Dental health effects adverse childhood experiences on U.S. adults: BRFSS 2010-2012
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OBJECTIVE: To examine association between Adverse Childhood Experiences (ACE) and teeth extracted due to dental caries or periodontitis among young and middle-aged US adults. METHODS: Study sample included 15,474 and 17,430 respondents aged 18-64 completing 2010 and 2012 Behavioral Risk Factor Surveillance System (BRFSS) survey respectively. Outcome was any self-reported tooth extraction due to caries or periodontitis. Primary predictor were self-reported 11 ACE answers (categorized into none, 1, 2, and 3+) before 18 years of age. Covariates included smoking, heavy alcohol consumption, diabetes, health coverage and access to dental care. Odds ratios were computed from unadjusted and adjusted logistic regression models. RESULTS: Overall ACE prevalence was 66.5% and 64.9% in BRFSS 2010 and 2012 study sample respectively. In unadjusted models we observed a graded association wherein adults reporting experienced 2 and 3+ ACE were more likely to experience tooth extractions compared to those reporting no ACE exposure. (BRFSS 2010 OR = 1.47,1.48; BRFSS 2012 OR = 1.33, 1.54 respectively; p<0.05). We found similar results in multivariate models after adjusting for covariates (BRFSS 2010 OR = 1.56,1.34; BRFSS 2012 OR = 1.36, 1.42 respectively; p<0.05). CONCLUSIONS: This study suggests potential long lasting impact of early adverse life events on oral health in young and middle adulthood. Young and middle-aged adults experiencing multiple ACE had significantly more extractions compared to adults who reported not experiencing any ACE. Multidisciplinary efforts between dentists, physicians and social therapists are needed to raise awareness about ACE as means of identifying and reducing dental health inequities.