Child maltreatment: a survey of dentists in southern Brazil

Prevalence of reported violence in children and adolescents in the clinical work of health professionals: a systematic review and meta-analysis

This article aims to analyze the prevalence of reporting and notification of violence in children and adolescents in the work of clinical health professionals. The search was performed in six electronic databases and the gray literature for studies published until June 1, 2022. Estimates of interest were calculated using random effects meta-analyses. Two reviewers independently evaluated the potentially eligible studies according to the following criteria: cross-sectional studies carried out with health professionals who provided clinical care for children and adolescents and dealt with violence cases. Two reviewers extracted data on included trial characteristics, methods, and outcomes. Expectations of interest were transformed using random effects meta-analyses. The meta-analysis of the prevalence of reports of violence performed with 42 articles was 41%. The notification meta-analysis occurred with 39 articles and was 30%. About one in two health professionals face situations of violence against children and adolescents in their clinical practice (41%), and approximately one in three health professionals report the cases (30%).

Orofacial manifestations of child maltreatment: A review

The recognition and reporting of child abuse and neglect continues to be a challenge in the healthcare setting. All healthcare providers, including dentists, should be aware of the high prevalence of orofacial injuries and conditions that are concerning for abuse and neglect. Sentinel injuries may appear trivial and do not require medical attention, but are unlikely caused by accidental mechanisms and, if not properly identified, often precede more severe abusive injuries. Concerning orofacial findings can manifest as bruising, eye injuries, intraoral injuries, pharyngeal perforations, facial bone fractures, and sexually transmitted infections. Abusive caregivers are likely to give inadequate explanations or no history at all to explain concerning findings. Medical providers' failure to make mandated reports about their concerns to the appropriate agencies can have significant long-term impacts on the physical and psychological well-being of children.

Exploring the Connection Between Domestic Violence and Masticatory Outcomes in the Pediatric Population: A Systematic Review

The potential interplay between domestic violence and masticatory outcomes in children and adolescents has garnered increasing attention. Understanding the association between domestic abuse and specific oral health parameters, such as biting habits, temporomandibular disorders (TMDs), and bruxism, holds implications for holistic healthcare interventions. This systematic review aims to synthesize the available evidence to elucidate the potential relationships between domestic abuse and targeted oral health outcomes in the pediatric population. A comprehensive search strategy was conducted across eight databases, namely, PubMed, Embase, Scopus, PsycINFO, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Library, and Google Scholar. Boolean operators and Medical Subject Headings (MeSH) keywords were strategically employed to optimize search precision. Clinical studies investigating the relationships between domestic abuse and TMDs, or bruxism, in children and adolescents were included. Two reviewers extracted the data independently. The methodological quality and risk of bias of the selected studies were critically appraised using the Newcastle-Ottawa scale. The systematic search identified three papers investigating the associations between domestic abuse and the targeted oral health parameters. Children in the age group of 6-19 years were assessed. The synthesized evidence revealed a consistent association between domestic abuse and masticatory outcomes. Individuals subjected to domestic abuse exhibited a greater percentage of masticatory anomalies. The methodological assessment of the included studies showed good quality. This systematic review provides a notable synthesis of evidence regarding the associations between domestic abuse and masticatory outcomes in children and adolescents. The complex nature of these relationships necessitates further research to unravel the underlying mechanisms and establish causality. The insights from this review highlight the significance of integrating abuse assessment within oral health evaluations and underscore the need for interdisciplinary collaborations to address the potential impact of abusive experiences on the oral health and well-being of the pediatric population.

Child abuse knowledge and attitudes among dental and oral health therapists in Aotearoa New Zealand: a cross-sectional study

BACKGROUND

Child abuse and neglect are significant social and health issues in New Zealand. As the government provides free oral care to children and adolescents, oral health practitioners are positioned to respond to child protection concerns. However, research on the knowledge and attitudes of oral health practitioners is limited. This study aimed to understand the knowledge and attitudes of New Zealand dental and oral health therapists in detecting and reporting child abuse and neglect.

METHODS

In this descriptive exploratory cross-sectional study, we invited registered New Zealand dental and oral health therapists treating children and adolescents to the anonymous online survey.

RESULTS

Among the 92 dental and oral health therapists, 72% agreed that they could recognise the signs and symptoms of child abuse and neglect. Yet, only 48% agreed they were familiar with the reporting process. During their professional careers, 62% had at least 1 suspected case; and only 21% had ever reported their concerns. Fear of false reporting (70%) was the most significant barrier.

CONCLUSIONS

Participants understood child abuse and neglect as significant social issues; however, the knowledge and attitudes to respond were limited. Efforts to enhance the knowledge and attitudes will be necessary to promote child safety and wellbeing.

