{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T21:54:55Z","timestamp":1787003695980,"version":"build-2736575974"},"reference-count":50,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009827","name":"Alexandria University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009827","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Dental caries remains the most common chronic disease in childhood. This study aimed to identify environmental stressors in children and estimate the association between salivary cortisol level as a stress biomarker and childhood caries. We conducted a case-control study involving 80 Egyptian children. The cases were 40 children with early childhood caries (ECC). The controls included 40 caries-free children. Data were collected from the parents or caregivers of the children using a questionnaire. The clinical examination included caries experience and an oral hygiene index. Saliva samples were collected and tested for unbounded cortisol levels. The results from the current study showed that the mean age for participants was 5.09\u2009\u00b1\u20090.66\u00a0years. Twenty-one of the children with ECC were girls. In multivariate regression, there is a significant association between ECC and elevated salivary cortisol levels (&gt;\u20090.57\u00a0\u00b5g\/dl) with an adjusted odds ratio (AOR) of 9.649 (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.003), father smoking (AOR\u2009=\u20095.791,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.030), sleeping with a bottle or food in the mouth (AOR\u2009=\u20098.481,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.027), and poor oral hygiene evaluated through the Silness-L\u00f6e Plaque Index (AOR\u2009=\u20096.681,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001). As a conclusion, the study indicates that salivary cortisol is an independent stress biomarker in relation to early childhood caries. Salivary cortisol as a stress biomarker can help clinicians provide an additional assessment tool for identifying caries risk in children.\n                  <\/jats:p>","DOI":"10.1038\/s41598-025-94327-0","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T02:37:00Z","timestamp":1743475020000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Association between environmental stress factors, salivary cortisol level and dental caries in Egyptian preschool children: a case-control study"],"prefix":"10.1038","volume":"15","author":[{"given":"Yosra Ahmed","family":"Hussein","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9524-1346","authenticated-orcid":false,"given":"Rania Hussein","family":"Refai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mai M. K.","family":"Hussein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamdouh Hanafy","family":"Abdou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdy Mohamed","family":"El Bordini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ola Mohamed","family":"Ewais","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3775-6226","authenticated-orcid":false,"given":"Mohamed Fakhry","family":"Hussein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,1]]},"reference":[{"issue":"2","key":"94327_CR1","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1177\/003335491012500202","volume":"125","author":"RM Benjamin","year":"2010","unstructured":"Benjamin, R. M. Oral health: the silent epidemic. Public Health Rep. 125 (2), 158\u2013159. https:\/\/doi.org\/10.1177\/003335491012500202 (2010).","journal-title":"Public Health Rep."