By Marilynn Larkin
NEW YORK—Bite marks and other oral injuries, as well as dental neglect and infections, are among the signs that should raise suspicion of child abuse, according to new guidance from the American Academy of Pediatrics and the American Academy of Pediatric Dentistry.
Dr. Susan Fisher-Owens of the University of California, San Francisco and colleagues coauthored the updated clinical report, published online July 31 in Pediatrics. The report describes problems involving a child’s teeth, gums and mouth that may signal physical or sexual abuse and dental neglect.
Such injuries may include:
- Contusions, burns, lacerations of the tongue, lips, fractured teeth and jaw fractures, which may have been inflicted with eating utensils, scalding liquids or caustic substances, or during forced feeding.
- Bruises, lichenification or scarring at corners of the mouth, which may be due to gags placed around the child’s mouth.
- Petechiae of the palate, particularly at the junction of the hard and soft palate, which may result from forced oral sex.
- Acute or healed bite marks that may indicate physical or sexual abuse.
Providers should also be aware that children with orofacial or dental abnormalities may be subject to bullying that leads to serious psychological issues, including depression and suicidal ideation. Dental problems, particularly tooth loss, are among the health issues seen in children who are victims of human trafficking.
If children’s dental health is neglected, the authors note, gum disease and untreated cavities may interfere with the ability to eat, grow and develop properly.
The authors stress that health care providers are required to report injuries that indicate possible abuse or neglect to child protective services in accordance with their local or state legal requirements.
The Prevent Abuse and Neglect through Dental Awareness coalition (http://bit.ly/2ucVTDX) is a resource for physicians seeking information on this issue, they add.
Dr. Fisher-Owens said, “Because different communities have different resources, all health care providers, including medical and dental providers, should be aware of the signs of negligence, abuse, bullying, and human trafficking.”
"Many families may not be able to access dental care for their children easily,” she told Reuters Health by email. “Therefore, a health care provider needs to evaluate whether such services are readily available, and be aware that physical or sexual abuse, bullying, and trafficking may result in dental or other oral injuries.”
“The point at which to consider whether to report dental negligence or abuse on the part of a parent is after the parent has been alerted to the child's condition and the treatment required, and has been helped to reduce barriers to access that treatment,” she noted.
“If parents do not obtain therapy after barriers to care have been removed,” she said, “the case should be reported to the appropriate child protective services agency.”
“Families who are involved in abuse or neglect may continue to visit the same dental provider, even while switching medical providers, so dental providers play a key role in helping to identify and protect children at risk,” she added.
Dr. Robert Morgan, chief of dentistry at Children’s Health in Dallas, Texas, said, “In my 30 plus years in pediatric dentistry, I have seen more than 10,000 patients, but have referred less than 50 for suspected child abuse.”
“From day one, we are trained to look for possible signs of abuse,” he told Reuters Health by email. “Pediatric dentists often see a child more than a pediatrician and have a longer bond with them because of the nature of dental treatment. As a result, children often confide in us.”
“One third of the pediatric population will chip or bruise their teeth or face, making a diagnosis of child abuse not as straightforward or simple as some might think,” he observed.
“The Children’s Health team is trained to look for obvious signs of child abuse, but we take it one step further,” he added. “If a dentist notices a sign that may indicate child abuse, they will reach out to the health care provider or primary care physician for that child.”
“What might look like negligence often is simply a lack of education about dental care,” Dr. Morgan pointed out. “Some parents don’t know what their child’s dental needs are or how to address them.”
“If I didn’t look for signs of child abuse, I wouldn’t be doing my job,” he concluded. “It’s a diagnosis we want to make sure we don’t miss.”
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