Prevalence of recognition and reporting of child physical abuse by dental surgeons and associated factors

Studies evaluating the factors associated with under reporting and with the recognition and reporting of child physical abuse are scarce and highly necessary. This study aimed to assess the prevalence of recognition and reporting of child physical abuse (CPA) by Brazilian dentistsin primary care and associated factors. A cross-sectional study was carried out with a representative sample of dentistsfrom the Family Health Strategy in Belo Horizonte. A self-administered questionnaire validated to Brazilian Portuguesewas used for data collection. Statistical analysis included univariate and multiple analyses through Poisson regression. A total of 181dentists participated in the study. Among them, 73 (40.3%) had already recognized some cases of CPA, but only 11 (6.1%) ended up reporting. Dentists with six to 19 years of experience as a municipal worker presented 2.38 times [PR = 2.38 (95%CI: 1.29-4.41)] more probability to recognize cases of CPA than the ones with less than six years. Having a graduate degree with a major in childcare [PR = 4.50 (95%CI: 1.08-18.68)] was associated with a larger number of reports. The employment duration as municipal worker was positively associated with the recognition of CPA cases and the prevalence of reporting was low.

Knowledge Levels and Educational Experiences among Dental Graduates in Saudi Arabia Regarding Child Abuse and Neglect: A National Study

Background: Child abuse and neglect (CAN) is considered a serious problem worldwide. Dentists have a significant role in recognizing and reporting CAN cases. Aim: The aim of this study was to assess the CAN-related knowledge and educational experiences among Saudi dental graduates. Design: Self-administered questionnaires were distributed to dental graduates from all dental schools in Saudi Arabia (n = 1552). Bivariate and multivariate logistic regression analyses were performed to assess the associations between knowledge level and different predictors. Results: A total of 988 dental graduates completed the questionnaire. The majority of them were dissatisfied with the amount of education they had received in their school (56.4%). Around 60% of the participants had inadequate knowledge regarding CAN. Graduates from government schools who received dental education about CAN and female participants had significantly higher odds of having adequate knowledge scores than others (odds ratio = 2.0, 3.1, and 1.7, respectively). Only 39.5% of the participants felt confident in their ability to identify CAN cases, and only 9.7% knew how to report such cases. Conclusions: Graduate dental students have insufficient knowledge about CAN. More time should be dedicated to educating students about this important topic in dental curricula.

Child maltreatment in Dubai and the Northern United Arab Emirates: dental hygienists and assistants' knowledge

PURPOSE

Dental assistants (DAs) and hygienists (DHs) should play an active role in the detection and reporting of child abuse and neglect (CAN). We aimed to investigate CAN knowledge of DAs and DHs in the United Arab Emirates (UAE) and some of the inhibiting factors to the process of CAN reporting.

METHODS

A cross-sectional study design was utilized. We surveyed 186 DAs and DHs using a previously validated self-administered anonymous CAN knowledge questionnaire. Statistical analysis was performed using χ²-square, Fisher's exact test, t test/Mann-Whitney, and a ROC curve (p < 0.05).

RESULTS

Among 186 DAs and DHs surveyed, satisfactory knowledge of CAN was demonstrated by 50.5%. DAs scored a significantly higher score of knowledge compared to DHs (p = 0.03). The most reported CAN referral inhibiting factor was "being afraid to get in trouble with parents". The recognition of a child with special needs and parents missing multiple appointments as risk factors for CAN was significantly higher in the DAs compared to DHs (p = 0.04, p = 0.024, respectively). Awareness of local laws was related to CAN knowledge in DAs (p = 0.012) and DHs (p = 0.008).

CONCLUSION

The lack of appropriate knowledge regarding CAN necessitates a clear reporting process and better education for DAs and DHs in the UAE.

Knowledge, Attitude, and Practices of Dental Practitioners Regarding Domestic Violence in Pakistan

Domestic violence is a complex social issue worldwide that includes a wide range of physical, sexual, psychological, economic, or emotional trauma to a child or adult. A large proportion of domestic violence cases remain unreported or undocumented. Dentists can play an important role in identifying and reporting these cases, but no such local study is available assessing the dental practitioners' attitudes and knowledge of evaluating physical abuse in Pakistan. The objective of this study was to assess the knowledge and practices of dental practitioners of Pakistan about domestic violence. This cross-sectional study was carried out over 2 months, among 330 dentists across Pakistan, selected by convenience sampling technique. Data was collected via a pre-validated online questionnaire, filled anonymously after taking informed consent. The survey questionnaire collected data about dentists' demographics, awareness, and experiences about domestic violence cases via close-ended questions. Only 10.6% of participating dentists received formal training in the management of domestic violence cases. Approximately 55% of participants knew that physical abuse should be reported in all circumstances; however, half of them could not accurately identify the legal authorities where suspected cases should be reported. Only 20% of the participating dentists had ever suspected a case of physical abuse and 30% of those actually reported it to legal authorities. Participants characterized fear of anger from relatives as the most significant barrier toward reporting suspected cases. The analysis revealed that Pakistan's dentists lack adequate knowledge regarding domestic violence in terms of identification, relevant physical signs/symptoms, and social indicators. Dentists of Pakistan had insufficient knowledge about the identification, management, and reporting of domestic violence cases. However, formal training and dentists' qualification were positively associated with overall awareness and practices regarding domestic violence case management.

