Oral and Dental Aspects of Child Abuse and Neglect

Abstract

In all 50 states, health care providers (including dentists) are mandated to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this report is to review the oral and dental aspects of physical and sexual abuse and dental neglect in children and the role of pediatric care providers and dental providers in evaluating such conditions. This report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, and diseases that may raise suspicion for child abuse or neglect. Oral health issues can also be associated with bullying and are commonly seen in human trafficking victims. Some medical providers may receive less education pertaining to oral health and dental injury and disease and may not detect the mouth and gum findings that are related to abuse or neglect as readily as they detect those involving other areas of the body. Therefore, pediatric care providers and dental providers are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions in children.

Oral injuries and occult harm in children evaluated for abuse

“…Medical clinicians should have a low threshold to undertake age-appropriate occult injury testing such as SS and neuroimaging in these children. The recent American Academy of Pediatrics consensus on oral and dental abuse supports our findings of oral injury as a marker of serious abuse 33. Dentists should consider referral for medical evaluation if any abuse concerns arise.…”

Is dental trauma more prevalent in maltreated children? A comparative Study in Southern Brazil

“…Although most of the injuries detected only involved enamel injury, as in cases of small fractures in the incisal angle, and required no intervention, both groups showed a low frequency of treatment following dental trauma. Although the failure to seek and follow through with dental treatment for the child may indicate negligence on the part of the parents, this is only considered when it is intentional, and other issues deserve attention, such as the lack of finances, ignorance, and not perceiving an oral condition as a problem . The majority of individuals in both groups were from low‐income families, which may justify the high rate of non‐executed treatments, since, in Brazil, income is a barrier to the use of dental health services …”

The mouth and maltreatment: safeguarding issues in child dental health

“…Oral signs of sexual abuse, whether as trauma or sexually transmitted infection, are said to be rarely obvious on examination 4. Specific information about examining for oral manifestations of sexual abuse and interpreting any findings is conspicuously absent from authoritative guidance documents,3 29 the primary focus being on anogenital signs and infections 46…”

“…Unexplained injury or petechiae at the junction of the hard and soft palate may be evidence of forced oral sex 4. Reported in less than 1% of sexually abused children,46 the characteristic oral lesions of syphilis are chancre in primary syphilis, mucous patches or snail-track ulcers in secondary syphilis and leukoplakia or gumma in tertiary syphilis 47.…”

“…In prepubertal children where there is no clear evidence of vertical transmission, these infections would be alerting features to suspect sexual abuse 29. The significance of oral warts in relation to sexual abuse is unclear 4. Adult women survivors of childhood sexual abuse self-report higher prevalence of a range of dental conditions, including bruxism (tooth clenching and grinding) and temperomandibular dysfunction 49…”