Water constitutes a majority of the human body and is essential for health. In addition, water intake can prevent dental caries by improving salivary lubrication and self-cleaning. This study aimed to determine the relationship between the amount of daily water intake and the symptoms of oral disease in Korean adolescents.
We used data from the Korea Youth Risk Behavior Web-based Survey (KYRBS), conducted in Korea in 2021, and identified the relationship between daily water intake and oral disease symptoms in Korean adolescents. KYRBS is a nationwide cross-sectional survey conducted by the Korea Disease Control and Prevention Agency (KDCA), and a total of 54,848 participants were included in this study.
After adjusting for confounding factors, logistic regression analysis showed that tooth pain was more often experienced by those who drank less than two cups of water per day (odds ratio [OR]: 1.14; 95% confidence interval [CI]: 1.01–1.30) than those who drank five or more cups of water per day.
A low daily water intake is associated with tooth pain, a symptom of dental caries. The results of our study suggest that increasing water intake may reduce dental caries. Therefore, adequate water intake may help prevent dental caries.
물은 신체의 대부분을 구성하는 건강의 필수 인자이며, 적정량의 물 섭취 시 타액 윤활 및 자정작용을 개선하여 치아우식증을 예방할 수 있다. 또한 물 섭취가 부족할 시 가당 음료 섭취 등으로 인한 구강질환을 유발하는 것으로 알려져있다. 이에 본 연구는 물 섭취와 구강질환 증상 사이의 관계를 밝히는것을 목표로 했다.
2021년 한국에서 실시된 한국청소년위험행태 웹기반 조사(KYRBS)의 데이터를 이용하여 한국 청소년의 일일 수분 섭취량과 구강질환 증상의 관계를 확인했다. KYRBS는 질병관리청(KDCA)이 실시하는 전국 단면 조사로, 이번 연구에는 총 54,848명의 참가자가 포함됐다.
교란요인을 보정한 후 로지스틱 회귀분석 결과, 하루에 물을 2컵 미만 마시는 사람에서 하루에 5컵 이상의 물을 마신 사람보다 치아 통증을 더 자주 경험하는 것으로 나타났다(OR: 1.14; 95% CI: 1.01-1.30).
일일 수분 섭취량이 적은 것은 충치의 증상인 치아 통증과 관련이 있다. 우리 연구 결과는 물 섭취를 늘리면 치아 우식증을 줄일 수 있음을 시사한다. 따라서 적절한 물 섭취는 충치 예방에 도움이 될 수 있다.
Adolescence is a period of change and development from childhood to adulthood. The lifestyle habitual of adolescents are closely related to a healthy lifestyle in adulthood
Water constitutes the majority of the human body and is essential for health. As the body can not store water, any water lost over a period of time must be replasced
In addition, a lack of water in the body can lead to dry mouth and thirst, and can cause various health-related symptoms in the mouth, such as burning mouth due to oral thirst and reduced salivation. If these symptoms persist, they can create an environment conducive to oral diseases
Therefore, it is necessary to re-evaluate the relationship between dental caries and periodontal disease according to the amount of water consumed per day. Most previous studies have examined the relationship between water intake and systemic diseases
This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines
This study used data from the 17th Korea Youth Risk Behavior Web-Based Survey (KYRBS), 2021 conducted by the Ministry of Education, the Ministry of Health and Welfare, and the Korea Disease Control and Prevention Agency (KDCA). The KYRBS is an annual cross-sectional survey designed to collect health information from Korean adolescents. To select a nationally representative sample, the KYRBS used stratified cluster sampling to 800 sample schools (400 middle school sand 400 high schools). Health information was collected using an anonymous, self-administered online method. In the 2021 survey, 59,006 adolescents were selected, and 54,848 participated in the survey (response rate: 92.9%). The KYRBS protocol was approved by the Institutional Review Board of the KDCA (2021-06EXP-02-P-A), and informed consent was obtained from all participants prior to their participation in the study. Additional information can be found in previous studies
The participants were asked, ‘In the past seven days, how often did you drink water (including bottled water, carbonated water, barley tea, etc.)?’ The answers were categorised as ‘less than two cups a day’, ‘three to four cups a day’, and ‘more than five cups a day’.
