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

ObjectiveTo 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 min, than no beverage or a standard serving of a...

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Main Authors: Mimansa Cholera, Rowena Cape, Thomas Tanbonliong, Jodi D. Stookey
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-06-01
Series:Frontiers in Nutrition
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Online Access:https://www.frontiersin.org/articles/10.3389/fnut.2025.1561771/full
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author Mimansa Cholera
Rowena Cape
Thomas Tanbonliong
Jodi D. Stookey
author_facet Mimansa Cholera
Rowena Cape
Thomas Tanbonliong
Jodi D. Stookey
author_sort Mimansa Cholera
collection DOAJ
description ObjectiveTo 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 min, than no beverage or a standard serving of apple juice.MethodsAfter baseline saliva collection, 105 healthy children (5–10y), attending routine dental check-ups, were randomly assigned to receive 500 mL water, 200 mL apple juice, or no drink. Simple unblinded randomization was stratified by age-and-sex-specific BMI percentile (5–85th or >85th). Follow-up saliva was collected at 45–60 min and classified with respect to insulin<170 pg/mL, pH > 7.0, buffering>5.0, osmolality<70 mmol/kg, amylase<60 μ/mL, IgG > 10 μg/mL, IgA < 112 μg/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.ResultsDrinking water instead of apple juice resulted in a significantly lower median saliva insulin (172 vs. 364 pg/mL), 10 times greater relative odds of saliva insulin below 170 pg/mL (OR = 10.84, 95%CI: 3.86–30.49, p < 0.001), and 5 times greater relative odds of 4 to 7 co-occurring saliva factors that protect against tooth decay (OR = 4.98, 95%CI: 1.42–17.48, p < 0.012). Drinking water instead of apple juice significantly increased the relative odds of pH > 7.0, buffering capacity>5.0, alpha-amylase<60 u/mL, and IgG > 10 μg/mL. Drinking water instead of no drink resulted in significantly lower median saliva insulin (172 vs. 266 pg/mL), significantly greater odds of saliva osmolality <70 mmol/kg, IgA < 112 μg/mL, and 4 to 7 co-occurring protective factors (OR = 4.63, 95%CI: 2.90–7.34, p < 0.001).ConclusionDrinking water instead of apple juice or no drink significantly improved 4 to 7 caries risk factors, simultaneously, within 60 min. The results warrant drinking water intervention to promote oral health.
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spelling doaj-art-2802bc9b65af44a9b104b787ad81c74e2025-08-20T02:35:32ZengFrontiers Media S.A.Frontiers in Nutrition2296-861X2025-06-011210.3389/fnut.2025.15617711561771Drinking water instead of apple juice or no drink results in greater odds of 4 to 7 co-occurring protective oral health factors within the hourMimansa Cholera0Rowena Cape1Thomas Tanbonliong2Jodi D. Stookey3Pediatric Dentistry, Department of Orofacial Sciences, University of California, San Francisco, San Francisco, CA, United StatesMaternal, Child & Adolescent Health, Epidemiology Unit, San Francisco Department of Public Health, San Francisco, CA, United StatesPediatric Dentistry, Department of Orofacial Sciences, University of California, San Francisco, San Francisco, CA, United StatesMaternal, Child & Adolescent Health, Epidemiology Unit, San Francisco Department of Public Health, San Francisco, CA, United StatesObjectiveTo 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 min, than no beverage or a standard serving of apple juice.MethodsAfter baseline saliva collection, 105 healthy children (5–10y), attending routine dental check-ups, were randomly assigned to receive 500 mL water, 200 mL apple juice, or no drink. Simple unblinded randomization was stratified by age-and-sex-specific BMI percentile (5–85th or >85th). Follow-up saliva was collected at 45–60 min and classified with respect to insulin<170 pg/mL, pH > 7.0, buffering>5.0, osmolality<70 mmol/kg, amylase<60 μ/mL, IgG > 10 μg/mL, IgA < 112 μg/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.ResultsDrinking water instead of apple juice resulted in a significantly lower median saliva insulin (172 vs. 364 pg/mL), 10 times greater relative odds of saliva insulin below 170 pg/mL (OR = 10.84, 95%CI: 3.86–30.49, p < 0.001), and 5 times greater relative odds of 4 to 7 co-occurring saliva factors that protect against tooth decay (OR = 4.98, 95%CI: 1.42–17.48, p < 0.012). Drinking water instead of apple juice significantly increased the relative odds of pH > 7.0, buffering capacity>5.0, alpha-amylase<60 u/mL, and IgG > 10 μg/mL. Drinking water instead of no drink resulted in significantly lower median saliva insulin (172 vs. 266 pg/mL), significantly greater odds of saliva osmolality <70 mmol/kg, IgA < 112 μg/mL, and 4 to 7 co-occurring protective factors (OR = 4.63, 95%CI: 2.90–7.34, p < 0.001).ConclusionDrinking water instead of apple juice or no drink significantly improved 4 to 7 caries risk factors, simultaneously, within 60 min. The results warrant drinking water intervention to promote oral health.https://www.frontiersin.org/articles/10.3389/fnut.2025.1561771/fulldrinking wateroral healthcaries risk factorssaliva insulinsaliva osmolalitysaliva pH
spellingShingle Mimansa Cholera
Rowena Cape
Thomas Tanbonliong
Jodi D. Stookey
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
Frontiers in Nutrition
drinking water
oral health
caries risk factors
saliva insulin
saliva osmolality
saliva pH
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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic drinking water
oral health
caries risk factors
saliva insulin
saliva osmolality
saliva pH
url https://www.frontiersin.org/articles/10.3389/fnut.2025.1561771/full
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