Oral and Dental Manifestations of Child Abuse

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Oral and Dental Manifestations of Child Abuse

A recent statement titled “Oral and Dental Aspects of Child Abuse and Neglect” and authored by members of the American Academy of Pediatric Dentistry, Section on Oral Health, Committee on Child Abuse and Neglect, and the American Academy of Pediatric Dentistry, Council on Clinical Affairs, Ad Hoc Working Group on Child Abuse and Neglect was published in both Pediatrics1Fisher-Owens SA, Lukefahr JL, Tate AR. Oral and dental aspects of child abuse and neglect. Pediatrics 2017;140(2). and Pediatric Dentistry.2Fisher-Owens SA, Lukefahr JL, Tate AR. Oral and dental aspects of child abuse and neglect. Pediatr Dent 2017;39(4):278-83.

The report emphasizes that all healthcare providers, including dental professionals, are required to notify an appropriate social services agency or law enforcement that abuse is suspected. This suspicion can develop as a result of a clinical dental examination or be based on information provided by the patient.

The report lists 6 categories of child abuse that can be observed in the oral cavity or peri-oral area. These categories include physical abuse, sexual abuse, bite marks, bullying, human trafficking and dental neglect.

Physical abuse: Injuries to the head and neck occur in more than half of all cases of child abuse, and the report emphasizes that the oral cavity may be where many injuries occur because of its role in communication, as well as ingestion of food and drink. There are many types of injuries associated with physical abuse, but fractures and burns are notable. Suspicion is also raised when there are multiple injuries, which appear to have occurred at different times.

Sexual abuse: Oral cavity involvement in sexual abuse is not uncommon, but actual physical evidence of abuse, or the presence of sexually-transmitted infections, is rare. If a sexually-transmitted infection is suspected, the lesion should be cultured, or molecular identification of a suspected pathogen should be performed. Sample collection is critical and specialized collection and sample transportation are often needed in these situations.

Bite marks: If present on the head and face, these are often indicative of abuse. The report notes that the origin of the bite mark is not always easy to determine, but that animal bite marks often tear the skin, and human bites do not, but cause contusions. Photographic or impression recording of the suspected abuse is often helpful, and a forensic dentist may need to be consulted.

Bullying: This may be experienced by children who have dental, oral and/or facial anomalies, and dental providers should be aware of this association.

Human trafficking: This often results in oral and dental problems in children, as a result of physical or sexual abuse, or neglect. Awareness on the part of the dental provider is essential.

Dental neglect: Defined as the presence of extensive dental disease when care is available, this is a form of child abuse. Here it is important to differentiate when the caregiver has adequate knowledge of the need for care, as opposed to caregivers without that knowledge. The financial barriers to dental care need to be considered.

Identification of this last category of child abuse represents a challenge for the dental professional and health care workers that must address the situation. The impact of dental neglect during childhood can have long-lasting effects.3Ramazani N. Child dental neglect: A short review. Int J High Risk Behav Addict 2014;3(4):e21861. There needs to be a distinction between deliberately withholding care and a lack of awareness on the part of the parent or care-giver regarding what needs to be done to prevent and treat oral/dental disease, or parental impairment due to addiction to drugs or alcohol, or a limited mental capacity. In any of these situations, the needs of the child must be considered first.4Costacurta M, Benavoli D, Arcudi G, Docimo R. Oral and dental signs of child abuse and neglect. Oral Implantol (Rome) 2015;8(2-3):68-73.

Perhaps surprisingly, there is relatively little published in the dental literature on oral and dental manifestations of child abuse, even though most reports agree that at least half of all cases involve injuries to the head and neck.5 Kaur H, Chaudhary S, Choudhary N, Manuja N, Chaitra TR, Amit SA. Child abuse: Cross-sectional survey of general dentists. J Oral Biol Craniofac Res 2016;6(2):118-23. A survey conducted to learn about general dentists’ attitudes regarding reporting of child abuse indicated that the major of respondents (55%) were not clear regarding their responsibilities to report their findings. There were no differences between male and female dentists.4Costacurta M, Benavoli D, Arcudi G, Docimo R. Oral and dental signs of child abuse and neglect. Oral Implantol (Rome) 2015;8(2-3):68-73. Nevertheless, professional intervention is essential when child abuse is suspected, as action can prevent further injury to the child, and help address the family problems that are the underlying cause of the abuse.6Jessee SA. Orofacial manifestations of child abuse and neglect. Am Fam Physician 1995;52(6):1829-34.

A detailed review of child abuse cases seen at one hospital observed that nearly 75% of the affected children were less than 3 years of age, and two-thirds of all children had an injury to the head and neck region. Extraoral findings were much more common than were intraoral findings.7Jessee SA. Physical manifestations of child abuse to the head, face and mouth: a hospital survey. ASDC J Dent Child 1995;62(4):245-9.

Conclusions

In conclusion, awareness is the key, and documentation is recommended when child abuse resulting in oral and dental injury is suspected. A challenge for the dental professional is when to seek outside assistance when child abuse is suspected. This will depend in large part on the caregiver’s response to the discussion following the examination of the child. Consulting with dental and medical professionals with expertise and experience in this field is often helpful.

References

  • 1.Fisher-Owens SA, Lukefahr JL, Tate AR. Oral and dental aspects of child abuse and neglect. Pediatrics 2017;140(2).
  • 2.Fisher-Owens SA, Lukefahr JL, Tate AR. Oral and dental aspects of child abuse and neglect. Pediatr Dent 2017;39(4):278-83.
  • 3.Ramazani N. Child dental neglect: A short review. Int J High Risk Behav Addict 2014;3(4):e21861.
  • 4.Costacurta M, Benavoli D, Arcudi G, Docimo R. Oral and dental signs of child abuse and neglect. Oral Implantol (Rome) 2015;8(2-3):68-73.
  • 5. Kaur H, Chaudhary S, Choudhary N, Manuja N, Chaitra TR, Amit SA. Child abuse: Cross-sectional survey of general dentists. J Oral Biol Craniofac Res 2016;6(2):118-23.
  • 6.Jessee SA. Orofacial manifestations of child abuse and neglect. Am Fam Physician 1995;52(6):1829-34.
  • 7.Jessee SA. Physical manifestations of child abuse to the head, face and mouth: a hospital survey. ASDC J Dent Child 1995;62(4):245-9.