The Crucial Role of Dental Professionals in Detecting Child Abuse and Neglect

Child abuse and neglect are significant public health issues, affecting at least one in seven children in the United States each year, according to a recent clinical report “Oral and Dental Aspects of Child Abuse and Neglect” from the American Academy of Pediatrics. The legal framework across all 50 states, District of Columbia, and Commonwealth of Puerto Rico mandates that pediatricians, dental professionals, and other healthcare providers report any suspected cases of abuse or neglect to the appropriate authorities. This mandate underscores the critical role that healthcare professionals play in identifying and responding to child maltreatment.

This clinical report focuses on the oral aspects of child abuse and dental neglect, highlighting the need for a multidisciplinary approach to effectively detect and manage these cases. Oral injuries, infections, and diseases may often be the first or only indicators of abuse or neglect, particularly in cases where other forms of physical maltreatment may not be immediately evident. The mouth is a frequent site of physical and sexual abuse, with manifestations such as bite marks, bruises, lacerations, and dental neglect being common indicators.

For example, physical abuse may present as bruising on the face, forehead, or ear, which are often overlooked. The mnemonic TEN-4-FACESp has been developed to aid in the identification of bruising patterns concerning for abuse, particularly in young children. Research has shown that craniofacial, head, face, and neck injuries occur in more than half of child abuse cases, making the recognition of these injuries critical in preventing further harm.

Sexual abuse is another form of maltreatment that may manifest in the oral cavity. Children who have been sexually abused may present with sexually transmitted infections in the mouth, which may be noted by oral health professionals during routine dental appointments.

Medical child abuse (MCA), also known as Munchausen syndrome by proxy, is a form of maltreatment where a caregiver subjects a child to unnecessary and harmful medical care. MCA can also present with oral manifestations, such as recurrent mucosal bleeding or ulcerations, which may be misdiagnosed if the possibility of abuse is not considered. Accurate diagnosis of MCA is challenging due to the deceptive nature of the caregiver’s actions, but it is essential for preventing further harm to the child.

Bite marks are another potential indicator of abuse, and forensic odontologists can play a crucial role in their evaluation. Bite marks on the skin, especially those found on the cheeks, back, sides, arms, buttocks, and genitalia, may indicate physical or sexual abuse. The pattern and characteristics of these marks can provide valuable evidence in abuse investigations.

Dental neglect is a specific form of maltreatment that involves the willful failure of a parent or guardian to seek or follow through with necessary dental care for a child. This neglect can lead to significant oral health issues, including pain, infection, and loss of function, which can adversely affect a child’s overall development.

The report also addresses the impact of racial, ethnic, and economic disparities in the reporting of child maltreatment. Implicit bias among healthcare providers can influence the recognition and reporting of abuse, particularly when the family shares similar backgrounds with the professional.

Collaborations among pediatricians, dental professionals, and other healthcare providers is essential for the prevention, detection, and treatment of child abuse and neglect. By working together, these professionals can ensure that children receive the care and protection they need to thrive. Click here to read the clinical report.