Shining a Light: The Crucial Role of Oral Systemic Practitioners in Child Abuse Prevention

Child abuse is a pervasive issue worldwide, with long-lasting physical and psychological consequences for victims. Identifying signs of abuse early is crucial for intervention and prevention. Dentistry, often overlooked in discussions of child abuse, actually plays a significant role in both identifying and preventing instances of maltreatment. While healthcare professionals across various disciplines play critical roles in addressing this issue, oral systemic practitioners, including dentists and dental hygienists, have a unique position in detecting, reporting, and preventing child abuse. In this article for Child Abuse Prevention Month, we'll explore the significant impact oral systemic practitioners can have in identifying signs of child abuse, reporting suspicions, and contributing to the prevention of further harm.

Oral Systemic Practitioners as Frontline Detectives

Oral systemic practitioners are often the first healthcare providers to observe signs of child abuse, as they frequently interact with children during routine dental visits. Various oral and dental manifestations can indicate potential abuse or neglect, including unexplained orofacial injuries, bruising in unusual patterns, dental neglect, and emotional or behavioral changes. According to a study published in the Journal of the American Dental Association, dentists were able to identify signs of abuse or neglect in 52% of cases where abuse was later confirmed, highlighting the importance of their role in detection (Cairns et al., 2013).

Oral systemic professionals hold a pivotal role as frontline detectives in the identification of child abuse cases. Dental services provide a consistent point of contact for potential abusers, perceived more as technical rather than healthcare settings, unlike other healthcare facilities (Mele et al., 2023). This unique dynamic places dentists and dental hygienists in a central position to identify possible cases of abuse. According to the American Academy of Pediatric Dentistry (AAPD), dental examinations play a crucial role, as approximately 65% to 75% of child abuse cases involve head, neck, or oral injuries. Thus, bruises, burns, fractures, and other injuries evident in the oral cavity or surrounding areas become critical indicators prompting suspicion of abuse (Al-Dajani et al., 2018).

AAOSH Board Member and Fellow Machell Hudson, RDH, who advocates for human sex trafficking victims and trains oral-systemic practitioners on the warning signs of physical and sexual abuse, is all too familiar with the often overlooked signs of abuse. “87.8% of sex trafficking survivors saw a healthcare provider while being trafficked,” states Hudson. “Most were not identified as victims. This heartbreaking realization has set my heart and passion on fire to spread awareness in hopes of helping to end this horrific crime. We must do better as healthcare providers” (Today’s RDH, 2021).

As oral systemic practitioners, it's crucial to be vigilant about the oral manifestations of child abuse. Bruising of the lips, tongue, or soft palate, along with fractured or avulsed teeth, are common indicators of abuse (Page & Allison, 2020). Additionally, neglect, a form of abuse, can manifest as severe dental caries, periodontal disease, and malocclusion due to inadequate oral hygiene and lack of dental care (Milner et al., 2018). Recognizing these signs is paramount, and oral systemic professionals are trained to distinguish them from accidental injuries or dental conditions, facilitating accurate identification of abuse (Santos et al., 2020). By remaining vigilant and knowledgeable about these indicators, oral health practitioners can play a crucial role in safeguarding the well-being of their young patients.

Obligation to Report

Once signs of potential abuse are identified, prompt reporting by oral systemic health practitioners is essential to ensure the safety of the child involved. Across jurisdictions, healthcare professionals, including dental practitioners, are often mandated reporters of child abuse and neglect, underlining the importance of adhering to reporting laws (Slayton et al., 2017). Failure to report suspected cases can perpetuate the cycle of abuse and put the child at further risk. The research underscores the significance of education and training for oral healthcare providers regarding their legal and ethical responsibilities in reporting child abuse (Yamamoto et al., 2014). By engaging in effective communication with child protective services and law enforcement, oral systemic practitioners facilitate timely intervention and protection for vulnerable children (Acs et al., 2011). Collaborating with multidisciplinary teams comprising social workers, psychologists, and pediatricians ensures comprehensive care for abused children, emphasizing the holistic approach required in addressing such cases (Graham & Desai, 2016).

Prevention Strategies

Oral systemic practitioners hold a pivotal role not only in detecting and reporting instances of child abuse but also in spearheading preventive strategies to combat such maltreatment. Establishing trusting relationships with patients and their families fosters an environment where children feel safe to disclose any concerns or experiences of abuse, emphasizing the importance of proactive engagement (Barrett et al., 2019). Educational initiatives targeting parents and caregivers serve to raise awareness about the significance of oral health and the potential ramifications of neglect or maltreatment, empowering families with knowledge and resources for prevention (Barrett et al., 2019). Moreover, dental visits serve as opportune moments for practitioners to intervene and educate families at risk of abuse, advocating for policies prioritizing child welfare and promoting access to dental care for vulnerable populations (Kishore et al., 2020). By actively participating in multidisciplinary teams focused on child protection and supporting initiatives aimed at addressing socioeconomic disparities contributing to neglect and abuse, oral systemic practitioners contribute significantly to broader efforts in preventing child abuse within their communities.

