Prevalence of early childhood caries in a population of children with history of maltreatment

Child maltreatment and early childhood caries (ECC) have some common features including high prevalence rates, shared risk factors, and long-term consequences. The aim of this retrospective study was to determine the prevalence of ECC’s in an identified population of abused and neglected children in Toronto, Ontario. The sample consisted of 66 preschool-aged children admitted to the care of the Children's Aid Society of Toronto (CAST) who were referred for a dental evaluation from 1991 to 2004. Data on 3,185 schoolchildren collected by the Ministry of Health and Long-term Care from the general population of Toronto was used as the comparison group. Dental and social workers' records were examined.

Results showed that approximately 58% of the abused/neglected sample had ECC’s compared to only 30% among the comparison group. The proportion of children with untreated caries was 57% among "neglected" children (n = 53) and 62% in physical/sexual abuse cases (n = 13). Logistic regressions, controlling for age, sex, and type of abuse, revealed that children with Crown ward status and those in CAST care more than once were significantly less likely to have experienced caries.

These findings indicate that there are higher levels of tooth decay among abused/neglected children in the CAST than in the general population of 5-year-olds in Toronto. However, the study also revealed that CAST services had a protective effect on children's oral health, as evidenced by the lower likelihood of caries among Crown wards and those admitted to CAST more than once. The implication of the study results are that child protection services should investigate possible dental neglect in physical/sexual abuse and neglect cases and that there is a need for dental treatment and oral health promotion among this population. Limitations of the study include its retrospective nature, poor statistical power due to the small sample of CAST children, and incomplete measurement of relevant sociodemographic factors (namely socioeconomic status).