Oral disease symptoms included toothache and gingival bleeding. Regarding toothache the participants were asked, ‘In the past 12 months, have you had a sore, throbbing, or painful tooth?’. The participants were considered to have tooth pain if they answered yes. Regarding gingival bleeding, the participants were asked, ‘Have you had any symptoms of sore or bleeding gums in the past 12 months?’. The participants were considered to have gingival bleeding if they answered yes.
The health status characteristics of the subjects were subjective perception of their health (very good, good, normal, poor, very poor), current smoking (no, yes), current drinking (no, yes), body mass index (BMI; underweight≤18.5 kg/㎡), normal (18.5-22.9 kg/㎡), overweight (23.0-24.9 kg/㎡), obese (≥25.0 kg/㎡), and the number of times they brushed their teeth the previous day (0, 1-2, ≥3).
The dietary habits of the participants were determined on the basis of whether they had eaten food in the last seven days. Specifically, the participants were asked about eating breakfast (zero days, one to three days, four to six days, daily), eating fruit (zero days, one to two times, three to four times, five to six times, daily), drinking carbonated soda drinks (zero days, one to two times, three to four times, five to six times, daily), drinking sweet drinks (zero times, one to two times, three to four times, five to six times, daily), and eating fast food (zero times, one to two times, three to four times, five to six times, daily).
The general characteristics of the participants included sex (boy and girl), grade (middle school 1, 2, 3, high school 1, 2, 3), academic grades (very low, low, normal, high, very high), household economic status (very low, low, normal, high, very high), father’s education (middle school, high school, ≥college), and mother’s education (middle school, high school, ≥college).
All the statistical analyses were performed using complex sampling methods and procedures. General characteristics, frequency water intake, oral disease symptoms, health status characteristics, and dietary habits were analyzed. The Rao-Scott chi-square test was used to investigate differences in the overall characteristics, health-related characteristics, dietary, toothache, and gingival bleeding. Simple analysis adjusted for significant variable, and multiple logistic regression analysis was conducted to determine the relationship between frequency of daily water intake and toothache gingival bleeding. All analyses were conducted using IBM SPSS Statistics for Mac (ver. 27.0; IBM Corp., Armonk, NY USA). The threshold for statistical significance was
Among the general characteristics of the participants, there were statistically significant differences in tooth pain and gingival bleeding according to sex, grade, academic performance, household economic status, father’s education, and mother’s education (
| Variables | Tooth pain | Gingival bleeding | |||
|---|---|---|---|---|---|
| Total | |||||
| Sex | <0.001 | <0.001 | |||
| Male | 18.0(0.3) | 16.6(0.3) | |||
| Female | 24.7(0.3) | 21.8(0.3) | |||
| Grade | <0.001 | <0.001 | |||
| Middle 1 | 15.2(0.4) | 16.2(0.4) | |||
| Middle 2 | 18.9(0.5) | 17.2(0.4) | |||
| Middle 3 | 23.1(0.5) | 19.7(0.5) | |||
| High 1 | 22.0(0.5) | 18.9(0.5) | |||
| High 2 | 23.6(0.5) | 21.0(0.5) | |||
| High 3 | 25.0(0.6) | 21.7(0.6) | |||
| Academic performance | <0.001 | 0.007 | |||
| Very low | 21.5(0.6) | 19.0(0.5) | |||
| Low | 20.8(0.4) | 19.5(0.4) | |||
| Normal | 20.3(0.4) | 18.2(0.3) | |||
| High | 21.8(0.4) | 19.5(0.4) | |||
| Very high | 23.5(0.7) | 20.2(0.6) | |||
| Household income | <0.001 | <0.001 | |||
| Very high | 17.8(0.6) | 17.1(0.6) | |||
| High | 20.0(0.4) | 18.3(0.3) | |||
| Normal | 21.4(0.3) | 19.0(0.3) | |||
| Low | 27.2(0.7) | 23.6(0.7) | |||
| Very low | 28.5(1.5) | 24.6(1.4) | |||
| Father’s education | <0.001 | <0.001 | |||
| Middle | 25.9(2.1) | 26.6(2.2) | |||
| High | 22.5(0.5) | 20.1(0.5) | |||
| College | 22.3(0.4) | 20.0(0.3) | |||
| Mother’s education | <0.001 | <0.001 | |||
| Middle | 25.8(2.1) | 27.0(2.4) | |||
| High | 22.1(0.5) | 20.1(0.5) | |||
| College | 22.4(0.4) | 19.9(0.3) | |||
Values are presented as the weighted% (SE%).