Reporting of child physical abuse by a group of Brazilian primary care health professionals and associated factors

BACKGROUND

Evidences points to the importance of health professionals to recognize child abuse, but also to a high frequency of underreporting, even in countries where reporting is mandatory, like Brazil.

OBJECTIVE

To evaluate the frequency of non-reporting behavior of child physical abuse (CPA) among Brazilian primary care health professionals who recognized some cases in their careers and associated factors with reporting.

METHODS

Cross-sectional study conducted with a representative sample of dentists, nurses, family physicians, and pediatricians from the Family Health Strategy network in the city of Belo Horizonte, Brazil. A validated self-administered questionnaire for use in Brazil was applied in-person to professionals in 2014 and 2015. Pearson's chi-squared test (p < 0.05) and a binary logistic regression model was used.

RESULTS

A total of 715 professionals participated (response rate: 98.89%), 414 (57.3%) recognized cases, of which 171 (41.3%) reported. Reporting was associated with the type of profession, as pediatricians reported cases more than dentists [OR = 6.05 (95% CI: 1.24-29.50)], with the willingness to become involved [OR = 2.01 (95% CI: 1.02-3.97)] and knowledge regarding where to report cases [OR = 2.68 (95% CI: 1.25-5.74)]. Confidentiality was the barrier associated with a lower probability of reporting CPA cases [OR = 0.22 (95% CI: 0.08-0.66)].

CONCLUSIONS

There is a high frequency of non-reporting behavior. Pediatricians reported more CPA cases, followed by family doctors and nurses. Dentists were those who reported fewer cases. Reporting was also associated with a willingness to be involved in detecting/reporting abuse and knowing where to report CPA.

Role of a Dentist in the Diagnosis of Child Abuse and Neglect: A Literature and Narrative Review

Background:

Child Abuse (CA) is defined as any physical or psychological harm inflicted upon children. The most commonly affected anatomical region in these cases is the orofacial complex, thereby placing dentists in a dominant position for detecting CA. The statistical figures referred to CA are high, and many cases go unreported.

Objective:

To determine the level of knowledge, the aptitudes and capacity of dentists in reporting cases of CA; the barriers facing the reporting of cases; and the key clinical characteristics for the detection of CA.

Methodology:

A search was made of the PubMed (MEDLINE), ScienceDirect, LILACS and SciELO databases for articles published up until March 2019, involving analytical observational and descriptive studies relevant to the objectives of our study. All articles were independently reviewed by two authors.

Results:

Injuries caused by CA are largely located in the orofacial region – the most prevalent being caries, burns and fractures. The most frequently identified risk factor is behavioral alterations on the part of the parents or caregivers. The reviewed studies reflect a discrepancy between suspected and reported cases of CA.

Conclusion:

Although dentists are able to detect injuries, there is a great lack of knowledge about how to report cases of CA to the authorities. It is interesting to establish guidelines for the detection and reporting of suspicious cases. Improved training in forensic and legal dentistry is needed, together with the establishment of detection and reporting protocols. The clinical signs detected in the case of CA and neglect include untreated caries, poor oral hygiene, traumatisms, burns, lacerations and biting. The recognition of such signs and correct case history compilation are essential for the detection of CA.

Dentists' intention to report suspected violence: a cross-sectional study in eight Arab countries

OBJECTIVES

This study assessed dentists' intention in eight Arab countries to report suspected exposure to violence among patients and factors associated with this intention based on the theory of planned behaviour.

METHODS

A cross-sectional study was conducted in 2016 including a convenience sample of dentists practising in public, private and academic sectors in Algeria, Egypt, Jordan, Kuwait, Libya, Palestine, Saudi Arabia and Yemen. Respondents answered a self-administered questionnaire collecting information about personal and professional background and perceived ability to identify victims of violence. The questionnaire assessed (on a scale from 1 to 10 using six negative statements) dentists' perception of healthcare system mandated reporting of suspected violence. Six statements were used to assess professional attitude towards reporting suspected violence. Logistic regression was used to assess the association between intention to report suspected violence and perceived ability, perception and attitude adjusting for confounders.

