Guideline on Oral and Dental Aspects of Child Abuse and Neglect

LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form

Resident: Boboia Date: 12/4/09
Article title: Guideline on Oral and Dental Aspects of Child Abuse and Neglect
Author(s):
Journal: Pediatric Dentistry Reference Manual
Volume #; Number; Page #s): 28:7
Year: 2007
Purpose Review the oral and dental aspects of physical/sexual abuse and dental neglect and the role of physicians and dentists in evaluating such conditions.
Abstract
In all 50 states, physicians and dentists are required to report cases of abuse and neglect to law enforcement agencies. This report addresses: bite marks, perioral and introral injuries, infections, and disease suspicious for child abuse or neglect. Physicians recieve minimal training in oral health and dental injury and may therefore not detect certain aspects of abuse as readily as they do on other parts of the body.
Physical Abuse:
Craniofacial, head, face, and neck injuries occur in more then half of the cases of child abuse. Signs of neglect (caries, gingivitis, and other oral health problems) should also be reported. Some authorities believe the oral cavity may be a central focus for physical abuse because of its significance in communication and nutrition. Injuries may be inflicted with instruments such as eating utensils, bottle (during force feeding), hands, fingers, scalding liquids, or caustic substances. Contusions, burns, oral lacerations, fractured / displaced teeth, and facial bones / jaw fractures are all common findings among abuse cases. One study showed the lips were the most common site (54%) for inflicted injuries (followed by the oral mucosa, teeth, gingiva, and tongue). Unintentional or accidental injuries to the mouth must be distinguished from abuse by using the history, timing, and mechanism of injury (as well as the child’s developmental capabilities and characteristics of the injury).
Sexual Abuse:
Oral-genital contact suspicion necessitates a referral to a specialized clinic equipped to conduct a comprehensive examination. Oral / perioral gonorrhea in prepubertal children is pathognomonic for sexual abuse but rare among prepubertal girls evaluated for sexual abuse. Pharyngeal gonorrhea is usually asymptomatic. HPV is a little tricky when attempting to determine a mode of transmission to the oral region. Vertical and horizontal modes of transmission through non-sexual contact does occur.
Bite Marks:
Should be suspected when ecchymoses, abrasions, or lacerations are found in an elliptical or ovoid pattern. Animal bites tear flesh and human bites compress flesh (rarely causing tissue avulsion). Photographs should be taken where the angle of the camera lens is directly over the bite and perpendicular to the plane of the bite to avoid distortion. Swabbing the bite for DNA and taking a PVS impression of it are also very helpful forensic tools. Photographs and documentation should be repeated for at least 3 days to document the evolution of the bite. Involvement of a forensic odontologist or pathologist to evaluate and document the bite pattern is appropriate.
Dental Neglect:
Def: “willful failure of a 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”. “The point at which to consider a parent negligent and to begin intervention occurs after the parent has been properly alerted by a health care professional about the nature and extent of the child’s condition, the specific treatment needed, and the mechanism of accessing the treatment”.

Conclusions:
The Prevent Abuse and Neglect Through Dental Awareness phone # is (501) 661-2595 or email Lmouden@healthyarkansas.com