Examining Adverse Childhood Experiences as a Risk Factor for Preventive Dental Care and Tooth Decay: National Survey of Children's Health 2022–2023

OBJECTIVE: To assess the association between cumulative adverse childhood experiences (ACEs) and oral health outcomes among US children and adolescents in the post-COVID-19 period, specifically examining preventive dental care receipt and caregiver-reported tooth decay. METHODS: We analyzed nationally representative data from the 2022-2023 National Survey of Children's Health (NSCH), using a cross-sectional study design. The analytic sample included 44,489 children aged 6-17 years with complete geographic data. Multivariable logistic regression models estimated associations between cumulative ACE exposure and two outcomes: receipt of a preventive dental visit in the past year and parent-reported tooth decay. Models adjusted for sociodemographic, household, and health-related factors, including language, income, insurance type, special healthcare needs, and rural residence. RESULTS: Children exposed to four or more ACEs had significantly higher odds of experiencing tooth decay (aOR 1.60; 95% CI 1.33-1.94) compared with those with less than four ACEs. After adjustment, cumulative ACE exposure was not associated with reduced receipt of preventive dental care. Other predictors of tooth decay included low household income, public insurance, special healthcare needs, speaking a non-English language at home, and rural residence. Children with high ACE exposure continued to exhibit disproportionate oral health burdens. CONCLUSIONS: These findings suggest that childhood adversity is associated with poorer oral health status, while preventive dental care utilization may be influenced by broader socioeconomic and contextual factors. Given the cross-sectional design and reliance on caregiver-reported measures, longitudinal studies are needed to clarify temporal relationships and better understand the pathways linking childhood adversity and oral health outcomes.