Comparative Study of Dental Pain Between Children With and Without a History of Maltreatment

Aims: To assess the presence of dental pain in child abuse victims and to compare the findings to children in the same age group with no history of abuse in a Southern Brazilian city. Methods: This cross-sectional comparative study was carried out in a convenience sample of 68 child abuse victims from a center for psychologic support and in a comparative group of 204 students from public and private schools, all aged between 8 and 12 years. Data for socioeconomic and demographic variables were collected, and information regarding dental pain in the last 6 months was obtained via interviews with the children. World Health Organization criteria were used to assess the presence of decayed, missing, or filled teeth in primary and permanent dentition. Dental trauma was measured using the O’Brien Index, and gingival bleeding was assessed. Crude and adjusted logistic regression analyses were performed to assess the association between dental pain and history of abuse. Results: Reporting of dental pain was higher among child abuse victims (54.41%) than in the comparative group (36.14%) (P < .01). After adjustment for clinical variables in the logistic regression analyses, the child abuse victims group had an odds ratio of 2.03 (95% confidence interval 1.13 to 3.64) for dental pain (P = .01). Conclusion: Child abuse victims presented a higher prevalence of dental pain than children with no history of maltreatment, regardless of oral health status.

child;child abuse;oral health;pain;toothache

1. World Health Organization. Preventing child maltreatment: A guide to taking action and generating evidence. Geneva: World Health Organization, 2007.

2. Bentley T, Widom CS. A 30-year follow-up of the effects of child abuse and neglect on obesity in adulthood. Obesity (Silver Spring) 2009;17:1900–1905.

3. Thomas C, Hyppönen E, Power C. Obesity and type 2 diabetes risk in midadult life: The role of childhood adversity. Pediatrics 2008;121:e1240–e1249.

4. Widom CS, DuMont K, Czaja SJ. A prospective investigation of major depressive disorder and comorbidity in abused and ne- glected children grown up. Arch Gen Psychiatry 2007;64:49–56.

5. Jun HJ, Rich-Edwards JW, Boynton-Jarrett R, Austin SB, Frazier AL, Wright RJ. Child abuse and smoking among young women: The importance of severity, accumulation, and timing. J Adolesc Health 2008;43:55–63.

6. Widom CS, Marmorstein NR, White HR. Childhood victimization and illicit drug use in middle adulthood. Psychol Addict Behav 2006;20:394–403.

7. Speetjens P, Thielen F, Ten Have M, de Graaf R, Smit F. Child maltreatment: Long-term economic consequences and implica- tions [in Dutch]. Tijdschr Psychiatr 2016;58:706–711.

8. Thielen FW, Ten Have M, de Graaf R, et al. Long-term economic consequences of child maltreatment: A population-based study. Eur Child Adolesc Psychiatry 2016;25:1297–1305.

9. Duda JG, Biss SP, Bertoli FM, et al. Oral health status in victims of child abuse: A case-control study. Int J Paediatr Dent 2017; 27:210–216.

10. Valencia-Rojas N, Lawrence HP, Goodman D. Prevalence of early childhood caries in a population of children with history of maltreatment. J Public Health Dent 2008;68:94–101.

11. Cavalcanti AL. Prevalence and characteristics of injuries to the head and orofacial region in physically abused children and ad- olescents—A retrospective study in a city of the Northeast of Brazil. Dent Traumatol 2010;26:149–153.

12. da Silva Júnior IF GM, Goettems ML, Azevedo MS. Oral health status of children and adolescents victims of abuse: A literature review. RSBO 2016;13:104–108.

13. da Silva-Júnior IF, Hartwig AD, Stüermer VM, Demarco GT, Goettems ML, Azevedo MS. Oral health-related quality of life in Brazilian child abuse victims: A comparative study. Child Abuse Negl 2018;76:452–458.

14. Barrêtto EP, Ferreira EF, Pordeus IA. Determinant factors of toothache in 8- and 9-year-old schoolchildren, Belo Horizonte, MG, Brazil. Braz Oral Res 2009;23:124–130.

15. Boeira GF, Correa MB, Peres KG, et al. Caries is the main cause for dental pain in childhood: Findings from a birth cohort. Caries Res 2012;46:488–495.

16. Slade GD. Epidemiology of dental pain and dental caries among children and adolescents. Community Dent Health 2001;18: 219–227.

17. Policy on acute pediatric dental pain management. Pediatr Dent 2017;39:99–101.

18. Bastos JL, Peres MA, Peres KG, Araujo CL, Menezes AM. Toothache prevalence and associated factors: A life course study from birth to age 12 yr. Eur J Oral Sci 2008;116:458–466.

19. McGrath PA. Psychological aspects of pain perception. Arch Oral Biol 1994;39(suppl):s55–s62.

20. Ferreira-Júnior OM, Freire Mdo C, Moreira Rda S, Costa LR. Contextual and individual determinants of dental pain in preschool children. Community Dent Oral Epidemiol 2015;43:349–356.

21. Schuch HS, Correa MB, Torriani DD, Demarco FF, Goettems ML. Perceived dental pain: Determinants and impact on Brazilian schoolchildren. J Oral Facial Pain Headache 2015;29:168–176.

