Introduction: 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. Methods: 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). Results: 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. Conclusion: 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.

1.
Felitti
VJ
,
Anda
RF
,
Nordenberg
D
,
Williamson
DF
,
Spitz
AM
,
Edwards
V
, et al
.
Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study
.
Am J Prev Med
.
1998
;
14
(
4
):
245
58
.
2.
Hughes
K
,
Bellis
MA
,
Hardcastle
KA
,
Sethi
D
,
Butchart
A
,
Mikton
C
, et al
.
The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis
.
Lancet Public Health
.
2017
;
2
(
8
):
e356
66
.
3.
Loveday
S
,
Hall
T
,
Constable
L
,
Paton
K
,
Sanci
L
,
Goldfeld
S
, et al
.
Screening for adverse childhood experiences in children: a systematic review
.
Pediatrics
.
2022
;
149
(
2
):
e2021051884
.
4.
Bahanan
L
,
Ayoub
S
.
The association between adverse childhood experiences and oral health: a systematic review
.
J Public Health Dent
.
2023
;
83
(
2
):
169
76
.
5.
Sartori
LRM
,
Pereira
DH
,
Baker
SR
,
Correa
MB
.
Association between adverse childhood experiences and oral health in adulthood: a systematic scoping review
.
J Fam Violence
.
2023
;
38
(
8
):
1607
24
.
6.
Pitts
NB
,
Zero
DT
,
Marsh
PD
,
Ekstrand
K
,
Weintraub
JA
,
Ramos-Gomez
F
, et al
.
Dental caries
.
Nat Rev Dis Primers
.
2017
;
3
:
17030
.
7.
Holst
D
,
Schuller
AA
,
Aleksejuniené
J
,
Eriksen
HM
.
Caries in populations-a theoretical, causal approach
.
Eur J Oral Sci
.
2001
;
109
(
3
):
143
8
.
8.
Brondani
B
,
Knorst
JK
,
Ardenghi
TM
,
Mendes
FM
,
Brondani
MA
.
Community and individual socioeconomic inequalities and dental caries from childhood to adolescence: a 10-year cohort study
.
Community Dent Oral Epidemiol
.
2024
;
52
(
4
):
540
9
.
9.
Broomhead
T
,
Baker
SR
.
From micro to macro: structural determinants and oral health
.
Community Dent Oral Epidemiol
.
2023
;
51
(
1
):
85
8
.
10.
Tomazoni
F
,
Vettore
MV
,
Mendes
FM
,
Ardenghi
TM
.
The association between sense of coherence and dental caries in low social status schoolchildren
.
Caries Res
.
2019
;
53
(
3
):
314
21
.
11.
Knorst
JK
,
Vettore
MV
,
Brondani
B
,
Emmanuelli
B
,
Tomazoni
F
,
Ardenghi
TM
.
Sense of coherence moderates the relationship between social capital and oral health-related quality of life in schoolchildren: a 10-year cohort study
.
Health Qual Life Outcomes
.
2022
;
20
(
1
):
56
.
12.
Bright
MA
,
Alford
SM
,
Hinojosa
MS
,
Knapp
C
,
Fernandez-Baca
DE
.
Adverse childhood experiences and dental health in children and adolescents
.
Community Dent Oral Epidemiol
.
2015
;
43
(
3
):
193
9
.
13.
Crouch
E
,
Nelson
J
,
Radcliff
E
,
Martin
A
.
Exploring associations between adverse childhood experiences and oral health among children and adolescents
.
J Public Health Dent
.
2019
;
79
(
4
):
352
60
.
14.
Von Elm
E
,
Altman
DG
,
Egger
M
,
Pocock
SJ
,
Gøtzsche
PC
,
Vandenbroucke
JP
.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies
.
J Clin Epidemiol
.
2008
;
61
(
4
):
344
9
.
15.
Piovesan
C
,
Ardenghi
TM
,
Guedes
RS
,
Ekstrand
KR
,
Braga
MM
,
Mendes
FM
.
Activity assessment has little impact on caries parameters reduction in epidemiological surveys with preschool children
.
Community Dent Oral Epidemiol
.
2013
;
41
(
3
):
204
11
.
16.
Guedes
RS
,
Piovesan
C
,
Floriano
I
,
Emmanuelli
B
,
Braga
MM
,
Ekstrand
KR
, et al
.
Risk of initial and moderate caries lesions in primary teeth to progress to dentine cavitation: a 2-year cohort study
.
Int J Paediatr Dent
.
2016
;
26
(
2
):
116
24
.
17.
