The role of occurrence and co-occurrence of adverse childhood experiences on oral health-related quality of life among adolescents

Adverse childhood experiences (ACEs) are early negative events that can have lasting consequences on an individual’s overall health, including oral health. Since oral health problems are highly prevalent in the population and impact people’s daily lives, well-being and quality of life, it is important to identify the main determinants. This study aimed to investigate the role of ACEs on oral health-related quality of life (OHRQoL) among adolescents.

This cross-sectional analysis is nested within a cohort study initiated in 2010 with preschoolers from southern Brazil. The analysis focused on data from the most recent follow-up, involving adolescents aged 14 to 18 years. Data collection covered the period between March and December 2023. ACEs were assessed through the Family Environment Section of the Brazilian version of the Adverse Childhood Experiences—International Questionnaire (ACE-IQ), while OHRQoL was evaluated using the short version of Child Perceptions Questionnaire 11–14 (CPQ11-14). Sociodemographic variables were considered as potential confounders, and associations were analyzed using adjusted Poisson regression models. Results are present in Ratio of Means (RM) and 95% confidence interval (95%CI).

A total of 406 adolescents were included in the study. Adolescents exposed to specific ACEs—such as living with someone with substance use problems (RM 1.10; 95%CI 1.01–1.20), with mental illness or suicidal behavior (RM 1.18; 95%CI 1.09–1.27), or incarceration history (RM 1.11; 95%CI 1.01–1.21)—showed higher CPQ11-14 scores. Parental divorce (RM 1.08; 95%CI 1.01–1.16) and parental death (RM 1.37; 95%CI 1.21–1.54) were also associated with poorer OHRQoL. The co-occurrence of ACEs was related with gradual impacts on OHRQoL: adolescents with one, two, or three ACEs presented CPQ11-14 scores 32, 40 and 61% higher (RM:1.32, 1.40, and 1.61, respectively) compared to those without ACEs.

The findings demonstrate a consistent association between different ACEs and poorer OHRQoL. The accumulation of multiple ACEs was also associated with a gradual worsening of OHRQoL, emphasizing the consequence of co-occurring adversities.