},{"issue":"3","key":"94327_CR2","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1080\/00016357.2019.1679389","volume":"78","author":"MC Niskanen","year":"2020","unstructured":"Niskanen, M. C., Mattila, P. T., Niinimaa, A. O., Vehkalahti, M. M. & Knuuttila, M. L. Behavioural and socioeconomic factors associated with the simultaneous occurrence of periodontal disease and dental caries. Acta Odontol. Scand. 78 (3), 196\u2013202. https:\/\/doi.org\/10.1080\/00016357.2019.1679389 (2020).","journal-title":"Acta Odontol. Scand."},{"key":"94327_CR3","doi-asserted-by":"publisher","unstructured":"Pitts, N. B. et al. Dental caries. Nat. Rev. Dis. Primers. 3 (1), 1\u20136. https:\/\/doi.org\/10.1038\/nrdp.2017.30 (2017).","DOI":"10.1038\/nrdp.2017.30"},{"issue":"1","key":"94327_CR4","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/s13005-020-00237-z","volume":"16","author":"M Kazeminia","year":"2020","unstructured":"Kazeminia, M. et al. Dental caries in primary and permanent teeth in children\u2019s worldwide, 1995 to 2019: a systematic review and meta-analysis. Head Face Med. 16 (1), 22. https:\/\/doi.org\/10.1186\/s13005-020-00237-z (2020).","journal-title":"Head Face Med."},{"issue":"14","key":"94327_CR5","doi-asserted-by":"publisher","first-page":"8527","DOI":"10.3390\/ijerph19148527","volume":"19","author":"HM Wong","year":"2022","unstructured":"Wong, H. M. Childhood caries management. Int. J. Environ. Res. Public Health. 19 (14), 8527. https:\/\/doi.org\/10.3390\/ijerph19148527 (2022).","journal-title":"Int. J. Environ. Res. Public Health"},{"issue":"7","key":"94327_CR6","doi-asserted-by":"publisher","first-page":"830","DOI":"10.2047\/jioh-08-07-17","volume":"8","author":"ZD Baghdadi","year":"2016","unstructured":"Baghdadi, Z. D. Early childhood caries and Indigenous children in Canada: prevalence, risk factors, and prevention strategies. J. Int. Oral Health. 8 (7), 830\u2013837. https:\/\/doi.org\/10.2047\/jioh-08-07-17 (2016).","journal-title":"J. Int. Oral Health"},{"key":"94327_CR7","doi-asserted-by":"publisher","first-page":"157","DOI":"10.3389\/fped.2017.00157","volume":"5","author":"S Anil","year":"2017","unstructured":"Anil, S. & Anand, P. S. Early childhood caries: prevalence, risk factors, and prevention. Front. Pead. 5, 157. https:\/\/doi.org\/10.3389\/fped.2017.00157 (2017).","journal-title":"Front. Pead."},{"issue":"1","key":"94327_CR8","doi-asserted-by":"publisher","first-page":"4153","DOI":"10.1038\/s41598-022-08116","volume":"12","author":"TS Carvalho","year":"2022","unstructured":"Carvalho, T. S., Lussi, A., Schlueter, N. & Baumann, T. Differences in susceptibility of deciduous and permanent teeth to erosion exist, albeit depending on protocol design and method of assessment. Sci. Rep. 12 (1), 4153. https:\/\/doi.org\/10.1038\/s41598-022-08116- (2022).","journal-title":"Sci. Rep."},{"key":"94327_CR9","doi-asserted-by":"publisher","first-page":"196","DOI":"10.3389\/fped.2020.00196","volume":"8","author":"MO Folayan","year":"2020","unstructured":"Folayan, M. O. et al. Association between environmental health, ecosystem vitality, and early childhood caries. Front. Pead. 8, 196. https:\/\/doi.org\/10.3389\/fped.2020.00196 (2020).","journal-title":"Front. Pead."},{"issue":"4","key":"94327_CR10","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1177\/03795721231209358","volume":"44","author":"H Nadeeshani","year":"2023","unstructured":"Nadeeshani, H., Kudagammana, S. T., Herath, C., Jayasinghe, R. & Liyanage, R. Early childhood caries and nutritional status of children: A review. FoodNutr. Bull. 44 (4), 249\u2013264. https:\/\/doi.org\/10.1177\/03795721231209358 (2023).","journal-title":"FoodNutr. Bull."