Adverse Childhood Experiences and Oral Health Status of children living in Rural Areas of Alexandria, Egypt: A household Survey

INTRODUCTION Adverse Childhood Experiences (ACE) affect individuals’ well-being in their formative years and have inversely proportional relationship with the person’s health(1). When children are victims of ACEs, they become at risk of developing chronic diseases and commonly report higher incidence of caries in primary and permanent teeth(2). Scarce research assessed the link between Adverse childhood experiences (ACE) and oral health status of Egyptian children. This study aims to investigate the association between ACE and the oral health status of children living in rural areas in Alexandria, Egypt. METHODOLOGY This study was carried out from May 2019 to February 2020 after obtaining the approval of the Research Ethics Committee, Faculty of Dentistry, Alexandria University (IRB 00010556 – IORG 0008839). The minimal required sample size was calculated (3) to be 294≈ 300. Household survey was carried out in rural Northwestern Delta, Alexandria, Egypt using a multistage stratified random sampling. Children were included if they were residents of rural areas in Alexandria, aged between 6-18 years, free of mental or physical diseases and the parent/ caregiver was available and consented to participate. Data were collected using WHO oral health questionnaire, ACE questionnaire and clinical examination using DMF/dft, gingival and plaque index(4). Data collection was cut short due to the COVID-19 pandemic resulting in a sample of 229 participants and attempts to complete recruit were unsuccessful. The associations between the dependent variables (DMFT, dft, and GI) and the explanatory variables were assessed using linear regression analysis RESULTS AND DISCUSSION Most children were females (57.2%) and mean age was 9.81 (SD 3.06). Also, 157 (68.6%) children had caries experience in primary teeth, mean ± SD dft= 3.03± 3.14. The mean ± SD gingival and plaque scores were 1.14± 0.37 and 1.40± 0.57, respectively. Also, 10.5% of children brushed at least once daily, 95.2% had sugary snacks at least once a day and 46.3% reported visiting the dentist at least once last year. The mean ± SD ACE score was 4.15 ± 1.91. Figure 1 shows that the most frequent ACEs were financial hardships (90.8%), witnessing violence (83.8%) and unfair treatment (60.3%). Table 1 presents the factors associated with dft score. Model 1 shows that ACE was not significantly associated with dft score. Model 2 shows that sugar score, dental visits and plaque index score were not significantly associated with dft score. The adjusted “R2” of model 1 and model 2 were the same = 0.44. Variable Model 1