Adverse Childhood Experiences (ACEs) and oral health

The study participants may not be representative of the real-world population

Adverse childhood experiences (ACEs) are defined as stressful or potentially traumatic events that occur before age 18 years and have a negative lasting effect on health and well-being. ACEs include physical, emotional, and sexual abuse and household dysfunction, such as parental mental illness, intimate partner violence (IPV), parental drug abuse, and parental separation (Loveday S et al. 2022) .  ACEs increases the risk of developing chronic disease and adoption of  behaviours such as smoking, alcohol consumption, and substance use. A number of studies have shown links between ACES and oral health.

This study aimed to review studies that examined the relationship between adverse childhood experiences (ACEs) exposure and oral health among adults.


A protocol was registered in PROSPERO. Searches were conducted in the Medline, Cochrane, Web of Science, CINAHL, ProQuest, ScienceDirect, and Google Scholar databases. Observational studies of oral health in adults ≥18 years with previous exposures to any ACEs were considered.  Two reviewers independently selected studies extracted data and assessed risk of bias. The Newcastle–Ottawa Scale (NOS)  adapted for cross-sectional observational studies, was used to assess the risk of bias. Outcomes included last dental visit, number of extracted teeth, last dental cleaning, number of permanent teeth removed, tooth loss (having more than eight teeth lost due to dental caries or damage), missing, or filled teeth (having more than 12 missing or filled teeth), and current number of remaining teeth. A narrative summary was undertaken.


  • 4 cross-sectional studies were included.
  • 2 studies were conducted in the USA, one in Japan and one in the UK.
  • All 4 studies were considered to be satisfactory for risk of bias.
  • All 4 studies found a greater number of missing teeth in those experiencing ACEs.
  • Two studies found and increased time between dental visits in those with a history of ACEs.
  • Time between dental cleanings was great in patients with a history of ACEs
  • A dose response was seen with increases in ACE scores showing an increase in poor oral health.


The authors concluded: –

There is an association between ACE and poor oral health. Moreover, the association was proven to have a dose-response relationship. Given that the studies in the literature were cross-sectional, causality cannot be determined with certainty, therefore interpretation of the results should be cautious. Longitudinal follow-up studies are needed to understand how ACEs contribute to oral diseases later in life.


The reviewers registered a protocol in PROSPERO and searched a wide range of databases. Only four studies could be included and all 4 of the included studies were cross-sectional in nature so as noted by the authors’ longitudinal studies would be needed to help establish causality.  The studies were conducted in 3 countries so the findings may not be generalisable. Dental professional need to be aware that people have may have suffered ACEs and of the impact on oral health of ACEs. They can support individuals to modify risk oral health behaviours prevent advancing disease and help them develop resilience by providing a safe and supportive environment.


Primary Paper

Bahanan L, Ayoub S. The association between adverse childhood experiences and oral health: A systematic review. J Public Health Dent. 2023 Mar 14. doi: 10.1111/jphd.12564. Epub ahead of print. PMID: 36916213.

Review protocol on PROSPERO

Other references

Loveday S, Hall T, Constable L, Paton K, Sanci L, Goldfeld S, Hiscock H. Screening for Adverse Childhood Experiences in Children: A Systematic Review. Pediatrics. 2022 Feb 1;149(2):e2021051884. doi: 10.1542/peds.2021-051884. PMID: 35104358; PMCID: PMC9677935.



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