Association of Adverse Childhood Experiences with Oral Health Status of children living in Rural Areas of Alexandria, Egypt: A household Survey

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Abstract Background: Scarce research assessed the link between Adverse childhood experiences and oral health status of Egyptian children whose level of oral diseases and Adverse childhood experiences may be different from western countries and who have high level of caries. This study aims to investigate the association between ACE and the oral health status of children living in rural areas in Alexandria, Egypt.Methods: A cross-sectional household survey was carried in North Western Delta, including 300 children 6-18 years old. Children were examined for dental caries and gingival condition then questioned about their oral hygiene habits and sugar consumption. Mothers/caregivers answered the adverse childhood experiences questionnaire. Three linear regression models were used to assess the relationship between dependent variables (primary caries experience, permanent caries experience, gingival score) and exposure (ACE) after adjusting for potential confounders. Furthermore, another 3 models were used to evaluate oral health behaviors (sugar consumption, plaque consumption, dental visits) effect on dependent variables. Results: Most children were females (57.2%), mean age was 9.81, SD= 3.06. 68.6% children had caries experience in their primary teeth (mean ± SD dft= 3.03± 3.14) and 27.9% had caries experience in their permanent teeth (mean ± SD DMFT= 0.60 ± 1.16) with mean ± SD gingival index score 1.14± 0.37. The mean ± SD ACE score was 4.15 ± 1.91. When comparing adjusted R2 of ACE models and oral health behaviors models; dft model of both had an identical value of 0.44. However, adjusted R2 of ACE models (DMFT =0.20, and gingival score =0.03) were different than those in oral health behaviors models (DMFT =0.22, gingival score =0.45).Conclusions: ACEs explained the same amount of variation in primary caries experience as sugar consumption, plaque accumulation and dental visits. Yet, it doesn’t have the same effect on permanent caries experience or the gingival condition. Therefore, ACEs might have the same effect on primary dental caries as oral health behaviors. Further research is needed to evaluate if a dose-response relationship is present between ACEs, oral health and oral health behaviors as suggested by previous research.

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