Orofacial trauma in child abuse: types, prevalence, management, and the dental profession's involvement

Department of Pediatric Dentistry

Lutheran Medical Center

Date: 08/28/2009

Article title: Orofacial trauma in child abuse: types, prevalence, management, and the dental profession's involvement

Author(s): Howard L. Needleman, DMD

Journal: Pediatric Dentistry

Volume (number): Vol 8

Month, Year: 1986

Major topic: Child abuse

Minor topics: dental trauma management

Type of Article: Review of Literature

Main Purpose: Review types of injuries to the primary dentition and present evidence based treatments

Overview of method of research: Review of Literature as well as professional opinion

Findings:

Trauma to the head and associated areas occurs in approximately 50% of cases of physically abused children.

Soft tissues are the most common injury in child abuse and are usually on the face

Injuries to the upper lip and frenum are common findings in severely abused children

As dentists make an effort to be aware of these injuries, abuse detection will increase.

Key points/Summary :

• Common abuse findings: Fractures, subdural hematomas, abrasions & lacerations, contussions & ecchymoses, bursns, bites, dental trauma.
• In the past, dentists have done a poor job reporting abuse; dentists have not always been aware that they are legally mandatory reporters.
• The primary goal in detection is to bring the needed social services to families to help them overcome their problems.
• How to detect abuse:
• Is the injury consistent with the history?
• Are there signs of previous traumas?
• Is there bruising at various levels of healing?
• Does the parent exhibit unusual behavior are does the child seem to be traumatized?
• Is there evidence of neglect or poor supervision?
• Make appropriate referrals when pathology presents you are uncomfortable treating
• If the injury is within your realm of specialty, then treat appropriately.
• Soft tissue: use ice packs
• Abrasions: cleanse and dress as needed
• Frenum tears: suture only if alveolar bone is exposed and the wound opens with lip movement
• Suture choice: 5-0 or 6-0 silk for skin removing them 4 days post-op; 3-0, 4-0 chromic gut for muscalature; 4-0, 5-0 plain gut for mucosa.
• Human bites: very serious, antibiotics recommended and don't close wound. (refer this)
• Facial fractures are relatively rare, but nasal fractures occur most frequently. Refer all alveolar and mandible fractures to an oral surgeon--even if treatment is not indicated.

Assessment of article: A solid review of child abuse as it pertains to pediatric dentistry, but a lot of the literature used is really dated. It would be nice to see a current article on this same topic.