Adverse Childhood Experiences and Dental Caries among Adolescents

Adverse childhood experiences (ACEs) are negative events occurring before age 18 that may impact health. Children exposed to ACEs often receive inadequate preventive care and have a higher prevalence of diseases like dental caries. However, research on this topic remains limited. This study evaluated the association between ACEs and dental caries in adolescents.

This is a cross-sectional study nested in a cohort performed with a representative sample of preschools from Santa Maria, southern Brazil. This study used data from the last follow-up, with individuals aged between 14 and 18. Data collection was performed through structured questionnaires administered face-to-face and oral clinical examinations. All research team was previously trained and calibrated. Dental caries was measured by International Caries Detection and Assessment System (ICDAS). ACE was evaluated by questions of the Brazilian version of the Adverse Childhood Experiences-International Questionnaire (ACE-IQ), considering alcohol and drug use, suicidal intent, imprisonment, divorce, or death of family members. The co-occurrence of ACEs was also evaluated. Sociodemographic and behavioral variables were used as covariables. Poisson regression models were used to investigate the associations with results present in rate ratio (RR) and 95% confidence interval (CI).

A total of 406 adolescents were examined. The mean of teeth with dental caries was 1.45 (standard deviation 3.6). The rate of dental caries was 56% higher in adolescents who lived with someone who has been sent to prison (RR: 1.56; 95% CI: 1.02-1.90) and 22% higher in adolescents who witnessed their parents' divorce (RR: 1.22; 95% CI: 1.02-1.45) compared to those counterparts. The other ACEs separately were not associated with dental caries. Adolescents exposed to one, two, or more ACEs concomitantly had significantly higher caries rates compared to those with no exposure.

Individuals who witnessed parental divorce or imprisonment exhibited higher rates of dental caries. Moreover, exposure to one, two, or more concurrent ACEs was associated with higher dental caries rates compared to no exposure. These findings underscore the importance of considering specific ACEs within the family environment when assessing their impact on dental caries.