The Prevalence of Adverse Childhood Experiences (ACEs) in a Canadian Orthodontic Population

Background: Adverse Childhood Experiences (ACEs) are experiences that can be harmful or threatening, or the absence of necessities for human development, such as neglect, physical or sexual abuse, or the death of a parent. American census data found that the prevalence of one or more ACEs is 62% and four or more ACEs is 16%. There is a significant gap in our knowledge of ACEs within a Canadian context. Moreover, the prevalence of ACEs amongst orthodontic patients is yet to be explored.

Purpose: The objective of this study was to investigate the prevalence of ACEs in a Canadian context amongst orthodontic patients. We hypothesized that there may be a high prevalence of ACEs in an academic orthodontic population.

Methods: This was an exploratory cross-sectional observational study using a convenience sample from an orthodontic clinic. A validated ACE questionnaire was adapted for use at an urban Canadian academic orthodontic clinic. Inclusion criteria were patients attending the clinic for regular orthodontic treatment who provided informed consent to participate. Exclusion criteria were those below the age of 16. Participants were recruited via consecutive convenience sampling during their regular clinic visit and were provided minor monetary compensation for their time spent answering the survey electronically, using a tablet provided by the research team. Statistical analysis was conducted using R and SPSS. Chi-square tests for independence were conducted.

Results: A total of 334 participants (179 females and 153 males) were recruited. The mean age was 21.3 years old (SD=7.9). Over half (54.8%, n=183) identified with an ethnic minority group and 45.2% (n=151) identified as White. Most participants (68.0%, n=227) experienced one or more ACEs, while 29.4% (n=98) experienced 4 or more ACEs. Amongst adolescents aged 16 to 17 years old, the prevalence of one or more ACEs was 62.7% (n=99). The prevalence of one or more ACEs amongst adults aged 18 years and above was 72.7% (n=128). The most common ACEs reported were witnessing domestic violence (42.2%, n=141), experiencing domestic verbal (36.5%, n=122) or physical (32.6%, n=109) abuse, and living with a caretaker with mental illness (33.8%, n=113). Some individuals (13.8%, n=46) in this sample experienced sexual abuse. Chi-square tests for independence revealed a higher proportion of females experienced emotional neglect (χ²=10.793, p=0.001), sexual abuse (χ²=15.799, p<0.001), parental mental illness (χ²=10.450, p=0.001), parental substance misuse (χ²=5.697, p=0.017), and parental divorce (χ²=10.586, p=0.005) compared to males. There was no significant difference between males and females for the prevalence of parental incarceration (χ²=1.673, p=0.196), witnessing intimate partner violence (χ²=5.885, p=0.053), experiencing physical abuse (χ²=4.766, p=0.093), or experiencing physical neglect (χ²=4.727, p=0.094).

Conclusion: ACEs affected most participants (68%) in this sample, highlighting the relevance of trauma-informed care in a Canadian orthodontic clinic setting. The relevance of ACEs in orthodontic care has never been explored and the vast implications will be discussed.