Safe, supportive neighborhoods: Are they associated with childhood oral health?

OBJECTIVE: There has been limited examination of how community-level supports may influence oral health metrics among children. The purpose of our study is to examine the association between two types of community-level positive childhood experiences and oral healthcare and oral health outcomes among children ages 6 to 17 years of age. METHODS: This study uses a cross-sectional data set from the 2018-2019 National Survey of Children's Health. Two oral health metrics were used: preventive dental care, measured as one or more preventive dental visits in the past 12 months, and tooth decay, measured as tooth decay or cavities in the last 12 months. To quantify living in safe, stable, equitable environments, questions on residing in a safe and supportive neighborhood were used. Descriptive statistics and bivariate analyses were used to calculate frequencies, proportions, and unadjusted associations for each variable (n = 40,290). Multivariable logistic regression models were used. RESULTS: In an adjusted analysis, children who lived in a supportive neighborhood had a higher likelihood of receiving a preventive dental visit than children who did not live in a supportive neighborhood (aOR 1.41; 95% CI 1.21-1.65). Children who lived in a safe neighborhood were less likely to have tooth decay than children who did not live in a safe neighborhood (aOR 0.75; 95% CI 0.65-0.86). CONCLUSIONS: The findings from this study highlight the role of social structures in tightening the safety net for oral healthcare in children.

Exploring associations between adverse childhood experiences and oral health among children and adolescents.

OBJECTIVES: The aim of this article is to examine the association between preventive dental care and adverse childhood experiences (ACEs), and the association between tooth decay and ACEs, controlling for preventive dental care. METHODS: A cross-sectional study was conducted with a sample of 33,395 respondents from the 2016 National Survey of Children's Health, a nationally representative sample of US children. Sociodemographic information, ACE questions, and oral health and health-care utilization information were used. Descriptive statistics, bivariate analyses, and multivariable regression models were performed. RESULTS: Children with four or more ACEs were less likely to have a preventive dental visit than children with less than four ACEs (79.7 percent versus 88.7 percent, P < 0.0001). Children with four or more ACEs were more likely to have tooth decay (26.7 percent versus 12.5 percent, P < 0.0001) than their counterparts. Children exposed to four or more ACEs had lower odds of receiving preventive dental visits than children exposed to less than four ACEs (aOR 0.67; 95 percent CI 0.50-0.89). Children with four or more ACEs had higher odds of decayed teeth than children exposed to fewer than four ACEs (aOR 2.08; 95 percent CI 1.61-2.70), even after controlling for preventive dental care. CONCLUSIONS: Pediatricians, dental hygienists, and dentists need to be aware of how childhood trauma may hinder both caregivers and children from engaging in preventive oral health care or dental treatment. The information provided in our study can inform policies and programs that support children's oral health, through the identification and mitigation of childhood trauma.

The experience of adverse childhood experiences and dental care in childhood.

OBJECTIVES: Routine preventive dental care is important to overall child health and well-being. However, the experience of adversity in childhood may prevent children from getting adequate preventive care. This study seeks to explore how the prevalence of adverse childhood experiences (ACEs) and the role of a protective adult may be associated with dental care utilization in childhood. METHODS: Data from the 2016 South Carolina Behavioral Risk Factor Surveillance System (SC BRFSS), which interviews adults eighteen year of age and older, were used in this study. Dental care utilization in childhood was measured as the adult retrospectively reported frequency of dental care in childhood: at least once every 2 years (adequate dental care) or less often than every 2 years (inadequate dental care). ACEs were determined by asking about each of respondent's childhood exposure to eleven childhood experiences, including divorce, parental incarceration, domestic violence, drug and alcohol abuse, mental illness and emotional, physical or sexual abuse. The presence of a protective adult in childhood included respondents who had an adult who made them feel safe and protected during childhood. Descriptive and bivariate statistics explored differences in the adequacy of child dental care by ACE exposure, the presence of a protective adult and selected demographic characteristics. Multivariate regression models were used to examine the impact of counts and types of ACEs and the presence of a protective adult with inadequate childhood dental care. RESULTS: The unweighted study sample included 7079 respondents ageing from 18 to 79 years of age Sampling weights were used for all analyses. Among all respondents, 71.7% reported receiving adequate dental care during childhood; 28.3% responded that they received inadequate dental care. Adjusting for sociodemographic characteristics, respondents who experienced four or more ACEs had a higher likelihood of inadequate dental care than respondents who reported no ACEs (aOR 2.79; 95% CI 2.77-2.82). The odds of reporting inadequate dental care were lower among those grew up with an adult who made them feel safe and protected (aOR 0.38; 95% CI 0.37-0.39). CONCLUSIONS: The presence of protective factors may mitigate the effects of ACEs on paediatric dental care. This research contributes to the literature through the further identification of the role of dentists in identifying signs of abuse and neglect.