Knorst
JK
,
Menegazzo
GR
,
Emmanuelli
B
,
Mendes
FM
,
Ardenghi
TM
.
Effect of neighborhood and individual social capital in early childhood on oral health-related quality of life: a 7-year cohort study
.
Qual Life Res
.
2019
;
28
(
7
):
1773
82
.
18.
Noronha
TG
,
Knorst
JK
,
Godois
LDS
,
Emmanuelli
B
,
Ardenghi
TM
,
Tomazoni
F
.
Sense of coherence moderates the relationship between perceived racial discrimination and oral health-related quality of life in schoolchildren
.
J Dent
.
2023
;
131
:
104432
.
19.
Pereira
FG
,
Viana
MC
.
Cross-cultural adaptation of the adverse childhood experiences international questionnaire
.
Rev Saude Publica
.
2021
;
55
:
79
.
20.
Ismail
AI
,
Sohn
W
,
Tellez
M
,
Amaya
A
,
Sen
A
,
Hasson
H
, et al
.
The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries
.
Community Dent Oral Epidemiol
.
2007
;
35
(
3
):
170
8
.
21.
Guedes
RS
,
Piovesan
C
,
Antunes
JL
,
Mendes
FM
,
Ardenghi
TM
.
Assessing individual and neighborhood social factors in child oral health-related quality of life: a multilevel analysis
.
Qual Life Res
.
2014
;
23
(
9
):
2521
30
.
22.
Levin
KA
,
Currie
C
.
Adolescent toothbrushing and the home environment: sociodemographic factors, family relationships and mealtime routines and disorganisation
.
Community Dent Oral Epidemiol
.
2010
;
38
(
1
):
10
8
.
23.
Moya-López
M
,
Gómez-De Diego
R
,
Carrillo-Díaz
M
,
Romero-Maroto
M
,
Ruiz-Guillén
A
.
Eating behaviours, oral hygiene, and caries in a population of Spanish children with divorced parents: a cross-sectional study
.
J Clin Med
.
2023
;
12
(
19
):
6189
.
24.
Price
LH
,
Kao
HT
,
Burgers
DE
,
Carpenter
LL
,
Tyrka
AR
.
Telomeres and early-life stress: an overview
.
Biol Psychiatry
.
2013
;
73
(
1
):
15
23
.
25.
Mezzich
AC
,
Bretz
WA
,
Day
BS
,
Corby
PM
,
Kirisci
L
,
Swaney
M
, et al
.
Child neglect and oral health problems in offspring of substance-abusing fathers
.
Am J Addict
.
2007
;
16
(
5
):
397
402
.
26.
Testa
A
,
Jackson
DB
.
Parental incarceration and children’s oral health in the United States: findings from the 2016-2018 National Survey of Children’s Health
.
Community Dent Oral Epidemiol
.
2021
;
49
(
2
):
166
75
.
27.
Bressler
R
,
Yeroshalmi
F
,
Shah
P
,
Badner
V
.
Association of parental divorce with oral health in U.S. Children and adolescents
.
Pediatr Dent
.
2024
;
46
(
5
):
312
7
.
28.
Bomysoad
RN
,
Francis
LA
.
Adverse childhood experiences and mental health conditions among adolescents
.
J Adolesc Health
.
2020
;
67
(
6
):
868
70
.
29.
Chu
B
,
Marwaha
K
,
Sanvictores
T
,
Awosika
AO
,
Ayers
D
.
Physiology, stress reaction
. In:
StatPearls
.
Treasure Island (FL)
:
StatPearls Publishing
;
2025
.
30.
Keremi
B
,
Beck
A
,
Fabian
TK
,
Fabian
G
,
Szabo
G
,
Nagy
A
, et al
.
Stress and salivary glands
.
Curr Pharm Des
.
2017
;
23
(
27
):
4057
65
.
31.
Lynge Pedersen
AM
,
Belstrøm
D
.
The role of natural salivary defences in maintaining a healthy oral microbiota
.
J Dent
.
2019
;
80
(
Suppl 1
):
S3
12
.
32.
Houtepen
LC
,
Heron
J
,
Suderman
MJ
,
Fraser
A
,
Chittleborough
CR
,
Howe
LD
.
Associations of adverse childhood experiences with educational attainment and adolescent health and the role of family and socioeconomic factors: a prospective cohort study in the UK
.
PLoS Med
.
2020
;
17
(
3
):
e1003031
.
33.
Mitchell
R
,
Popham
F
.
Effect of exposure to natural environment on health inequalities: an observational population study
.
Lancet
.
2008
;
372
(
9650
):
1655
60
.
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