22. Instituto Brasileiro de Geografia e Estatística. https://www.ibge. gov.br/. Accessed 19 December, 2018.

23. Goettems ML, Correa MB, Vargas-Ferreira F, et al. Methods and logistics of a multidisciplinary survey of schoolchildren from Pelotas, in the southern region of Brazil. Cad Saude Publica 2013;29:867–878.

24. Silveira ERD, Goettems ML, Demarco FF, Azevedo MS. Clinical and individual variables in children’s dental fear: A school-based investigation. Braz Dent J 2017;28:398–404.

25. World Health Organization. Oral Health Surveys: Basic Methods, ed 5. Geneva: World Health Organization, 2013.

26. O’Brien M. Children’s dental health in the United Kingdom, 1993: A survey carried out by the Social Survey Division of OPCS, on behalf of the United Kingdom health departments, in collabora- tion with the dental schools of the Universities of Birmingham and Newcastle. London: HMSO, 1994.

27. Chiapinotto FA, Vargas-Ferreira F, Demarco FF, Corrêa FO, Masotti AS. Risk factors for gingivitis in a group of Brazilian schoolchildren. J Public Health Dent 2013;73:9–17.

28. Krüger MS, Lang CA, Almeida LH, Bello-Corrêa FO, Romano AR, Pappen FG. Dental pain and associated factors among pregnant women: An observational study. Matern Child Health J 2015;19:504–510.

29. Williams AC, Craig KD. Updating the definition of pain. Pain 2016;157:2420–2423.

30. Pires ALD, Miyazaki MCOS. Maltreatment against children and adolescents: Literature review for health professionals. Arq de Ciênc Saúde 2005;12:42–49.

31. Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S. Burden and consequences of child maltreatment in high-in- come countries. Lancet 2009;373:68–81.

32. Pfeiffer L, Salvagni EP. Current view of sexual abuse in child- hood and adolescence [in Portuguese]. J Pediatr (Rio J) 2005;81 (5 suppl):s197–s204.

33. Rutter M. Protective factors in children’s responses to stress and disadvantage. Ann Acad Med Singapore 1979;8:324–338.

34. Courchesne E, Chisum HJ, Townsend J, et al. Normal brain de- velopment and aging: Quantitative analysis at in vivo MR imaging in healthy volunteers. Radiology 2000;216:672–682.

35. Bastos JLD, Gigante DP, Peres KG, Nedel FB. Determinação social da odontalgia em estudos epidemiológicos: Revisão teóri- ca e proposta de um modelo conceitual. Ciên Saúde Coletiva 2007;12:1611–1621.

36. Defrin R, Schreiber S, Ginzburg K. Paradoxical pain perception in posttraumatic stress disorder: The unique role of anxiety and dissociation. J Pain 2015;16:961–970.

37. Powers A, Fani N, Pallos A, Stevens J, Ressler KJ, Bradley B. Childhood abuse and the experience of pain in adulthood: The me- diating effects of PTSD and emotion dysregulation on pain levels and pain-related functional impairment. Psychosomatics 2014; 55:491–499.

38. Blackburn-Munro G, Blackburn-Munro RE. Chronic pain, chronic stress and depression: Coincidence or consequence? J Neuroendocrinol 2001;13:1009–1023.

39. Fava M. The role of the serotonergic and noradrenergic neu- rotransmitter systems in the treatment of psychological and physical symptoms of depression. J Clin Psychiatry 2003;64 (suppl 13):26–29.

40. Sachs-Ericsson N, Kendall-Tackett K, Hernandez A. Childhood abuse, chronic pain, and depression in the National Comorbidity Survey. Child Abuse Negl 2007;31:531–547.

41. Mashoto KO, Astrøm AN, David J, Masalu JR. Dental pain, oral impacts and perceived need for dental treatment in Tanzanian school students: A cross-sectional study. Health Qual Life Outcomes 2009;7:73.

42. McGrath PA, Gillespie J. Pain assessment in children and ad- olescents. In: Turk DC, Melzack R (eds). Handbook of Pain Assessment, ed 2. New York: Guilford, 2001:97–118.

43. Garey KW. The role of matching in epidemiologic studies. Am J Pharm Ed 2004;68: Article 83.

44. Szklo M, Nieto FJ. Epidemiology: Beyond the Basics. Oxford University, Aspen: 2001.

45. Pau A, Baxevanos KG, Croucher R. Family structure is asso- ciated with oral pain in 12-year-old Greek schoolchildren. Int J Paediatr Dent 2007;17:345–351.

46. Borges CM, Cascaes AM, Fischer TK, Boing AF, Peres MA, Peres KG. Dental and gingival pain and associated factors among Brazilian adolescents: An analysis of the Brazilian Oral Health Survey 2002–2003 [in Portuguese]. Cad Saude Publica 2008;24:1825–1834.

47. Freire Mdo C, Leles CR, Sardinha LM, Paludetto Junior M, Malta DC, Peres MA. Dental pain and associated factors in Brazilian adolescents: The National School-Based Health Survey (PeNSE), Brazil, 2009 [in Portuguese]. Cad Saude Publica 2012;28(suppl):s133–s145.

48. Peres MA, Peres KG, Frias AC, Antunes JLF. Contextual and in- dividual assessment of dental pain period prevalence in adoles-cents: A multilevel approach. BMC Oral Health 2010;10:20.