# Impact of Sleep and Associated Factors on the Prevalence of Early Childhood Caries: An Analytical Cross-Sectional Study

## TL;DR

This study finds that poor sleep, frequent snacking, and screen time before bed are linked to higher rates of tooth decay in young children.

## Contribution

The study identifies sleep patterns and screen time as novel risk factors for early childhood caries.

## Key findings

- 68.2% of children had early childhood caries, with 37% having severe cases.
- Late bedtime and reduced sleep duration were significantly associated with higher caries prevalence.
- Frequent snacking and screen time before bed increased the risk of tooth decay.

## Abstract

Background: Early childhood caries (ECC) occur soon after the eruption of teeth and can progress rapidly, causing severe impact on the physical, physiological, and psychological well-being of the child. Irregularities in sleep patterns can result in decreased salivary flow rate and the immune response, which ultimately can affect the rate of progression of early childhood caries.

Aim: To assess the prevalence of early childhood caries and its association with sleep practices, the habit of frequent snacking, and the usage of phones and smart devices by children before bedtime in the age group of three to five years.

Methodology: An analytical cross‑sectional study was conducted among 349 preschoolers aged three to five years studying in preschools of Gandhinagar city, Gujarat, to assess the caries prevalence and associated factors such as sleep practices and oral hygiene practices of children, as well as their snacking practice. A validated, structured questionnaire was administered to parents/guardians, and then caries status was evaluated using the deft index for each participant. Data was systematically compiled and analyzed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). The association between early childhood caries and sleep disorder, the habit of frequent snacking, the bedtime of the child, the screen time of the child before going to bed, and oral hygiene was tested by the chi-square independent test of association.

Result: The caries were prevalent among 238 (68.2%) children in the study population. Out of 238 children, 88 (37%) were found to have severe early childhood caries. The prevalence of caries was significantly associated with late bedtime (after 11), i.e., among 110 children (76.9%) (P=0.034), decreased sleep duration (p=0.027), extracurricular activity (p=<0.001), and late dinner time (P=0.034). Multivariate regression shows bedtime (B=1.024, p=0.003) and frequent snacking (B=-1.364, p=0.011) significantly impact deft scores (R²=0.042, p=0.001), with frequent snacking (OR=0.412) leading to elevated frequency of caries.

Conclusion: The present study demonstrates the intricate relationship between sleep practices, oral hygiene, and dietary habits with the prevalence of ECC. Irregular sleep patterns, frequent snacking, and excessive screen exposure before bedtime were identified as potential risk factors contributing to the increased burden of early childhood caries (ECC).