Understanding the association between self-reported poor oral health and exposure to adverse childhood experiences: a retrospective study

Abstract

Background: Adverse childhood experiences, including physical, sexual or emotional abuse, can have detrimental impacts on child and adult health. However, little research has explored the impact that such early life experiences have on oral health. This study examines whether experiencing adverse childhood experiences before the age of 18 years is associated with self-reported poor dental health in later life. Methods: Using stratified random probability sampling, a household survey (N = 5307; age range 18-69 years) was conducted in the South of England (Hertfordshire, Luton and Northamptonshire). Data were collected at participants' homes using face-to-face interviews. Measures included exposure to nine adverse childhood experiences, and two dental outcomes: tooth loss (> 8 teeth lost due to dental caries or damage) and missing or filled teeth (direct or indirect restorations; > 12 missing or filled teeth). Results: Strong associations were found between exposure to childhood adversity and poor dental health. The prevalence of tooth loss was significantly higher (8.3%) in those with 4+ adverse childhood experiences compared to those who had experienced none (5.0%; p < 0.05). A similar relationship was found for levels of missing or filled teeth (13.4%, 4+ adverse childhood experiences; 8.1%, none; p < 0.001). Exposure to 4+ adverse childhood experiences was associated with a higher level of tooth loss and restorations at any age, compared to individuals who had not experienced adversity. Demographically adjusted means for tooth loss increased with adverse childhood experience count in all age groups, rising from 1.0% (18-29 years) and 13.0% (60-69 years) in those with none, to 3.0% and 26.0%, respectively in those reporting 4+. Conclusions: Exposure to childhood adversity could be an important predictive factor for poor dental health. As oral health is an important part of a child's overall health status, approaches that seek to improve dental health across the life-course should start with safe and nurturing childhoods free from abuse and neglect. Given the growing role that dental professionals have in identifying violence and abuse, it seems appropriate to raise awareness in the field of dentistry of the potential for individuals to have suffered adverse childhood experiences, and the mechanisms linking childhood adversity to poor dental health.

Association between adverse childhood experiences, bullying, self-esteem, resilience, social support, caries and oral hygiene in children and adolescents in sub-urban Nigeria

“…ACE occur before the age of 18 years [1], and include physical, sexual and emotional abuse and neglect, as well as bullying victimization and parental separation. They directly increase the likelihood of a child having poor oral health, including dental caries [2][3][4], and are also associated with adult health risks, such as cardiovascular diseases [5], diabetes mellitus [6] and smoking [7] which in turn, are associated with poor oral health in adulthood [8][9][10]. ACE further have negative impacts on the neuroendocrine-immune system and host defense mechanism [11] thereby causing high psychological stress [12] that increase the risk for poor oral hygiene and, thereby, caries [13].…”

Association between adverse childhood experiences among children with special healthcare needs and dental care utilization

“…Continuing education and dental school curriculum updates for novel methods to address unmet needs, build trust, and help CSHCN with ACEs are important. [34][35] One such novel method is to study trauma survivors' needs and experiences, and develop a framework of dental care that incorporates trauma-informed care. 36 Trauma associated with ACEs may involve several psychosocial barriers, including fear of dental care, feeling of lack of control, and embarrassment of dental issues.…”

“…Raising awareness among dental health professionals to identify CSHCN with ACEs is critical. Continuing education and dental school curriculum updates for novel methods to address unmet needs, build trust, and help CSHCN with ACEs are important 34–35 . One such novel method is to study trauma survivors' needs and experiences, and develop a framework of dental care that incorporates trauma‐informed care 36 …”

A Comparison of Oral Health Outcomes of Self-Reported and Agency-Notified Child Maltreatment in a Population-Based Birth Cohort at 30-Year-Old Follow-Up

“…Finally, dental status and oral health care were determined by direct questioning without confirmation from clinical records or physical examination. However, self-reported dental status has been used in other work (14). Furthermore, we chose dental extraction as the primary outcome rather than, say, the number of remaining teeth to help minimize recall bias.…”

“…A large population-based survey of more than 5000 English adults reported that childhood maltreatment was associated with both tooth loss and restorations at any age even after adjustment for age, sex, ethnicity, and deprivation (14). However, limitations included a lack of information on concurrent smoking and mood status (14). These two factors show a strong association with both poor oral health and previous child abuse, and so could be important covariates (15,16).…”