Myran Lena, Sun Yi-Qian, Dahllöf Göran, Willumsen Tiril, Rønneberg Anne, Havnen Audun, Kvist Therese, Sen Abhijit, Høvik Hedda
Center for Oral Health Services and Research, Mid-Norway (TkMidt), Trondheim, Norway.
Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
BMC Oral Health. 2025 Jul 10;25(1):1141. doi: 10.1186/s12903-025-06486-1.
Adverse childhood experiences (ACEs) may contribute to dental fear, which can negatively affect long-term oral health. We aimed to examine associations between specific and cumulative ACEs and dental fear in adolescents, investigate possible sex differences, and explore the potential mediating role of dental fear in the relationship between ACEs and caries experience.
This cross-sectional study included 5882 Norwegian adolescents aged 13-17 years from the Young-HUNT4 Survey in Norway. Self-reported ACEs (i.e., physical and sexual abuse, witnessing violence, parental divorce, parental alcohol problems, and bully victimisation) and dental fear were combined with clinical measures of caries experience. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between ACEs and dental fear. Effect modification by sex was assessed using the likelihood ratio test. A counterfactual-based mediation analysis was conducted to estimate a potential mediating effect of dental fear on the relationship between ACEs and caries experience, with results presented as ratios of means (RMs) with bias-corrected 95% CIs.
All specific ACEs were associated with higher odds of reporting dental fear, compared to those not reporting the given ACE. Adolescents reporting any ACE had a 74% higher likelihood of reporting dental fear compared to those without ACEs (OR 1.74, 95% CI 1.29-2.33). A dose-response relationship was observed, with a one-unit increase in ACE exposure associated with higher odds of reporting dental fear (OR 1.25, 95% CI 1.15-1.36). There was evidence of effect modification by sex, with the associations between any ACE and dental fear being more pronounced in females. Further, dental fear accounted for 5.9% of the total effect in the association between any ACE and caries experience.
Specific and cumulative ACEs were associated with dental fear among adolescents, with a stronger association in females. Our findings indicate a partial mediating role of dental fear in the association between ACEs and caries experience. This study highlights the value of incorporating ACEs and dental fear into patient assessment.
童年不良经历（ACEs）可能导致牙科恐惧，这会对长期口腔健康产生负面影响。我们旨在研究特定和累积的ACEs与青少年牙科恐惧之间的关联，调查可能存在的性别差异，并探讨牙科恐惧在ACEs与龋齿经历关系中的潜在中介作用。
这项横断面研究纳入了来自挪威青年HUNT4调查的5882名13 - 17岁的挪威青少年。自我报告的ACEs（即身体和性虐待、目睹暴力、父母离异、父母酗酒问题以及受欺凌）和牙科恐惧与龋齿经历的临床测量结果相结合。采用逻辑回归来估计ACEs与牙科恐惧之间关联的比值比（ORs）和95%置信区间（CIs）。使用似然比检验评估性别对效应的修正作用。进行了基于反事实的中介分析，以估计牙科恐惧对ACEs与龋齿经历关系的潜在中介效应，结果以均值比（RMs）及偏差校正的95% CIs表示。
与未报告特定ACEs的青少年相比，所有特定的ACEs都与报告牙科恐惧的较高几率相关。报告任何ACEs的青少年报告牙科恐惧的可能性比未经历ACEs的青少年高74%（OR 1.74，95% CI 1.29 - 2.33）。观察到剂量反应关系，ACE暴露每增加一个单位，报告牙科恐惧的几率就更高（OR 1.25，95% CI 1.15 - 1.36）。有证据表明存在性别对效应的修正作用，任何ACEs与牙科恐惧之间的关联在女性中更为明显。此外，牙科恐惧在任何ACEs与龋齿经历的关联中占总效应的5.9%。
特定和累积的ACEs与青少年的牙科恐惧相关，在女性中关联更强。我们的研究结果表明牙科恐惧在ACEs与龋齿经历的关联中起部分中介作用。本研究强调了将ACEs和牙科恐惧纳入患者评估的价值。
