Editor’s Note: Dental phobias, pediatric dental care and helping people of all ages who suffer from dental anxiety are important to Incisor, as well as to our readers. We will be running a multi-part special highlighting the link between childhood trauma and oral health.

Part one focuses on the effect of specific childhood traumas, like divorce or abuse, on the utilization of dental care and resulting oral health; part two turns toward preventing adverse childhood experiences (ACE) in the dental office, and utilizing sedation dentistry for trauma-free experiences.


It’s common knowledge that trauma experienced in childhood has far-reaching effects on long-term physical health, including heart disease, mental illness, and other maladies. But are there repercussions from adverse childhood experiences (ACE) that affect both adequacy of care and long-term oral health, and how can dental professionals mitigate such effects?

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How can “trauma-informed” sedation dentistry have a major long-term positive impact on physical and mental health?

A 2018 study in the journal, Community Dentistry and Oral Epidemiology sought to explore the link between adversity in childhood and receiving adequate dental care. The effect of a protective adult on childhood dental care utilization was also studied.

The research began with the premise that “the experience of adversity in childhood may prevent children from getting adequate preventative [sic] care.” In other words, the environment a child grows up within—mental and physical—may impact the prevalence of visits to the dentist.

Respondents who experienced four or more ACEs had a higher likelihood of inadequate dental care than respondents who reported no ACEs.

ACEs were determined by asking about each of respondent's childhood exposure to eleven childhood experiences, among them:

  • Divorce
  • Parental incarceration
  • Domestic violence
  • Drug and alcohol abuse
  • Mental illness
  • Emotional, physical or sexual abuse

The presence of a protective adult in childhood, including respondents fortunate enough to have an adult who made them feel safe and protected during childhood, was also factored into the study, utilizing multivariate regression models to examine the impact of counts and types of ACEs.

The sample included 7,079 respondents, between the ages of 18-79 years of age, and revealed that:

  • 71.4% reported receiving adequate dental care during childhood
  • 28.3% responded that they received inadequate dental care

According to the study, “Adjusting for sociodemographic characteristics, respondents who experienced four or more ACEs had a higher likelihood of inadequate dental care than respondents who reported no ACEs (aOR 2.79; 95% CI 2.77-2.82). The odds of reporting inadequate dental care were lower among those grew up with an adult who made them feel safe and protected (aOR 0.38; 95% CI 0.37-0.39).”

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The study concluded that, “The presence of protective factors may mitigate the effects of ACEs on pediatric dental care.“ So, while traumatic experiences may be factors in children receiving inadequate dental care, positive experiences with protective adults may be a key factor in children’s chances of receiving adequate care.

Why is that the case? What is the connection?

Is it that the latter group develops trust that the world is fundamentally a safe place—of which visits to the dentist are a part—thereby decreasing anxiety-based avoidance?

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Is the former group more influenced by general anxiety and feelings of being unsafe, or is there more because caregiver abuse and neglect are indicative of oral health neglect in the children under their supervision?

Most importantly, how can sedation dentists preserve the feelings of security among children and adults benefitting from a low ACE background, while assuring those who were victims of trauma that they are safe in the dentist’s chair?

While ACE affects the outcome of whether or not a child receives adequate dental care, it also appears to directly correlate to the condition of their teeth (which, besides frequency of care, may also be influenced by diet and household rituals.)

A 2014 study, “Adverse childhood experiences and dental health in children and adolescents” published in Community Dentistry and Oral Epidemiology, dug deeper into causal factors’ effects on tooth condition and the presence of caries “to explore how specific toxic stressors, specifically adverse childhood experiences (ACE), and their frequencies may be associated.”

Pediatric dental health was measured in subjects using parental reports of the condition of teeth, as well as the presence of a toothache, decayed teeth, and/or unfilled cavities in the past 12 months in their child.

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Again, 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 also financial hardship.

The results indicated that, “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.

The study indicated a “significant association between childhood psychosocial issues and dental health,” and recommended consideration of preventive dental care incorporating routine screening for multiple biological stressors, including ACEs, as a means of identifying and reducing dental health inequities.

Considering the potential for sedation dentists to fill, not just teeth, but to stand as a proxy in the role of “protective adult” with the power to make them feel safe, insights into how to maximize that positive influence on pediatric patients—and perhaps restore it in adult patients—is worth a deeper look.

And that’s exactly what we will do in part two of this series.


Works Cited

Crouch, E, et al. “The experience of adverse childhood experiences and dental care in childhood” Community Dentistry and Oral Epidemiology. 2018 Oct;46 (5):442-448. doi: 10.1111/cdoe.12389. Epub 2018 Jun 6.

Bright, Melissa, et al. (2014). “Adverse childhood experiences and dental health in children and adolescents.” Community Dentistry and Oral Epidemiology. 43. 10.1111/cdoe.12137.

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