Trauma that children’s experienced in early life causes them to be at greater risk for tooth loss in later life

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Even if children grow up to overcome childhood adversity, the trauma they experience in early life causes them to be at greater risk for tooth loss, according to University of Michigan researchers.

Haena Lee, a postdoctoral researcher at the U-M Institute for Social Research, assessed the impact of adverse childhood events on oral health – specifically, total tooth loss – later in life. These events included childhood trauma, abuse and, to a lesser extent, smoking.

“The significant effects of these adverse experiences during childhood on oral health are persistent over and above diabetes and lung disease, which are known to be correlates of poor oral health,” Lee said.

Current research focuses on health conditions such as diabetes and lung disease that can be risk factors for oral health, she says.

Medication for diabetes causes dry mouth, which can lead to poor oral health.

Heavy smoking, associated with lung disease, can also cause tooth loss.

“But it’s not just these medical conditions that explain your oral function,” said Lee, also a research fellow affiliate of the Population Studies Center and a research fellow in the Survey Research Center.

Nearly 20 percent of Americans over age 50 are estimated to live with no teeth, and I want to draw attention to life course histories that can capture some other important pathways to this oral health disparity.”

Lee drew data from the 2012 Health and Retirement Study, a nationally representative longitudinal study of older adults and their spouses in the United States.

The study includes a core survey collected every two years and a supplemental survey every off year.

In 2015, the supplemental survey asked detailed information about childhood family history.

Lee derived the participants’ oral health information from the 2012 HRS core survey and their childhood experiences, adult educational attainment and poverty status from previous HRS surveys and the 2015 supplemental survey.

Using this data, she investigated three models of life course research: the sensitive period, defined as the time in a person’s life during which events have the most impact on his or her development; the accumulation model, which examines the effect of the accumulation of events over the life course; and the social mobility model, which examines the change in a person’s socioeconomic status during that person’s life.

She discovered that more than 13 percent of adults over 50 had lost all of their permanent teeth.

Nearly 30 percent of respondents experienced financial hardship, or had lost their parents or experienced a parental divorce by age 16.

Ten percent of the respondents had experienced physical abuse and 18 percent smoked during childhood.

Nearly half held a high school diploma or less and 20 percent of respondents had lived in poverty at least once since age 51.

After controlling for adult socioeconomic status, diabetes and lung disease, Lee found the long-term impact of childhood trauma and abuse on total tooth loss.

She also found that older adults are at higher risk of total tooth loss if they have consistently experienced adverse events throughout life.

Lee says she suspects adverse events could impact tooth loss through sociobehavioral pathways.

For example, abused children may be more likely to engage in health behaviors such as binge drinking or excessive consumption of sugar or nicotine use, which can contribute to tooth loss.

Stress can also impact inhibitory control of the brain, which may lead to nicotine dependence.

Childhood trauma may have a negative effect on learning and achievement, and people with low educational attainment may be less likely to hold jobs that provide dental insurance.

“It’s really sad to say that adversity breeds adversity, but it really seems that dental health is rooted in adverse experiences you encounter over the life course, particularly in childhood,” Lee said.

“Future policy may benefit from considering the role of childhood adversity and beyond to reduce further oral health disparity.”


Although adults often say things like, “He was so young when that happened. He won’t even remember it as an adult,” childhood trauma can have a lifelong effect.

And while kids are resilient, they’re not made of stone.

That’s not to say your child will be emotionally scarred for life if he endures a horrific experience. With appropriate interventions, adults can help kids recover from traumatic experiences more effectively.

But it’s important to recognize when your child may need professional help with dealing with a trauma. Early intervention could prevent your child from experiencing ongoing effects of the trauma as an adult.

What It Is

There are many different experiences that can constitute trauma. 

Physical or sexual abuse, for example, can be clearly traumatic for children.

One-time events, like a car accident or a particularly severe natural disaster (like a hurricane, for example), can take a psychological toll on children as well.

Ongoing stress, such as living in a dangerous neighborhood or being the victim of bullying, can be traumatic, even if it just feels like daily life to an adult.

