Adverse childhood experiences from birth to age 6 years and changes in dental caries experience from age 7 to 10 years.

Objectives: To examine the association of the timing and accumulation of exposure to adverse childhood experiences (ACEs) from birth to age 6 years, with changes in dental caries from age 7 to 10 years.

Methods: This was a longitudinal study using data from 7633 children in the Avon Longitudinal Study of Parents and Children (ALSPAC), Bristol, England. Experience of eight ACEs (physical, emotional and sexual abuse; parental mental illness, separation, substance misuse and conviction; and interparental violence) was determined from annual questionnaires completed by mothers and partners, from birth until age 6 years. ACEs were counted cross-sectionally (co-occurrence at every age) and longitudinally (accumulation). Dental caries was measured using child reports on the number of decayed and filled teeth at ages 7 and 10 years. Mixed-effects Poisson regression was used to model caries increments, adjusting for confounders.

Results: The mean number of decayed and filled teeth was 1.06 (95%CI: 0.99, 1.12) at age 7 years, increasing to 1.47 (95%CI: 1.40, 1.54) at age 10 years. The accumulation of ACEs was associated with greater caries increments (Rate Ratio: 1.15, 95%CI: 1.02, 1.30). In terms of the timing of exposure to ACEs, only the co-occurrence of ACEs at ages 4 (RR=1.13, 95%CI: 1.03-1.23), 5 (1.13, 95%CI: 1.03-1.23) and 6 years (1.14, 95%CI: 1.03-1.27) was associated with greater caries increments.

Conclusion: There was a dose-response relationship between the cumulative exposure to ACEs in the first 6 years of life and subsequent changes in dental caries. In addition, recent exposure to ACEs (4-6 years of age) seemed more relevant to child dental caries than earlier exposure.

Clinical significance: Experience of adversity during childhood, such as child maltreatment and household dysfunction, can increase children's caries risk. This knowledge can help dentists identify vulnerable children or families during routine dental visits.