},{"issue":"1","key":"94327_CR11","doi-asserted-by":"publisher","first-page":"29","DOI":"10.4103\/0976-9668.107257","volume":"4","author":"H \u00c7olak","year":"2013","unstructured":"\u00c7olak, H., D\u00fclgergil, \u00c7. T., Dalli, M. & Hamidi, M. M. Early childhood caries update: A review of causes, diagnoses, and treatments. J. Nat. Sci. Biology Med. 4 (1), 29\u201338. https:\/\/doi.org\/10.4103\/0976-9668.107257 (2013).","journal-title":"J. Nat. Sci. Biology Med."},{"issue":"9","key":"94327_CR12","doi-asserted-by":"publisher","first-page":"205","DOI":"10.3390\/dj11090205","volume":"11","author":"V Padmanabhan","year":"2023","unstructured":"Padmanabhan, V. et al. Association between salivary cortisol levels, dental anxiety, and dental caries in children: A cross-sectional study. Dentistry J. 11 (9), 205. https:\/\/doi.org\/10.3390\/dj11090205 (2023).","journal-title":"Dentistry J."},{"key":"94327_CR13","doi-asserted-by":"publisher","unstructured":"Mohiti, A., Ardakani, M. E. & Amooei, M. The effect of systemic corticosteroid use on the pH and viscosity of saliva. Shiraz E Med. J. 22 (4). https:\/\/doi.org\/10.5812\/semj.101710 (2021).","DOI":"10.5812\/semj.101710"},{"issue":"6","key":"94327_CR14","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.3390\/ijms20061443","volume":"20","author":"M Magacz","year":"2019","unstructured":"Magacz, M., K\u0119dziora, K., Sapa, J. & Krzy\u015bciak, W. The significance of lactoperoxidase system in oral health: application and efficacy in oral hygiene products. Int. J. Mol. Sci. 20 (6), 1443. https:\/\/doi.org\/10.3390\/ijms20061443 (2019).","journal-title":"Int. J. Mol. Sci."},{"issue":"5","key":"94327_CR15","doi-asserted-by":"publisher","first-page":"1876","DOI":"10.1017\/S0954579420001315","volume":"32","author":"AR Tarullo","year":"2020","unstructured":"Tarullo, A. R., Tuladhar, C. T., Kao, K., Drury, E. B. & Meyer, J. Cortisol and socioeconomic status in early childhood: A multidimensional assessment. Dev. Psychopathol. 32 (5), 1876\u20131887. https:\/\/doi.org\/10.1017\/S0954579420001315 (2020).","journal-title":"Dev. Psychopathol."},{"key":"94327_CR16","doi-asserted-by":"publisher","unstructured":"Agarwal, S., Chandak, M., Reche, A. & Singh, P. V. The prevalence of dental fear and its relationship to dental caries and gingival diseases among school children in Wardha. Cureus 15 (10). https:\/\/doi.org\/10.7759\/cureus.46360 (2023).","DOI":"10.7759\/cureus.46360"},{"issue":"6","key":"94327_CR17","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1089\/ars.2012.4751","volume":"18","author":"Y Hamzany","year":"2013","unstructured":"Hamzany, Y. et al. Is human saliva an indicator of the adverse health effects of using mobile phones? Antioxid. Redox. Signal. 18 (6), 622\u2013627. https:\/\/doi.org\/10.1089\/ars.2012.4751 (2013).","journal-title":"Antioxid. Redox. Signal."},{"key":"94327_CR18","unstructured":"World Health Organization. Egypt releases results of epidemiological study on oral health status. WHO. (2014). http:\/\/www.emro.who.int\/egy\/egypt-events\/results-of-epidemiological-study-on-oral-health-status-released.html"},{"key":"94327_CR19","doi-asserted-by":"publisher","unstructured":"Abbass, M. M. et al. The prevalence of dental caries among Egyptian children and adolescences and its association with age, socioeconomic status, dietary habits and other risk factors. A cross-sectional study. F1000Research 8. https:\/\/doi.org\/10.12688\/f1000research.17047.1 (2019).","DOI":"10.12688\/f1000research.17047.1"},{"issue":"3","key":"94327_CR20","doi-asserted-by":"publisher","first-page":"249","DOI":"10.17796\/jcpd.34.3.l858480k80031jn2","volume":"34","author":"K Rai","year":"2010","unstructured":"Rai, K., Hegde, A. & Shetty, S. Estimation of salivary cortisol in children with rampant caries. J. Clin. Pediatr. Dentistry. 