*by Rao-Scott chi-square test
Looking at the health-related characteristics related to gingival pain, participants who considered themselves to be in poor health and those who brushed zero times a day had the highest rates of tooth pain at 36.4% and 27.2%, respectively. These results were considered statistically significant (
| Variables | Tooth pain | Gingival bleeding | |||
|---|---|---|---|---|---|
| Subjective health | <0.001 | <0.001 | |||
| Very good | 13.7(0.4) | 13.3(0.3) | |||
| Good | 20.0(0.3) | 17.7(0.3) | |||
| Normal | 25.1(0.4) | 22.5(0.4) | |||
| Bad | 33.9(0.7) | 29.5(0.8) | |||
| Very bad | 36.4(3.0) | 38.6(3.1) | |||
| Smoking | 0.752 | 0.597 | |||
| No | 25.9(0.8) | 21.7(0.8) | |||
| Yes | 25.5(0.9) | 22.4(1.0) | |||
| Drinking | 0.793 | 0.003 | |||
| No | 25.2(0.5) | 21.3(0.4) | |||
| Yes | 25.0(0.6) | 23.4(0.6) | |||
| BMI (kg/m2) | 0.080 | 0.062 | |||
| Underweight | 20.7(0.4) | 19.5(0.4) | |||
| Normal | 21.6(0.3) | 19.3(0.3) | |||
| Overweight | 21.5(0.6) | 18.4(0.5) | |||
| Obesity | 20.4(0.5) | 18.2(0.5) | |||
| Brushing previous day | <0.001 | <0.001 | |||
| 0 | 27.2(2.1) | 28.5(2.2) | |||
| 1-2 | 22.2(0.3) | 19.5(0.3) | |||
| ≥3 | 19.8(0.3) | 18.3(0.3) | |||
BMI, Body mass index
Values are presented as the weighted% (SE%).
*by Rao-Scott chi-square test
The variable dietary habits was related to toothache and breakfast consumption. The consumption of fruit, carbonated drinks, sweet drinks, fast food, and water intake were all statistically significant (
Dietary variables associated with gingival bleeding included the consumption of breakfast, fruit, and carbonated drinks. The consumption of sweet drinks, fast food, and water intake were all statistically significant (
| Variables | Tooth pain | Gingival bleeding | |||
|---|---|---|---|---|---|
| Breakfast | <0.001 | <0.001 | |||
| 0 | 21.3(0.4) | 19.4(0.4) | |||
| 1-3 | 22.8(0.4) | 20.6(0.4) | |||
| 4-6 | 22.1(0.4) | 19.3(0.4) | |||
| Daily | 19.0(0.4) | 17.3(0.3) | |||
| Fruit | 0.002 | 0.017 | |||
| 0/week | 22.7(0.6) | 20.5(0.6) | |||
| 1-2/week | 21.5(0.4) | 19.4(0.3) | |||
| 3-4/week | 21.0(0.4) | 18.7(0.4) | |||
| 5-6/week | 21.6(0.6) | 19.2(0.6) | |||
| Daily | 19.9(0.5) | 18.4(0.4) | |||
| Drinking sparkling soda | <0.001 | 0.012 | |||
| 0/week | 20.8(0.4) | 19.3(0.4) | |||
| 1-2/week | 20.6(0.3) | 18.6(0.3) | |||
| 3-4/week | 21.4(0.4) | 19.0(0.4) | |||
| 5-6/week | 24.1(0.8) | 21.3(0.8) | |||
| Daily | 23.5(0.8) | 19.8(0.7) | |||
| Drinking sweet drinks | <0.001 | <0.001 | |||
| 0/week | 18.6(0.5) | 18.0(0.4) | |||
| 1-2/week | 19.3(0.3) | 18.2(0.3) | |||
| 3-4/week | 22.1(0.4) | 19.4(0.4) | |||
| 5-6/week | 24.5(0.6) | 20.2(0.6) | |||
| Daily | 26.2(0.7) | 22.1(0.6) | |||
| Fast food | <0.001 | <0.001 | |||
| 0/week | 18.3(0.4) | 17.5(0.4) | |||
| 1-2/week | 20.5(0.3) | 18.7(0.3) | |||
| 3-4/week | 24.2(0.5) | 20.7(0.5) | |||
| 5-6/week | 26.3(1.1) | 21.7(1.0) | |||
| Daily | 27.7(1.6) | 24.6(1.5) | |||
| Water intake | <0.001 | <0.001 | |||
| < 1 cup | 28.5(1.2) | 23.7(1.0) | |||
| 1-2 cups/day | 25.1(0.5) | 22.0(0.4) | |||
| 3 cups/day | 21.6(0.4) | 19.2(0.4) | |||
| 4 cups/day | 19.8(0.5) | 17.7(0.4) | |||
| ≥5 cups/day | 19.2(0.3) | 17.9(0.3) | |||
Values are presented as the weighted% (SE%).
