May 2019 Volume LIV Number 3


Addressing Adversity to Improve Lifelong Oral Health for Children

September 2015 Volume L Number 5

By Robert Block, M.D., F.A.A.P., American Academy of Pediatrics Past President

Beginning in the 1990s with the Adverse Childhood Experiences (ACE) studies, and with continuing emphasis on the effect of childhood adversities on many aspects of a child's life, it is now known that toxic stress—which is unrelenting and often associated with abuse, neglect, and family dysfunction—can have lifelong effects on health. It is becoming increasingly clear that health professionals who interact with children and their families have a new responsibility to assess and identify possible adversities. This responsibility has been recognized for a number of years in the dental community through the PANDA (Prevent Abuse and Neglect through Dental Awareness) program. 

New information released by the British Dental Health Foundation reports, "children exposed to adverse experiences were more than twice as likely to develop tooth decay and gum disease and suffer from conditions such as unfilled cavities, missing teeth and toothache, all of which can have serious implications for overall health."

It is important to consider dental health in addition to other health areas as contributing factors to the link between adversities and increased risk for serious health issues, not only in childhood, but continuing into adult life. New discoveries in neuroscience and genetics are now providing some explanations on the physiology of stress as it relates to brain health and other health conditions. The American Academy of Pediatrics (AAP) has been focusing its efforts on early childhood development for many years, and is now adding resources to help pediatricians, dentists, and other professionals who work with children to identify and provide community, and professional services to families with children who otherwise might have an unhealthy future.

Through the emerging Center on Healthy, Resilient Children, the AAP hopes to provide education, practice suggestions, and resources for pediatricians to help discover and screen for adversities a child may be experiencing. The work of the Center will build on several existing initiatives within the Academy. Through its strategic priority on Early Brain and Child Development (, the Academy developed numerous educational resources for pediatricians and others, as well as practice-level tools. In addition, a project started with funding from the Department of Justice, the Resilience Project (http://www.aap. org/theresilienceproject), provides resources for the medical home to identify and care for children who have already been exposed to violence. 

Stronger connections between the medical home and community partners-such as the dental home and others-will help families find the support they need. Together, pediatricians and dentists can use their position as trusted resources for children to identify children at risk, increasing the chance that children's adverse situations might be identified early enough to be remediated. The existing resources-combined with ongoing collaboration with the members of the Section on Oral Health provide a strong foundation to move these efforts forward.

The ACE studies focused on problems within a child's family such as physical, sexual, or emotional abuse, domestic violence, drugs and alcohol, and similar issues. More recent exploration has led to the addition of many social determinants of health, such as poverty and generational adversity to the risk factors for child and adult health issues. Even with today's advanced medical environment, not every child is able to become an adult. But it is certainly true that every adult was once a child. Every dentist, pediatrician, and other health professionals are becoming more aware that preventing, screening for, and finding resources to reverse toxic stress will have life changing effects on children, families, communities, and even states and nations. Developing and sustaining a healthy future workforce is one example of the far-reaching implications of mitigating toxic stress through resiliency.

One way to identify children at risk, and to foster resiliency, will be the strengthening of medical and dental homes. Exchange of information between a child's dentist and pediatrician can expand the reach of the "health home," increasing the chances for finding adversities that might be amenable to amelioration thorough professional and community-based resources. The results may be instrumental in changing the health trajectory and not only improving a child's health, but also creating a foundation for a healthier, more resilient adult. We believe that is a laudable goal.  

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