34 (3), 249\u2013252. https:\/\/doi.org\/10.17796\/jcpd.34.3.l858480k80031jn2 (2010).","journal-title":"J. Clin. Pediatr. Dentistry"},{"issue":"9","key":"94327_CR21","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1016\/j.jdent.2013.06.005","volume":"41","author":"X Gao","year":"2013","unstructured":"Gao, X. et al. Validity of caries risk assessment programmes in preschool children. J. Dent. 41 (9), 787\u2013795. https:\/\/doi.org\/10.1016\/j.jdent.2013.06.005 (2013).","journal-title":"J. Dent."},{"issue":"Suppl 1","key":"94327_CR22","doi-asserted-by":"publisher","first-page":"S42","DOI":"10.4103\/jispcd.JISPCD_148_17","volume":"7","author":"SR Laksmiastuti","year":"2017","unstructured":"Laksmiastuti, S. R., Budiardjo, S. B. & Sutadi, H. Validated questionnaire of maternal attitude and knowledge for predicting caries risk in children: epidemiological study in North Jakarta, Indonesia. J. Int. Soc. Prev. Community Dentistry. 7 (Suppl 1), S42\u2013S47. https:\/\/doi.org\/10.4103\/jispcd.JISPCD_148_17 (2017).","journal-title":"J. Int. Soc. Prev. Community Dentistry"},{"issue":"1","key":"94327_CR23","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1177\/0022034518799080","volume":"98","author":"M Fontana","year":"2019","unstructured":"Fontana, M. et al. Predicting caries in medical settings: risk factors in diverse infant groups. J. Dent. Res. 98 (1), 68\u201376. https:\/\/doi.org\/10.1177\/0022034518799080 (2019).","journal-title":"J. Dent. Res."},{"key":"94327_CR24","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.sleep.2017.01.014","volume":"33","author":"KC Janssen","year":"2017","unstructured":"Janssen, K. C., Phillipson, S., O\u2019Connor, J. & Johns, M. W. Validation of the Epworth sleepiness scale for children and adolescents using Rasch analysis. Sleep. Med. 33, 30\u201335. https:\/\/doi.org\/10.1016\/j.sleep.2017.01.014 (2017).","journal-title":"Sleep. Med."},{"key":"94327_CR25","unstructured":"World Health Organization. Mean number of decayed, missing, and filled permanent teeth (mean DMFT) among the 12-year-old age group. WHO (2016). https:\/\/www.who.int\/data\/gho\/indicator-metadata-registry\/imr-details\/3812"},{"issue":"1","key":"94327_CR26","doi-asserted-by":"publisher","first-page":"121","DOI":"10.3109\/00016356408993968","volume":"22","author":"J Silness","year":"1964","unstructured":"Silness, J. & L\u00f6e, H. Periodontal disease in pregnancy II. Correlation between oral hygiene and periodontal condition. Acta Odontol. Scand. 22 (1), 121\u2013135. https:\/\/doi.org\/10.3109\/00016356408993968 (1964).","journal-title":"Acta Odontol. Scand."},{"issue":"9","key":"94327_CR27","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.1016\/j.psyneuen.2008.06.010","volume":"33","author":"SJ Kelly","year":"2008","unstructured":"Kelly, S. J., Young, R., Sweeting, H., Fischer, J. E. & West, P. Levels and confounders of morning cortisol collected from adolescents in a naturalistic (school) setting. Psychoneuroendocrinology 33 (9), 1257\u20131268. https:\/\/doi.org\/10.1016\/j.psyneuen.2008.06.010 (2008).","journal-title":"Psychoneuroendocrinology"},{"issue":"2","key":"94327_CR28","first-page":"A41","volume":"2","author":"BA Kalman","year":"2004","unstructured":"Kalman, B. A. & Grahn, R. E. Measuring salivary cortisol in the behavioral neuroscience laboratory. J. Undergrad. Neurosci. Educ. 2 (2), A41 (2004).","journal-title":"J. Undergrad. Neurosci. Educ."