{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:09:06Z","timestamp":1753891746754,"version":"3.41.2"},"reference-count":71,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T00:00:00Z","timestamp":1749513600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To inform drinking water guidance and intervention, this randomized controlled trial tested the hypothesis that a standard serving of drinking water would normalize saliva insulin and improve caries risk factors to a greater extent, within 60\u202fmin, than no beverage or a standard serving of apple juice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>After baseline saliva collection, 105 healthy children (5\u201310y), attending routine dental check-ups, were randomly assigned to receive 500\u202fmL water, 200\u202fmL apple juice, or no drink. Simple unblinded randomization was stratified by age-and-sex-specific BMI percentile (5\u201385th or &amp;gt;85th). Follow-up saliva was collected at 45\u201360\u202fmin and classified with respect to insulin&amp;lt;170\u202fpg\/mL, pH\u202f&amp;gt;\u202f7.0, buffering&amp;gt;5.0, osmolality&amp;lt;70\u202fmmol\/kg, amylase&amp;lt;60 \u03bc\/mL, IgG\u202f&amp;gt;\u202f10 \u03bcg\/mL, IgA\u202f&amp;lt;\u202f112 \u03bcg\/mL, and the sum of protective factors. In intention-to-treat analyses, quantile regression models tested for drinking water effects on median oral health factors and logistic regression models tested for greater relative odds of normalized saliva insulin and protective factors after drinking water.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Drinking water instead of apple juice resulted in a significantly lower median saliva insulin (172 vs. 364\u202fpg\/mL), 10 times greater relative odds of saliva insulin below 170\u202fpg\/mL (OR\u202f=\u202f10.84, 95%CI: 3.86\u201330.49, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001), and 5 times greater relative odds of 4 to 7 co-occurring saliva factors that protect against tooth decay (OR\u202f=\u202f4.98, 95%CI: 1.42\u201317.48, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.012). Drinking water instead of apple juice significantly increased the relative odds of pH\u202f&amp;gt;\u202f7.0, buffering capacity&amp;gt;5.0, alpha-amylase&amp;lt;60 u\/mL, and IgG\u202f&amp;gt;\u202f10 \u03bcg\/mL. Drinking water instead of no drink resulted in significantly lower median saliva insulin (172 vs. 266\u202fpg\/mL), significantly greater odds of saliva osmolality &amp;lt;70\u202fmmol\/kg, IgA\u202f&amp;lt;\u202f112 \u03bcg\/mL, and 4 to 7 co-occurring protective factors (OR\u202f=\u202f4.63, 95%CI: 2.90\u20137.34, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Drinking water instead of apple juice or no drink significantly improved 4 to 7 caries risk factors, simultaneously, within 60\u202fmin. The results warrant drinking water intervention to promote oral health.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2025.1561771","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T05:23:11Z","timestamp":1749532991000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Drinking water instead of apple juice or no drink results in greater odds of 4 to 7 co-occurring protective oral health factors within the hour"],"prefix":"10.3389","volume":"12","author":[{"given":"Mimansa","family":"Cholera","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rowena","family":"Cape","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Tanbonliong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jodi D.","family":"Stookey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,10]]},"reference":[{"volume-title":"Oral health","year":"2024","key":"ref1"},{"volume-title":"About cavities (tooth decay)","year":"2024","key":"ref2"},{"volume-title":"MouthHealthy. 4 reasons water is the best beverage for your teeth","year":"2024","key":"ref3"},{"volume-title":"Be smart drink water: a guide for school principals in restricting the Sale and Marketing of Sugary Drinks in and around schools","year":"2024","key":"ref4"},{"volume-title":"Oral health data systems: my water\u2019s fluoride","year":"2024","key":"ref5"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1900","DOI":"10.2105\/AJPH.2010.200915","article-title":"Impact of poor oral health on children's school attendance and performance","volume":"101","author":"Jackson","year":"2011","journal-title":"Am J Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"66","DOI":"10.14485\/HBPR.5.2.7","article-title":"School hours lost due to acute\/unplanned dental care","volume":"5","author":"Naavaal","year":"2018","journal-title":"Health Behav Policy Rev"},{"volume-title":"Diet and nutrition to prevent dental problems","year":"2024","author":"Tungare","key":"ref8"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"11S","DOI":"10.14219\/jada.archive.2008.0347","article-title":"The effect of saliva