child abuse and the dental professional

Jacey Sheckler, RDH, MS

Physical abuse

Sexual abuse

Bite marks

Dental neglect

Behavior issues

Emotional maltreatment

Craniofacial, head, face, and neck injuries occur in more than half of the cases of child abuse.

Careful intraoral and perioral examination

Look for oral trauma, caries, gingivitis and other oral health problems

Oral cavity may be central focus for physical abuse because of effect on communication and nutrition

Has unexplained burns, bites, bruises, broken bones, or black eyes

Has fading bruises or other marks noticeable after an absence from school

Seems frightened of the parents and protests or cries when it is time to go home

Shrinks at the approach of adults

Reports injury by a parent or another adult caregiver

Offers conflicting, unconvincing, or no explanation for the child's injury

Describes the child as "evil," or in other very negative way

Uses harsh physical discipline with the child

Has a history of abuse as a child

Contusions, burns, or lacerations of the tongue, lips, buccal mucosa, palate (soft and hard), gingiva alveolar mucosa, or frenum

Fractured, displaced, or avulsed teeth

Facial bone and jaw fractures.

Discolored teeth, indicating pulpal necrosis, may result from previous trauma

Multiple injuries, injuries in different stages of healing, or a discrepant history

Oral cavity is a frequent site of sexual abuse in children, but visible oral injuries or infections are rare.

Referral to specialized clinical settings equipped to conduct comprehensive examinations is recommended.

The American Academy of Pediatrics statement "Guidelines in the Evaluation of Sexual Abuse of Children" provides information regarding these examinations.

Be careful not to assume - many variables!

Has difficulty walking or sitting

Suddenly refuses to change for gym or to participate in physical activities

Reports nightmares or bedwetting

Experiences a sudden change in appetite

Demonstrates bizarre, sophisticated, or unusual sexual knowledge or behavior

Becomes pregnant or contracts a venereal disease, particularly if under age 14

Runs away

Reports sexual abuse by a parent or another adult caregiver

Is unduly protective of the child or severely limits the child's contact with other children, especially of the opposite sex

Is secretive and isolated

Is jealous or controlling with family members

Acute or healed bite marks may indicate abuse

Abrasions or lacerations are found in an elliptical or ovoid pattern

Animal bite – tears flesh

Human bite – compresses flesh

Forensic odontologists and pathologists are prepared to thoroughly evaluate bite marks

AAPD defines as “willful failure of parent or guardian to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection.“

Caregivers’ knowledge, or lack thereof, must be differentiated.

ECC, periodontal diseases, other oral conditions

Left untreated, leads to pain, infection, loss of function

Adversely affect learning, communication, nutrition, and other activities necessary for normal growth and development

Is frequently absent from school

Begs or steals food or money

Lacks needed medical or dental care, immunizations, or glasses

Is consistently dirty and has severe body odor

Lacks sufficient clothing for the weather

Abuses alcohol or other drugs

States that there is no one at home to provide care

Appears to be indifferent to the child

Seems apathetic or depressed

Behaves irrationally or in a bizarre manner

Is abusing alcohol or other drugs

Shows sudden changes in behavior or school performance

Has not received help for physical or medical problems brought to the parents' attention

Has learning problems (or difficulty concentrating) that cannot be attributed to specific physical or psychological causes

Is always watchful, as though preparing for something bad to happen

Lacks adult supervision

Is overly compliant, passive, or withdrawn

Comes to school or other activities early, stays late, and does not want to go home

Shows little concern for the child

Denies the existence of—or blames the child for—the child's problems in school or at home

Asks teachers or other caregivers to use harsh physical discipline if the child misbehaves

Sees the child as entirely bad, worthless, or burdensome

Demands a level of physical or academic performance the child cannot achieve

Looks primarily to the child for care, attention, and satisfaction of emotional needs

Rarely touch or look at each other

Consider their relationship entirely negative

State that they do not like each other

Shows extremes in behavior, such as overly compliant or demanding behavior, extreme passivity, or aggression

Is either inappropriately adult (parenting other children, for example) or inappropriately infantile (frequently rocking or head-banging, for example)

Is delayed in physical or emotional development

Has attempted suicide

Reports a lack of attachment to the parent

Constantly blames, belittles, or berates the child

Is unconcerned about the child and refuses to consider offers of help for the child's problems

Overtly rejects the child

family isolation

lack of finances

parental ignorance

lack of perceived value of oral health

lack of insurance

lack of access to health care

determine if dental services are readily available and accessible to the child

be certain that the caregivers understand the explanation of the disease and its implications

attempt to assist the families in finding: financial aid transportation public facilities for needed services

if caregiver fails to obtain therapy, the case should be reported to the appropriate child protective services agency.

Such individuals in Pennsylvania include:

Social workers Teachers and other school personnel Physicians and other health-care workers Mental health professionals Child care providers Medical examiners or coroners Law enforcement officers Clergy

Pediatricians and pediatric dentists

Oral and maxillofacial surgeons Mandated training with child abuse

curriculum

PANDA - Prevent Abuse and Neglect Through Dental Awareness Coalition- telephone: 501-661-2595; e-mail: lmouden@healthyarkansas.com)

Childhelp® National Child Abuse Hotline (800.4.A.CHILD).

Nancy Kellogg, MD and the Committee on Child Abuse and Neglect ; Oral and Dental Aspects of Child Abuse and Neglect ; PEDIATRICS Vol. 116 No. 6 December 2005, pp. 1565-1568 (doi:10.1542/peds.2005-2315

http://www.childwelfare.gov/pubs/factsheets/signs.cfm

Edelman, C., Mandle, C. “Health Promotion throughout the Life Span” Seventh Edition. St. Louis, MO: Mosby, Elsevier, 2010

Leifer, G., Hartston, H. “Growth and Development Across the Life Span: A Health Promotion Focus” First Edition. St. Louis, MO: Saunders 2004