},{"issue":"1","key":"94327_CR29","doi-asserted-by":"publisher","first-page":"45","DOI":"10.3233\/NPM-181723","volume":"11","author":"T Sridevi","year":"2018","unstructured":"Sridevi, T., Pranoti, S., Anand, S., Umesh, W. & Sachin, G. Factors associated with early childhood caries among 3 to 6 year old children in India: a case control study. J. Neonatal-Perinatal Med. 11 (1), 45\u201350. https:\/\/doi.org\/10.3233\/NPM-181723 (2018).","journal-title":"J. Neonatal-Perinatal Med."},{"key":"94327_CR30","doi-asserted-by":"publisher","first-page":"10","DOI":"10.23804\/ejpd.2018.19.01.02","volume":"19","author":"S Caruso","year":"2018","unstructured":"Caruso, S., Gatto, R., Cinque, B., Cifone, M. G. & Mattei, A. Association between salivary cortisol level and caries in early childhood. Eur. J. Paediatr. Dent. 19, 10\u201315. https:\/\/doi.org\/10.23804\/ejpd.2018.19.01.02 (2018).","journal-title":"Eur. J. Paediatr. Dent."},{"issue":"1","key":"94327_CR31","doi-asserted-by":"publisher","first-page":"7","DOI":"10.5005\/jp-journals-10063-0064","volume":"12","author":"SP Rani","year":"2021","unstructured":"Rani, S. P., Amrutha, C., Anantharaj, A., Praveen, P. & Sudhir, R. Salivary cortisol: A biomarker for stress indicator in children. CODS-Journal Dentistry. 12 (1), 7\u201310. https:\/\/doi.org\/10.5005\/jp-journals-10063-0064 (2021).","journal-title":"CODS-Journal Dentistry"},{"key":"94327_CR32","doi-asserted-by":"publisher","unstructured":"Pani, S. C., Abuthuraya, D., AlShammery, H. M., AlShammery, D. & AlShehri, H. Salivary cortisol as a biomarker to explore the role of maternal stress in early childhood caries. Int. J. Dent. (2013). https:\/\/doi.org\/10.1155\/2013\/565102","DOI":"10.1155\/2013\/565102"},{"issue":"17","key":"94327_CR33","doi-asserted-by":"publisher","first-page":"11102","DOI":"10.3390\/ijerph191711102","volume":"19","author":"R Dumitrescu","year":"2022","unstructured":"Dumitrescu, R. et al. The impact of parental education on schoolchildren\u2019s oral health\u2014a multicenter cross-sectional study in Romania. Int. J. Environ. Res. Public Health. 19 (17), 11102. https:\/\/doi.org\/10.3390\/ijerph191711102 (2022).","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"94327_CR34","doi-asserted-by":"publisher","unstructured":"Almajed, O. S., Aljouie, A. A., Alharbi, M. S. & Alsulaimi, L. M. The impact of socioeconomic factors on pediatric oral health: A review. Cureus 16 (2), e53567. https:\/\/doi.org\/10.7759\/cureus.53567 (2024).","DOI":"10.7759\/cureus.53567"},{"issue":"3","key":"94327_CR35","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1111\/j.1752-7325.2004.tb02750.x","volume":"64","author":"JD Shenkin","year":"2004","unstructured":"Shenkin, J. D., Broffitt, B., Levy, S. M. & Warren, J. J. The association between environmental tobacco smoke and primary tooth caries. J. Public Health Dent. 64 (3), 184\u2013186. https:\/\/doi.org\/10.1111\/j.1752-7325.2004.tb02750.x (2004).","journal-title":"J. Public Health Dent."},{"issue":"6","key":"94327_CR36","doi-asserted-by":"publisher","first-page":"600","DOI":"10.5005\/jp-journals-10005-1831","volume":"13","author":"S Mosharrafian","year":"2020","unstructured":"Mosharrafian, S., Lohoni, S. & Mokhtari, S. Association between dental caries and passive smoking and its related factors in children aged 3\u20139 years old. Int. J. Clin. Pediatr. Dentistry. 13 (6), 600. https:\/\/doi.org\/10.5005\/jp-journals-10005-1831 (2020).","journal-title":"Int. J. Clin. Pediatr. Dentistry"},{"issue":"6","key":"94327_CR37","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1111\/j.1365-3016.2008.00950.x","volume":"22","author":"T Hanioka","year":"2008","unstructured":"Hanioka, T., Nakamura, E., Ojima, M., Tanaka, K. & Aoyama, H. Dental caries in 3-year\u2010old children and smoking status of parents. Paediatr. Perinat. Epidemiol. 