in the children and their parents were included. Children who received treatment for three or more dental caries were defined as having many caries. Logistic regression analysis was performed to evaluate whether these factors were associated with the number of caries.

RESULTS

The percentage of children with many caries (≥3) was 38.4%. In univariate analysis, being in 5^th or 6^th grade, frequent snacking, short sleep duration, long hours of media use, paternal smoking, and parental skipping of breakfast were significantly associated with many caries. Lack of affluence was marginally significant. In multivariate analysis, the association of short hours of sleep and long hours of media use remained significant. The adjusted odds ratio (OR) for media use of 1-2 h and more than 2 h were 1.79 (95% confidence interval [CI]: 1.30-2.46) and 2.24 (95% CI: 1.61-3.11) respectively. The adjusted OR for less than 8 h of sleep was 1.49 (95% CI: 1.07-2.06).

CONCLUSIONS

Long duration of media use and short duration of sleep were associated with dental caries. Establishing a healthy lifestyle is necessary for preventing dental caries in children.

Dental caries and associated factors in 3 to 5-year-old children in Zhejiang Province, China: an epidemiological survey

BACKGROUND

Dental caries in preschool children is prevalent worldwide, but data regarding its magnitude and associated factors were not available for preschool children in Zhejiang Province, China. This study examines the dental caries situation and its associated factors in Zhejiang Province.

METHODS

A total of 1591 children aged 3-5 years and their parents or caregivers were enrolled in this study. The condition of their teeth was assessed by three dental technicians qualified to WHO 2013 criteria. A structured questionnaire was completed by the children's parents or caregivers. A logistic regression analysis was used to analyze the risk factors that may be associated with dental caries occurring among preschool children.

RESULTS

Caries prevalence (dmft> 0) of 3-5 year old children in Zhejiang Province was 70.4%. The mean decayed, missing and filled teeth (dmft) scores of the 3, 4 or 5 year old children surveyed were 2.96 ± 4.07, 4.42 ± 4.66, and 5.75 ± 5.19 respectively. The negative binomial regression model found that higher dental caries prevalence was found in children as age increased, with lower body mass index (BMI), with longer breastfeeding duration and with fewer hours of sleep.

CONCLUSIONS

The dental caries prevalence and dmft score of 3-5-year-old children in Zhejiang Province was high, and it was associated with age, BMI, breastfeeding duration and hours slept.

Early Childhood Caries: Epidemiology, Aetiology, and Prevention

Early childhood caries (ECC) is one of the most prevalent diseases in children worldwide. ECC is driven by a dysbiotic state of oral microorganisms mainly caused by a sugar-rich diet. Additionally, poor oral hygiene or insufficient dental plaque removal leads to the rapid progression of ECC. ECC leads not only to dental destruction and pain with children, but also affects the quality of life of the caregivers. Children with extensive ECC are at high risk to develop caries with the permanent dentition or will have other problems with speaking and/or eating. To prevent ECC, several strategies should be taken into account. Children should brush their teeth with toothpastes containing gentle ingredients, such as mild surfactants and agents showing antiadherent properties regarding oral microorganisms. Parents/caregivers have to help their children with brushing the teeth. Furthermore, remineralizing and nontoxic agents should be included into the toothpaste formulation. Two promising biomimetic agents for children's oral care are amorphous calcium phosphate [Ca_x(PO₄)_yn H₂O] and hydroxyapatite [Ca₅(PO₄)₃(OH)].