on dental caries","volume":"139","author":"Stookey","year":"2008","journal-title":"J Am Dent Assoc"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.disamonth.2018.09.009","article-title":"Nutrition and oral health","volume":"65","author":"Gondivkar","year":"2019","journal-title":"Dis Mon"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/j.adaj.2015.10.019","article-title":"The pH of beverages in the United States","volume":"147","author":"Reddy","year":"2016","journal-title":"J Am Dent Assoc"},{"key":"ref12","first-page":"7","article-title":"Clinical aspects of salivary biology for the dental clinician","volume":"1","author":"Walsh","year":"2008","journal-title":"J Min Interv Dent"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1128\/MMBR.62.1.71-109.1998","article-title":"Oral microbial ecology and the role of salivary immunoglobulin a","volume":"62","author":"Marcotte","year":"1998","journal-title":"Microbiol. Mol. Biol. Rev."},{"key":"ref14","first-page":"CD010856","article-title":"Water fluoridation for the prevention of dental caries","volume":"6","author":"Iheozor-Ejiofor","year":"2015","journal-title":"Coch. Data Sys. Rev."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1177\/154405910808700407","article-title":"Optimal drinking water composition for caries control in populations","volume":"87","author":"Bruvo","year":"2008","journal-title":"J Dent Res"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"49","DOI":"10.2166\/wh.2017.139","article-title":"Caries affected by calcium and fluoride in drinking water and family income","volume":"16","author":"Arvin","year":"2018","journal-title":"J Water Health"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2","DOI":"10.33309\/2639-9164.020103","article-title":"Saliva as a biomarker for dental caries: a systematic review","volume":"2","author":"Hegde","year":"2019","journal-title":"J. Conserv. Dent."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"15123","DOI":"10.1038\/bdjteam.2015.123","article-title":"Saliva: a review of its role in maintaining oral health and preventing dental disease","volume":"2","author":"Dodds","year":"2015","journal-title":"BDJ Team"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1177\/00220345980770011101","article-title":"Longitudinal analysis of the association of human salivary antimicrobial agents with caries increment and cariogenic micro-organisms: a two-year cohort study","volume":"77","author":"Kirstil\u00e4","year":"1998","journal-title":"J Dent Res"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e32063","DOI":"10.1371\/journal.pone.0032063","article-title":"Roles of salivary components in Streptococcus mutans colonization in a new animal model using NOD\/SCID.e2f1\u2212\/\u2212 mice","volume":"7","author":"Ito","year":"2012","journal-title":"PLoS 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report","year":"2022","key":"ref38"},{"volume-title":"San Francisco unified School District (SFUSD) news. SF schools pushing kids to drink more tap water","year":"2012","author":"Decker","key":"ref39"},{"key":"ref40","article-title":"Buying a school water bottle with help from a 9-year old","volume-title":"Newsweek","author":"Hayes","year":"2022"},{"volume-title":"Square meals NSLP helper sheets, level up with school lunch and school breakfast, 2023-2024","year":"2023","key":"ref41"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"461","DOI":"10.4103\/0972-124X.118317","article-title":"Salivary pH: a diagnostic biomarker","volume":"17","author":"Baliga","year":"2013","journal-title":"J. Indian Soc. Periodontol."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"201","DOI":"10.3390\/ijerph19010201","article-title":"Comparative study of salivary pH, buffer capacity, and flow in patients with and without gastroesophageal reflux disease","volume":"19","author":"Bechir","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1111\/jpc.15325","article-title":"Detection of voluntary dehydration in pediatric populations using non-invasive point-of-care saliva and urine testing","volume":"57","author":"Faidah","year":"2021","journal-title":"J. Ped. Child. Health"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1159\/000526942","article-title":"Salivary proteins as dental caries biomarkers: a systematic review","volume":"56","author":"Ahmad","year":"2022","journal-title":"Caries Res"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.jobcr.2015.05.001","article-title":"Saliva as a prediction tool for dental caries: an in vivo study","volume":"5","author":"Singh","year":"2015","journal-title":"J. Oral. Biol. Craniofacial. Res."