*by Rao-Scott chi-square test
Compared with adolescents who consumed an average of five cups of water per day, adolescents who consumed one to two glasses or less were OR (Odds Ratio); 1.14 (95% CI; Confidence Interval: 1.01-1.30) more likely to experience toothache, which was a statistically significant difference.
In addition, the odds of experiencing gingival bleeding were OR; 1.10 (95% CI: 0.96-1.25) higher in adolescents who consumed less than one to two cups of water per day compared with adolescents who consumed an average of five cups of water per day, but this result was not significant <
| Variable | Tooth pain | Gingival bleeding | |
|---|---|---|---|
| Water intake | |||
| ≥5 cups/day | 1.00 | 1.00 | |
| 3-4 cups/day | 1.10(0.93-1.15) | 0.97(0.86-1.10) | |
| 1-2 cups/day | 1.14(1.01-1.30) | 1.10(0.96-1.25) | |
Data are expressed as the adjusted odds ratios (95% confidence intervals).
Tooth pain adjusted; sex, grade, academic performance, household income, father’s education, mother’s education, subjective health, brushing previous day, breakfast, fruit, drinking sparkling soda, drinking sweet, fast food
Gingival bleeding adjusted; sex, grade, academic performance, household income, father’s education, mother’s education, subjective health, dringking, brushing previous day, breakfast, fruit, drinking sparkling soda, drinking sweet, fast food by complex sampling binary logistic regression analysis
A lack of moisture in the body can create an environment that is conductive to oral diseases, such as dry mouth, tooth decay, and systemic problems. Therefore, it is necessary to re-evaluate the relationship between tooth decay and periodontal disease according to daily water intake. Adolescence is a period of change and development from childhood to adulthood. Dietary and lifestyle habits in adolescence are closely related to healthy lifestyle habits in adulthood, So, this study aimed to investigate the relationship between daily water intake and oral disease symptoms in adolescents. In this study, the incidences of toothache, gingival pain, and bleeding was high in the group with low daily water intake group. In addition, multivariate logistic regression analysis showed that, compared with those who consumed five cups of water daily, those who consumed less than one cup had 1.14 times more tooth pain, withch was a statistically significant difference. This result is similar to previous studies in which
Even low water intake or mild dehydration may be associated with the risk of chronic disease
There are several limitations to the current study. First, there are few previous studies on water intake and oral health behaviors and conditions, making it difficult to compare and interpret the results of this study. In addition, only associations and not causal relationships can be inferred from the results, owing to the cross-sectional design. Therefore, inferred research is needed. Nevertheless, this study is important because our findings may help to motivate Korean adolescents to increase their water intake. In addition, the current study provides baseline data for establishing hydration recommendations at the national level.
1. Dental caries is a common childhood disease, affecting 60-90% of children and adolescents worldwide. It causes pain, infection and interferes with daily activities.
2. Research in Korean adolescents found a link between daily water intake and oral health. Those who consumed more water (5 or more cups) had less toothache.
3. Adequate water intake is essential for oral health and may help prevent oral disease.
It is recommended that dietary guidelines include recommendations for water intake to promote oral health.