Abstract
BackgroundAdverse childhood experiences (ACE) and bullying have negative effects on oral health. Promotive assets (resilience, self-esteem) and resources (perceived social support) can ameliorate their negative impact. The aim of this study was to determine the association between oral diseases (caries, caries complications and poor oral hygiene), ACE and bully victimization and the effect of access to promotive assets and resources on oral diseases.MethodsThis was a secondary analysis of data collected through a cross-sectional school survey of children 6–16-years-old in Ile-Ife, Nigeria from October to December 2019. The outcome variables were caries, measured with the dmft/DMFT index; caries complications measured with the pufa/PUFA index; and poor oral hygiene measured with the oral hygiene index-simplified. The explanatory variables were ACE, bully victimization, resilience, self-esteem, and social support. Confounders were age, sex, and socioeconomic status. Association between the explanatory and outcome variables was determined with logistic regression.ResultsOf the 1001 pupils with complete data, 81 (8.1%) had poor oral hygiene, 59 (5.9%) had caries and 6 (10.2%) of those with caries had complications. Also, 679 (67.8%) pupils had one or more ACE and 619 (62.1%) pupils had been bullied one or more times. The median (interquartile range [IQR]) for ACE was 1(3), for bully victimization was 1(5), and for self-esteem and social support scores were 22(5) and 64(34) respectively. The mean (standard deviation) score for resilience was 31(9). The two factors that were significantly associated with the presence of caries were self-esteem (AOR: 0.91; 95% CI: 0.85–0.98; p = 0.02) and social support (AOR: 0.98; 95% CI: 0.97–1,00; p = 0.02). No psychosocial factor was significantly associated with caries complications. Self-esteem was associated with poor oral hygiene (AOR: 1.09; 95% CI: 1.09–1.17; p = 0.03).ConclusionThere was a complex relationship between ACE, bully victimization, access to promotive assets and resources by children and adolescents, and oral health. ACE and bully victimization were not associated with oral health problems. Though self-esteem was associated with caries and poor oral hygiene, the relationships were inverse. Promotive assets and resources were not associated with caries complications though resources were associated with lower prevalence of caries.
Highlights
Adverse childhood experiences (ACE) and bullying have negative effects on oral health
There was a complex relationship between ACE, bully victimization, access to promotive assets and resources by children and adolescents, and oral health
ACE and bully victimization were not associated with oral health problems
Summary
Adverse childhood experiences (ACE) and bullying have negative effects on oral health. ACE occur before the age of 18 years [1], and include physical, sexual and emotional abuse and neglect, as well as bullying victimization and parental separation They directly increase the likelihood of a child having poor oral health, including dental caries [2,3,4], and are associated with adult health risks, such as cardiovascular diseases [5], diabetes mellitus [6] and smoking [7] which in turn, are associated with poor oral health in adulthood [8,9,10]. Vasiliou et al [14] developed a conceptual framework from the works of Shankardass [15] and Pearlin et al [16], to explain the possible link between psychological stress and poor oral health They suggested that ACE may translate into chronic stress in the absence of promotive assets (resilience, self-esteem) and resources (perceived social support). Chronic stress results in allostatic load, a cumulative physiological impact of chronic stress, that impacts negatively on oral health directly (by increasing inflammatory response which causes periodontal disease [17, 18]) or indirectly (by causing the adoption of unhealthy oral habits such as poor oral maintenance that can result in poor oral hygiene and caries)
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