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1093\/clinchem\/42.7.1064","article-title":"High serum IgA concentrations in patients with diabetes mellitus: age wise distribution and relation to chronic complications","volume":"42","author":"Rodriguez-Segade","year":"1996","journal-title":"Clin Chem"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1007\/s00784-003-0222-7","article-title":"Salivary antibodies, amylase, and protein from children with early childhood caries","volume":"7","author":"de Farias","year":"2003","journal-title":"Clin. Oral Invest."},{"volume-title":"Data documentation, codebook, and frequencies, fasting questionnaire (FASTQX_I)","year":"","key":"ref49"},{"volume-title":"National health and nutrition examination survey, 2017-2018 questionnaire variable list","year":"","key":"ref50"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1017\/S1368980012004600","article-title":"The relationship of perceptions of tap water safety with intake of sugar-sweetened beverages and plain water among US adults","volume":"17","author":"Onufrak","year":"2014","journal-title":"Public Health Nutr"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1016\/j.jand.2016.02.014","article-title":"Reliability and validity of food frequency questions to assess beverage and food group intakes among low-income 2-to 4-year-old children","volume":"116","author":"Koleilat","year":"2016","journal-title":"J. Acad. Nutr. Diet."},{"volume-title":"Los Angeles County WIC survey, WIC parents questionnaire","year":"2017","key":"ref53"},{"volume-title":"Physical activity in U.S. youth aged 12\u201315 years. NCHS data brief no. 141","year":"2012","key":"ref54"},{"volume-title":"Physical activity guidelines for Americans","year":"2018","key":"ref55"},{"volume-title":"California health interview survey: survey topics and questionnaires","year":"2020","key":"ref56"},{"volume-title":"Caries risk assessment and management","year":"2023","key":"ref57"},{"volume-title":"Healthy people 2030. Reduce the proportion of children and adolescents with lifetime tooth decay \u2013 OH-01, data methodology and measurement","year":"2020","key":"ref58"},{"volume-title":"San Francisco children\u2019s oral health strategic plan 2020-2025","year":"2019","key":"ref59"},{"volume-title":"San Francisco children\u2019s oral health disparities, CavityFree SF strategic plan indicators 2015-2022","year":"2023","key":"ref60"},{"key":"ref61","first-page":"41","article-title":"Saliva as a mirror of the body health","volume":"2","author":"Ahmadi-Motamayel","year":"2010","journal-title":"Avic J Dent Res"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1067\/moe.2001.117815","article-title":"Type 1 diabetes mellitus, xerostomia, and salivary flow rates","volume":"92","author":"Moore","year":"2001","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1177\/10454411930040030701","article-title":"Salivary \u03b1-amylase: role in dental plaque and caries formation","volume":"4","author":"Scannapieco","year":"1993","journal-title":"Crit Rev Oral Biol Med"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"587","DOI":"10.5005\/jp-journals-10005-2645","article-title":"Evaluation of flow rate, pH, and buffering capacity of saliva in children with caries, fluorosis, and caries with fluorosis","volume":"16","author":"Rajendra","year":"2023","journal-title":"Int J Clin Pediatr Dent"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1016\/j.archoralbio.2008.05.002","article-title":"Saliva indices track hypohydration during 48h of fluid restriction or combined fluid and energy restriction","volume":"53","author":"Oliver","year":"2008","journal-title":"Arch Oral Biol"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"105545","DOI":"10.1016\/j.archoralbio.2022.105545","article-title":"A critical review on the association of hyposalivation and dental caries in children and adolescents","volume":"144","author":"Dos Santos","year":"2022","journal-title":"Arch Oral Biol"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"19","DOI":"10.3390\/nu8010019","article-title":"Negative, null and beneficial effects of drinking water on energy intake, energy expenditure, fat oxidation and weight change in randomized trials: a qualitative review","volume":"8","author":"Stookey","year":"2016","journal-title":"Nutrients"},{"key":"ref68","doi-asserted-by":"publisher","DOI":"10.3390\/nu15092069","article-title":"Voluntary hydration with skimmed lactose-free Milk during exercise in the heat: exploring effectiveness and tolerance","volume":"15","author":"Arag\u00f3n-Vargas","year":"2023","journal-title":"Nutrients"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1038\/s41405-023-00170-8","article-title":"Effect of various types of milk on salivary pH among children: a pilot randomized controlled crossover trial","volume":"9","author":"Zamzam","year":"2023","journal-title":"BDJ Open"},{"first-page":"565","volume-title":"Healthy beverage consumption in early childhood: recommendations from key national health and nutrition organizations: summary of oral health considerations. 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