title: Adverse childhood experiences and dental health in children and adolescents.
abstract: OBJECTIVE
  This study seeks to explore the how specific toxic stressors, specifically adverse childhood experiences (ACEs), and their frequencies may be associated with tooth condition and the presence of caries.
  
  
  METHODS
  Data from the 2011-12 National Survey for Child Health (NSCH), a nationally representative survey of child health, were used in this study. Pediatric dental health was measured using parent report of two characteristics: condition of teeth and having a toothache, decayed teeth, and/or unfilled cavities in the past 12 months. ACEs were measured by asking about a child's exposure to the divorce of a parent, parental incarceration, domestic violence, neighborhood violence, drug and alcohol abuse, mental illness, and financial hardship. Analyses were adjusted by sociodemographic characteristics, healthcare access and utilization, and comorbid chronic conditions.
  
  
  RESULTS
  The presence of even one ACE in a child's life increased the likelihood of having poor dental health. Additionally, having multiple ACEs had a cumulative negative effect on the condition of their teeth and the presence of dental caries (Odds Ratios 1.61-2.55). Adjusted models show that racial and socioeconomic factors still play a significant role in dental health.
  
  
  CONCLUSIONS
  In addition to the known disparities in dental caries, this study demonstrates that there is significant association between childhood psychosocial issues and dental health. Preventive dental care should be considered incorporating the screening of multiple biological stressors, including ACEs, in routine dental visits as a means of identifying and reducing dental health inequities.
authors.affiliation: Institute for Child Health Policy, University of Florida, Gainesville, FL, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Bright
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Alford
authors.forename: Melanie S
authors.initials: MS
authors.lastname: Hinojosa
authors.forename: Caprice
authors.initials: C
authors.lastname: Knapp
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Fernandez-Baca
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003731:Dental Caries / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008016:Life Change Events; D008297:Male; D015999:Multivariate Analysis; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology; D014076:Tooth Diseases / Q000453:epidemiology*; D014098:Toothache / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
keywords: pediatric dentistry; psychosocial aspects of oral health; stress