The Relationship Between Adverse Childhood Experiences (ACEs) and Malocclusion

Introduction: Adverse Childhood Experiences (ACEs) are stressful events such as abuse or neglect that may occur before age 18. The prevalence of ACEs amongst orthodontic patients and its correlation with malocclusion severity is yet to be explored. Objective: To examine the prevalence of ACEs in an orthodontic population and its link to orthodontic treatment need. Methods: A validated ACE survey was adapted for use in an orthodontic clinic. Orthodontic treatment need was assessed via pre-treatment records and the Index of Orthodontic Treatment Need (IOTN). Results: Of 334 participants, 68.0% (n=227) reported one or more ACEs and 29.4% (n=98) reported four or more ACEs. Ordinal regression revealed ACE score and IOTN grade are correlated (p=0.0488). Each 1-point increase in ACE score raised the odds of having a higher IOTN grade by 8.2% (OR=1.082, 95% CI [1.001, 1.172]). Conclusions: Most orthodontic patients (68%) in this sample have experienced one or more ACEs, highlighting the relevance of trauma-informed care in a Canadian orthodontic clinic setting. ACEs are associated with increased odds of orthodontic treatment need, helping to identify potential at-risk communities for intervention.