Relationship between Problematic Internet Use, Sleep Problems, and Oral Health in Korean Adolescents: A National Survey

We examined the relationship between Problematic Internet Use (PIU), sleep (sleep satisfaction, sleep duration), and experience of oral disease symptoms in Korean adolescents by gender. This cross-sectional study utilized the 6th (2010) Korean Youth Risk Behavior Web-based Survey. Participants comprised 74,980 students from 400 middle schools and 400 high schools nationwide. Among these, 73,238 students from 799 schools (38,391 boys, 34,847 girls, aged 13-18 years) were included in the analysis (inclusion rate = 97.7%). Multiple logistic regression and analysis of moment structures (AMOS) analyses were performed to identify meaningful relationships between the three factors. The high risk group of problematic internet usage had increased experience of oral disease symptoms (boys: adjusted odds ratio (AOR) = 1.92, 95% confidence interval (CI) = 1.63-2.28, girls: AOR = 1.98, 95% CI = 1.50-2.63) compared to the general group. Boys who used the Internet for 5-6 h had a higher risk of oral disease symptoms compared to those who used it for less than 1 h (OR = 1.24, 95% CI = 1.01-1.53); however, this difference was not significant in Models II and III. For girls, the risk of 5-6 h of use (Model I: OR = 1.69, 95% CI = 1.40-2.04) was higher than that of the boys. In addition, the difference was significant in Models II and III for girl students who used the Internet for 5-6 h. In subgroup analysis, the high-risk group had a higher odds ratio for mild symptoms of bad breath to severe symptoms such as sore and bleeding gums. In addition, in the path analysis, PIU affected sleep and indirectly affected oral health. Direct and indirect causal relationships between the three factors were confirmed. Therefore, it is important to recognize that PIU can have a detrimental effect on mental, physical, and oral health.