How physical and sexual abuse impacts oral health: a cross-sectional study from a Norwegian Children’s House

BACKGROUND: Although the association between neglect and an increased risk of oral disease is well established, the independent association between physical or sexual abuse and oral health has been less extensively studied. AIM: This study explored oral health condition in children suspected of being exposed to physical or sexual abuse by examining the association between abuse type and caries experience and gingival condition. It also assessed whether these associations were modified by age, sex, and ethnicity. METHODS: This cross-sectional study involved 328 children, aged 1-18 years, who underwent clinical forensic dental examinations at a Norwegian Children's House (NCH) from 2017 to 2021 (n = 328) due to suspected physical or sexual abuse. Data were collected from forensic dental and medical records at the NCH and included data from extra- and intra-oral examinations accompanied by conversations with the children. Negative binomial and logistic regression were performed for unadjusted, adjusted, and stratified analyses. Data are presented as ratios of means (RMs) and odds ratios (ORs), with 95% confidence intervals (CIs). RESULTS: Sexually abused children had a higher mean number of decayed teeth (DT) (RM 1.99, 95%CI 0.99-4.02) compared with physically abused children. They also more frequently received toothbrushing assistance. When stratifying by sex and ethnicity, the results revealed that sexually abused males had a higher mean number of DT compared with physically abused males (RM 4.23, 95%CI 1.37-13.12). A similar association was observed in sexually abused Ethnic Norwegian children (RM 3.53, 95%CI 1.60-7.82). Gingival condition varied by age. Sexually abused children exhibited better gingival condition before the age of four compared with their physically abused peers, but these conditions deteriorated after the age of thirteen, where the results showed an opposite association. CONCLUSIONS: The findings indicated that oral health condition varied according to abuse type, with poorer oral health conditions among sexually abused children than those physically abused. These results, underscore the crucial role of forensic and dental professionals in identifying oral health conditions that may signal possible abuse.