Associations of adverse childhood experiences with dental fear, and the mediating role of dental fear on caries experience: the Young-HUNT4 Survey

Background: 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. Methods: 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. Results: 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. Conclusions: 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.