Adverse Childhood Experiences and Untreated Dental Caries in Adulthood: Exploring Mediation by Educational Level, Depression Symptoms, and Oral Health-Related Behaviors

Abstract

Introduction: Adverse childhood experiences (ACEs) are relevant predictors for poor oral health in adulthood; however, the relationship with untreated dental caries remains unclear, as well as the underlying pathways. Therefore, the aim was to assess whether educational level, depressive symptoms, and oral health variables in adulthood mediate the association between exposure to adverse childhood experiences (ACEs) and the number of decayed teeth in adulthood. Methods: Using data from the 2015 Pelotas (Brazil) Birth Cohort Study, this observational study examined mothers' ACE scores (any occurrence and frequency-based) up to age 18 as exposures. The outcome was the maternal number of decayed teeth. Education, depressive symptoms, dental appointments in the past 12 months, and flossing were evaluated as potential mediators. Descriptive statistics and bivariate association tests were used, and mediation was tested using structural equation modeling (α=5%). Results: A total of 2,480 women were included. Considering exposure at least once, 13.4% reported no ACE and 24.9% reported 5+, regardless of frequency. When applying the frequency-based scoring, 7.1% scored 5+. The mean number of decayed teeth observed was 1.02 (SD=1.97). A bivariate association was found between the ACE’s frequency-based score and the number of decayed teeth. Structural equation modeling indicated that education was the critical mediator between frequency-based ACEs and decayed teeth, accounting for 90% of the association directly and an additional 8.3% due to its effects on teeth flossing. Conclusion: These findings highlight the mediating role of education in the association between frequency-based ACEs and untreated dental caries, underscoring its importance for interventions in the chain of risk.