Co-sleeping as a contributor to early childhood caries: Behavioral pathways and clinical outcomes

Early childhood caries (ECC) is a multifactorial chronic disease strongly influenced by feeding behaviors and oral hygiene practices. Co-sleeping is a common caregiving practice that may increase ECC risk by facilitating nocturnal feeding and limiting adequate nighttime oral care. This study aimed to evaluate the association between co-sleeping, related behavioral factors, and the presence and severity of ECC in children aged 1 to 6 years. A retrospective observational study was conducted using clinical and radiographic records from a pediatric dentistry clinic. The sample included 150 children aged 12 to 72 months. Parents completed a validated questionnaire on feeding practices, dietary habits, oral hygiene routines, sugar intake, and co-sleeping behaviors. ECC was assessed using the decayed, missing, and filled teeth index according to World Health Organization criteria. Logistic regression analyses were performed to identify associations between co-sleeping, behavioral variables, and ECC outcomes. Co-sleeping was reported in 18.7% of children. Co-sleeping children showed significantly higher mean decayed, missing, and filled teeth index scores than non-co-sleepers (7.14 vs 3.49). Co-sleeping was significantly associated with nighttime breastfeeding on demand, higher carbohydrate consumption, and inadequate oral hygiene practices (P < .05). In most co-sleeping cases (89.3%), children fell asleep with milk remaining in the oral cavity. Co-sleeping was associated with an approximately 2-fold increase in ECC risk, and behaviors that may increase the risk and severity of ECC, particularly nocturnal feeding and insufficient oral hygiene. Targeted parental education on nighttime feeding and oral care practices may help reduce ECC risk. Prospective studies are warranted to confirm these findings.