In fact, nearly any event can be considered traumatic to a child if:

  • It happened unexpectedly
  • It happened repeatedly
  • Someone was intentionally cruel
  • The child was unprepared for it

Childhood trauma also doesn’t have to occur directly to the child; for instance, watching a loved one suffer can be extremely traumatic as well.

Exposure to violent media can also traumatize children.

Just because an experience is upsetting, however, doesn’t make it traumatic. Parental divorce, for example, will likely affect a child but it isn’t necessarily traumatizing.

It’s also important to remember that just because a child endured a tragedy or a near-death experience, doesn’t mean he’ll automatically be traumatized. Some kids are much less affected by their circumstances than others.

When It Leads to PTSD

Many children are exposed to traumatic events at one point or another. While most of them experience distress following a traumatic event, the vast majority of them return to a normal state of functioning in a relatively short period of time.

But some children – between 3 and 15 percent of girls and 1 to 6 percent of boys—develop post-traumatic stress disorder (PTSD).

Children with PTSD may re-experience the trauma in their minds over and over again. They may also avoid anything that reminds them of the trauma or they may re-enact their trauma in their play.

Sometimes children believe they missed warning signs predicting the traumatic event. In an effort to prevent future traumas, they become hyper-vigilant in looking for warning signs that something bad is going to happen again.

Children with PTSD may also have problems with:

  • Fear
  • Depression
  • Anxiety
  • Anger and aggression
  • Self-destructive behavior
  • Feelings of isolation
  • Poor self-esteem
  • Difficulty trusting others

Even children who don’t develop PTSD may still exhibit emotional and behavioral issues following a traumatic experience. Here are some things to watch out for during the weeks and months after an upsetting event:

  • Increased thoughts about death or safety
  • Problems sleeping
  • Changes in appetite
  • Anger issues
  • Attention problems
  • School refusal
  • Somatic complaints like headaches and stomachaches
  • Loss of interest in normal activities
  • Irritability
  • Sadness
  • Development of new fears

Effect on Long-Term Health

Traumatic events can affect how a child’s brain develops. And that can have lifelong consequences.

Studies show that the more adverse childhood experiences a person has, the higher their risk of health and wellness problems later in life. Childhood trauma may increase an individual’s risk of:

  • Asthma
  • Depression
  • Coronary heart disease
  • Stroke
  • Diabetes

Additionally, a study published in 2016 in Psychiatric Times noted that the prevalence of suicide attempts was significantly higher in adults who experienced trauma, such as physical abuse, sexual abuse, and parental domestic violence, as a child.

Effect on Relationships

A child’s relationship with his caregiver – whether his parents, grandparents or otherwise – is vital to his emotional and physical health.

This relationship and attachment helps the little one learn to trust others, manage emotions and interact with the world around them.

When a child experiences a trauma that teaches him that he cannot trust or rely on that caregiver, however, he’s likely to believe that the world around him is a scary place and all adults are dangerous – and that makes it incredibly difficult to form relationships throughout their childhood, including with peers their own age, and into the adult years.

Children who struggle to maintain healthy attachments to caregivers are likely to struggle with romantic relationships during adulthood.

An Australian study of more than 21,000 child abuse survivors age 60 and older reported a higher rate of failed marriages and relationships.

How to Help

Family support can be key to reducing the impact trauma has on a child. Here are some ways to support a child after an upsetting event:

  • Encourage your child to talk about his feelings and validate his emotions.
  • Answer questions honestly.
  • Reassure your child that you’ll do everything you can to keep him safe.
  • Stick to your daily routine as much as possible.

If your child has been exposed to traumatic circumstances and you’ve noticed changes in her mood or behavior, talk to her pediatrician.

A physician can evaluate your child’s health and, if necessary, make a referral for mental health treatment.

Depending on your child’s age and needs, she may be referred for services such as cognitive behavioral therapy, play therapy, or family therapy. Medication may also be an option to treat your child’s symptoms.

More information: Haena Lee. A life course approach to total tooth loss: Testing the sensitive period, accumulation, and social mobility models in the Health and Retirement Study, Community Dentistry and Oral Epidemiology (2019). DOI: 10.1111/cdoe.12463

Provided by University of Michigan

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