22 (6), 546\u2013550 (2008).","journal-title":"Paediatr. Perinat. Epidemiol."},{"issue":"1","key":"94327_CR38","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1186\/s12903-023-03715-3","volume":"23","author":"A Arafa","year":"2023","unstructured":"Arafa, A. Household smoking impact on the oral health of 5- to 7-years-old children. BMC Oral Health. 23 (1), 1028. https:\/\/doi.org\/10.1186\/s12903-023-03715-3 (2023).","journal-title":"BMC Oral Health"},{"issue":"1","key":"94327_CR39","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1186\/s12903-023-03486-x","volume":"23","author":"G Misrabi","year":"2023","unstructured":"Misrabi, G., Karkoutly, M. & Bshara, N. The effect of secondhand smoke exposure on dental caries and gingival health among schoolchildren in Damascus, Syria: a cross-sectional study. BMC Oral Health. 23 (1), 745. https:\/\/doi.org\/10.1186\/s12903-023-03486-x (2023).","journal-title":"BMC Oral Health"},{"issue":"1","key":"94327_CR40","doi-asserted-by":"publisher","first-page":"193","DOI":"10.11604\/pamj.2020.36.193.24166","volume":"36","author":"D Uwayezu","year":"2020","unstructured":"Uwayezu, D., Gatarayiha, A. & Nzayirambaho, M. Prevalence of dental caries and associated risk factors in children living with disabilities in Rwanda: a cross-sectional study. Pan Afr. Med. J. 36 (1), 193. https:\/\/doi.org\/10.11604\/pamj.2020.36.193.24166 (2020).","journal-title":"Pan Afr. Med. J."},{"key":"94327_CR41","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12903-019-0795-4","volume":"19","author":"MD Robertson","year":"2019","unstructured":"Robertson, M. D. et al. Dental caries experience, care index and restorative index in children with learning disabilities and children without learning disabilities; a systematic review and meta-analysis. BMC Oral Health. 19, 1\u20136. https:\/\/doi.org\/10.1186\/s12903-019-0795-4 (2019).","journal-title":"BMC Oral Health"},{"key":"94327_CR42","doi-asserted-by":"publisher","first-page":"100968","DOI":"10.1016\/j.dr.2021.100968","volume":"61","author":"OV Burenkova","year":"2021","unstructured":"Burenkova, O. V., Naumova, O. Y. & Grigorenko, E. L. Stress in the onset and aggravation of learning disabilities. Dev. Rev. 61, 100968. https:\/\/doi.org\/10.1016\/j.dr.2021.100968 (2021).","journal-title":"Dev. Rev."},{"issue":"4","key":"94327_CR43","doi-asserted-by":"publisher","first-page":"1378","DOI":"10.3390\/jcm12041378","volume":"12","author":"A Arroyo Buenestado","year":"2023","unstructured":"Arroyo Buenestado, A. & Ribas-P\u00e9rez, D. Early childhood caries and sleep disorders. J. Clin. Med. 12 (4), 1378. https:\/\/doi.org\/10.3390\/jcm12041378 (2023).","journal-title":"J. Clin. Med."},{"key":"94327_CR44","first-page":"375","volume":"18","author":"SD Shantinath","year":"1996","unstructured":"Shantinath, S. D., Breiger, D., Williams, B. J. & Hasazi, J. E. The relationship of sleep problems and sleep-associated feeding to nursing caries. Pediatr. Dent. 18, 375\u2013378 (1996).","journal-title":"Pediatr. Dent."},{"key":"94327_CR45","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/j.jpeds.2018.03.033","volume":"198","author":"H Chen","year":"2018","unstructured":"Chen, H., Tanaka, S., Arai, K., Yoshida, S. & Kawakami, K. Insufficient sleep and incidence of dental caries in deciduous teeth among children in Japan: a population-based cohort study. J. Pediatr. 198, 279\u2013286. https:\/\/doi.org\/10.1016\/j.jpeds.2018.03.033 (2018).","journal-title":"J. Pediatr."