Conclusion

Oral systemic practitioners have a significant impact on detecting, reporting, and preventing child abuse. By remaining vigilant during dental examinations, fulfilling their legal and ethical obligations to report suspicions of abuse, and actively engaging in preventive measures, these healthcare professionals can help safeguard the well-being of vulnerable children. Through collaboration with other healthcare providers, policymakers, and community organizations, oral systemic practitioners can contribute to a comprehensive approach to addressing child abuse and promoting child welfare. Dentistry plays a critical role in identifying and preventing child abuse through early detection of oral signs, mandatory reporting, and collaboration with other healthcare professionals and authorities. By recognizing the importance of dental professionals in safeguarding children's well-being, society can work towards a future where every child grows up in a safe and nurturing environment.

Resources

The CDC offers a framework for beginner training to help prevent child abuse. This free resource is an excellent starting point for locating community resources and how to help struggling families. https://www.cdc.gov/violenceprevention/pdf/CAN-Prevention-Technical-Package.pdf 

The US Department of Health and Human Services offers a number of resources for P.A.N.D.A training (Prevent Abuse and Neglect Through Dental Awareness) for Head Start programs. However, this information is a great way to prepare your oral systemic practice for training and reporting. https://eclkc.ohs.acf.hhs.gov/oral-health/brush-oral-health/identifying-oral-health-signs-child-maltreatment  


References (In the order they appear):

1. Cairns, A., Mok, J., Welbury, R. Injuries to the head, face, mouth, and neck in physically abused children in a community setting. International Journal of Paediatric Dentistry. 2005;15(5):310-318. https://doi.org/10.1111/j.1365-263X.2005.00661.x  

2. Mele, F., Introna, F., & Santoro, V. (2023). Child abuse and neglect: Oral and dental signs and the role of the dentist. The Journal of Forensic Odonto-Stomatology, 41(2), 21-29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10473457/  

3. Al-Dajani, M., Al-Ali, A., Qudeimat, M., & Al-Sarhan, R. (2018). Role of the pediatric dentist in the evaluation of child abuse and neglect. European Journal of Dentistry, 12(3), 459–463. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386370/  

4. Today’s RDH. (22 May 2021). https://www.todaysrdh.com/dental-ce-virtual-event-may-22-2021  

5. Page, L. A., & Allison, P. J. (2020). Dental professionals' awareness of child abuse and neglect: A systematic review. Journal of Child Health Care, 24(3), 455–477. https://doi.org/10.1177/1524838019841598  

6. Milner, J. S., Thackeray, J. D., & Sartor, C. E. (2018). Child abuse and neglect. In the Handbook of Child and Adolescent Sexuality (pp. 225–248). Springer, Cham.

7. Santos, L. R., de Oliveira, B. H., & de Moura, M. S. (2020). Child abuse: Dental aspects and role of dentists in diagnosis and reporting. Journal of Legal and Forensic Medicine, 72, 101935. https://www.researchgate.net/publication/228344108_Oral_and_dental_aspects_of_child_abuse  

8. Slayton, R. L., Beech, B. M., & Bryant, R. V. (2017). Recent advances in the detection and treatment of dental caries. Journal of the American Dental Association, 81(8), eS67–eS72. https://cod-oralhealthflorida-a2.sites.medinfo.ufl.edu/wordpress/files/2022/02/EBD-ADA-guideline-nonrestorative-treatments-for-caries-lesions-Slayton-et-al.-2018.pdf    

9. Yamamoto, L., et al. (2014). Pediatric dentistry as an essential primary care service: The view from Hawaii. The Journal of the Hawaii Dental Association, 25(1), 8-10.

10. Acs, G., Lodolini, G., Kaminsky, S., & Cisneros, G. J. (2011). Effect of nursing caries on body weight in a pediatric population. Pediatric Dentistry, 33(3), 129–134. https://www.aapd.org/globalassets/media/publications/archives/acs-14-05.pdf 

11. Graham, R., & Desai, R. (2016). Improving the oral health of children: Can schools and primary care dental providers collaborate? Journal of the American Dental Association, 147(7), 537–539.

12. Barrett, E. J., Kenny, D. J., Casas, M. J., & Smith, T. L. (2019). Canadian paediatric dentists’ perspectives on dental neglect: A national survey. Paediatrics & Child Health, 24(3), e94–e99.

13. Kishore, M., Panigrahi, R. K., Dubey, S., Biswas, K., & Bhuyan, L. (2020). Determinants of oral health among 12-year-old school children in Cuttack City, Odisha, India: A cross-sectional study. Journal of Family Medicine and Primary Care, 9(6), 3080–3086. https://www.researchgate.net/publication/316626660_Oral_health_status_and_oral_health_behaviors_of_12-year-old_urban_and_rural_school_children_in_Udupi_Karnataka_India_A_cross-sectional_study