Sleep Problems, Early Childhood Caries, and Oral Health‐Related Quality of Life: An Approach Using Structural Equation Modeling

BACKGROUND: Early childhood caries (ECC) has a multifactorial nature. OBJECTIVE: This study aimed to develop a structural model to identify the association between possible sleep problems, ECC, and oral health-related quality of life (OHRQoL). DESIGN: A cross-sectional study was conducted with 575 children aged 3-5 years. ECC was assessed using the ICDAS-II by calibrated dentists. Possible sleep problems were determined using the Children's Sleep Habits Questionnaire. OHRQoL was measured using the ECOHIS. Data were analyzed using structural equation modeling through Mplus, version 8.6. RESULTS: Children with more severe stages of ECC experienced dental pain (β = 0.712; p < 0.001), and the presence of dental pain was associated with more disturbed sleep (β = 0.723; p < 0.001). ECC and dental pain negatively impacted the child's (β = 0.208; p < 0.001; β = 0.750; p < 0.001) and the family's (β = 0.347; p < 0.001; β = 0.612; p < 0.001) OHRQoL, respectively. CONCLUSION: An indirect association was found between ECC and children's sleep, mediated by the variable dental pain. ECC and dental pain were associated with higher OHRQoL scores.