Adverse Childhood Experiences and Oral Health of Children and Adolescents: A Systematic Review and Meta-Analysis.

Abstract

Adverse childhood experiences (ACEs) can be extremely traumatic, and their impact on health throughout the life course has been a public policy issue all around the world. Oral health conditions significantly influence quality of life, but its relationship with ACEs among children and adolescents is not well defined. This systematic review investigated the association between ACEs and oral health outcomes in children and adolescents. The search was conducted across six databases and the gray literature, with no restrictions. It included studies evaluating the association between ACEs and oral health outcomes (oral health condition, utilization of dental services, oral hygiene habits, or oral health related to quality of life) in individuals aged 0 to 19. Data of included studies were extracted and methodological quality was assessed. Meta-analysis was used for quantitative synthesis, and the Grading of Recommendations Assessment, Development and Evaluation approach assessed evidence certainty. From the 12 included studies, 11 had a cross-sectional design, and 1 was a cohort study. Seventeen types of ACEs were investigated, including neglect; violence between parents or caregivers; alcohol and substance abuse; and peer, community, and collective violence. The methodological quality compliance ranged between 38% and 100%. The meta-analysis revealed associations between ACEs and lower use of dental services, toothache, gingival bleeding, and dental cavities. Cumulative exposure to more than three ACEs was associated with poorer oral health. The certainty of the evidence varied from low to very low. These results highlight that children and adolescents with ACEs are more likely to present higher oral health problems, including decreased use of dental services.