Adverse childhood experiences and periodontal diseases and tooth loss in adults: A systematic review and meta-analysis

OBJECTIVES: To evaluate if there is an association between periodontal diseases (gingivitis and periodontitis) and adverse childhood experiences (ACEs) and further to evaluate the association between ACEs and tooth loss as the number of missing teeth has been recognised as a surrogate measure of periodontitis DATA SOURCES: Following comprehensive electronic (Pubmed, Web of Science, Scopus and PsycInfo) and manual literature searches until August 2024, the studies that measured ACEs and reported periodontal disease or tooth loss were included. Two independent reviewers assessed the risk of bias of the included studies using the Effective Public Health Practice Project Quality Assessment tool (EPHPP). A meta-analysis was performed using SPSS version 28 with a random effects model to pool odds ratios and leave-one-out sensitivity analysis. Further meta regression was conducted to examine if gender moderated these associations. STUDY SELECTION: Two reviewers screened 956 titles and abstracts, included 9 studies (108,609 participants) in the systematic review and 8 studies in the meta-analysis. The overall effect size for the association between ACEs and periodontal disease outcomes was 2.41 (95% CI: 1.42-3.39, p<0.001), and for tooth loss was 2.01 (95% CI:1.25-2.76, p<0.001) such that individuals exposed to childhood trauma were twice as likely to have periodontal disease or tooth loss compared to individuals not exposed to childhood trauma. CONCLUSION: This meta-analysis found a low-quality evidence for associations between ACEs and indicators of periodontal diseases. However, future studies should use longitudinal study designs and investigate the underlying mechanisms to clarify causal relationships and identify intervention opportunities. CLINICAL SIGNIFICANCE: Individuals exposed to Adverse Childhood Experiences (ACEs) are likely to have periodontal disease or tooth loss compared to individuals not exposed to ACEs. Further it is important to collaborate with mental health professionals for effective comprehensive patient management.