},{"key":"94327_CR46","doi-asserted-by":"publisher","unstructured":"Moro, J., Santos, P., Giacomin, A., Cardoso, M. & Bolan, M. Association between trouble sleeping and oral conditions among schoolchildren. Rev. Paulista Pediatria. 39, e2019342. https:\/\/doi.org\/10.1590\/1984-0462\/2021\/39\/2019342 (2020).","DOI":"10.1590\/1984-0462\/2021\/39\/2019342"},{"issue":"3","key":"94327_CR47","doi-asserted-by":"publisher","first-page":"20190092","DOI":"10.1098\/rsfs.2019.0092","volume":"10","author":"M Nollet","year":"2020","unstructured":"Nollet, M., Wisden, W. & Franks, N. P. Sleep deprivation and stress: a reciprocal relationship. Interface Focus. 10 (3), 20190092. https:\/\/doi.org\/10.1098\/rsfs.2019.0092 (2020).","journal-title":"Interface Focus"},{"issue":"2","key":"94327_CR48","doi-asserted-by":"publisher","first-page":"98","DOI":"10.4103\/JISPPD.JISPPD_60_20","volume":"38","author":"K Barjatya","year":"2020","unstructured":"Barjatya, K., Nayak, U. A. & Vatsal, A. Association between early childhood caries and feeding practices among 3\u20135-year-old children of Indore, India. J. Indian Soc. Pedod. Prev. Dentistry. 38 (2), 98\u2013103. https:\/\/doi.org\/10.4103\/JISPPD.JISPPD_60_20 (2020).","journal-title":"J. Indian Soc. Pedod. Prev. Dentistry"},{"issue":"3","key":"94327_CR49","doi-asserted-by":"publisher","first-page":"421","DOI":"10.5005\/jp-journals-10005-2356","volume":"16","author":"S Khodke","year":"2023","unstructured":"Khodke, S., Naik, S. & Agarwal, N. Infant dietary pattern and its association with early childhood caries in preschool children: A Cross-sectional study. Int. J. Clin. Pediatr. Dentistry. 16 (3), 421. https:\/\/doi.org\/10.5005\/jp-journals-10005-2356 (2023).","journal-title":"Int. J. Clin. Pediatr. Dentistry"},{"issue":"9","key":"94327_CR50","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1038\/s41415-019-0853-y","volume":"227","author":"JD Coxon","year":"2019","unstructured":"Coxon, J. D., Hosey, M. T. & Newton, J. T. The impact of dental anxiety on the oral health of children aged 5 and 8 years: a regression analysis of the child dental health survey 2013. Br. Dent. J. 227 (9), 818\u2013822. https:\/\/doi.org\/10.1038\/s41415-019-0853-y (2019).","journal-title":"Br. Dent. J."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-94327-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-94327-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-94327-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T02:37:19Z","timestamp":1743475039000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-025-94327-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,1]]},"references-count":50,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["94327"],"URL":"https:\/\/doi.org\/10.1038\/s41598-025-94327-0","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,1]]},"assertion":[{"value":"5 May 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 April 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee of the High Institute of Public Health, Alexandria University, Egypt.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The results\/data\/figures in this manuscript have not been published elsewhere, nor are they under consideration (from you or one of your Contributing Authors) by another publisher. All of the material is owned by the authors and\/or no permissions are required.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Before the start of the research, each participant\u2019s caregiver provided their informed permission.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}],"article-number":"11063"}}