RESULTS

The response rate was 65.2% (n=2936/4506) from general practitioners (70.9%) of mean age=31 years with 56.7% women. Of those, 68.8% intended to report and 52.2% considered themselves able to identify violence victims. The mean (SD) negative perception score=5.3/10 (2.1) and the mean (SD) professional attitude score=7.5/10 (1.9). In multivariate regression, intention to report was associated with professional attitude (OR 1.08, 95% CI 1.03 to 1.14), ability to identify violence victims (OR 1.76, 95% CI 1.45 to 2.12) and negative perception that reporting is not mandated (OR 0.89, 95% CI 0.85 to 0.94). Significant differences existed among countries in intention to report.

CONCLUSION

Most dentists intended to report suspected violence and their intention could be explained by the theory of planned behaviour which offers a framework for professional development to support violence victims. Sharing of training resources, policies and guidelines is needed to ensure that practices similar to international guidelines are consistently adopted by dentists across Arab countries.

Assessment of knowledge and attitudes of dental students in regard to child abuse in Turkey

INTRODUCTION

Child abuse is a serious public problem. Signs of abuse are often present in the oro-facial region and dentists are in a strategic position to recognise and report suspected cases. The aim of this study was to investigate dental students' knowledge about and attitudes towards child abuse.

MATERIAL AND METHODS

This study was performed at the Faculty of Dentistry of the Ondokuz Mayis University. The data were collected through a self-report questionnaire administered to dental students (137 female/111 male) in three different dental classes (third, fourth and fifth study years) and grouped by considering those students who have been training in the school year of 2013. The definition of physical and social indicators of abuse, awareness regarding legal and ethical responsibilities, students' experience and requests made by students were evaluated by the students' response to questions put in the questionnaire. Descriptive statistics and chi-square tests were performed to analyse the questionnaire data.

RESULTS

The questionnaire completion rate was 100%. About 67.74% of the third year, 40.71% of the fourth year and 16.67% of the fifth year believed that they could detect child abuse cases. However, results indicated a major lack of knowledge of social indicators, signs of physical abuse and reporting procedure amongst all respondents. The assessment of the total correct answers exhibited significant differences amongst third-, fourth- and fifth-year students' answers. Fifth-year students had the highest rate of correct responses (P < 0.05). Most students wanted to receive more knowledge about this topic.

CONCLUSION

Dental students in Turkey are not sufficiently prepared for their role in diagnosing suspected cases of child abuse.

Violence against children in Latin America and Caribbean countries: a comprehensive review of national health sector efforts in prevention and response

Background

Violence against children (VAC) remains a global problem. The health sector has an opportunity and responsibility to be part of the multi-sector collaboration to prevent and respond to VAC. This review aimed to assess the health sector’s response to VAC among Latin American & Caribbean (LAC) countries, particularly as it relates to physical violence, sexual violence, and neglect.

Method

National protocols for the identification and provision of health care to child survivors of violence, abuse and neglect were solicited in partnership with UNICEF and PAHO/WHO country offices within the LAC region. A parallel systematic review was undertaken in January 2015 to review studies published in the last 10 years that describe the regional health sector response to VAC.

Results

We obtained health sectors guidelines/protocols related to VAC from 22 of 43 (51 %) countries and reviewed 97 published articles/reports that met the review inclusion criteria. Country protocols were presented in Spanish (n = 12), Portuguese (n = 1), and English (n = 9). Thematic areas of country protocols included: 1) identifying signs and symptoms of VAC, 2) providing patient-centered care to the victim, and 3) immediate treatment of injuries related to VAC. The systematic review revealed that health professionals are often unaware of national protocols and lack training, resources, and support to respond to cases of VAC. Further, there is limited coordination between health and social protection services.

Conclusions

VAC remains an international, public health priority. Health professionals are well-positioned to identify, treat and refer cases of VAC to appropriate institutions and community-based partners. However, poor protocol dissemination and training, limited infrastructure, and inadequate human resources challenge adherence to VAC guidelines.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3562-3) contains supplementary material, which is available to authorized users.

Knowledge, attitudes, and behaviors of dentists regarding child physical abuse in Jeddah, Saudi Arabia

A large proportion of child physical abuse cases go undocumented and unreported. Dentists can play an important role in identifying and reporting these cases, but little has been reported about this issue in Saudi Arabia. The aims of the study were to (1) assess dentists' knowledge of child physical abuse, (2) assess dentists' attitudes towards child physical abuse, and (3) assess the behaviors of dentists in identifying and reporting child physical abuse. A cross-sectional survey of pediatric dentists, pediatric dentistry residents, and dental interns practicing at all of the dental schools in Jeddah, Saudi Arabia was conducted using an anonymous, self-administered questionnaire. The participants in current study demonstrated insufficient knowledge of the signs and symptoms of child physical abuse, actions that should be taken in suspected cases, circumstances in which to report such cases, and the legal authorities to which they should be reported. The attitudes of participants towards detecting and reporting cases were generally positive. Only 11% of the participants had suspected a case of child abuse, and only 3% of them reported it. Lack of knowledge about referral procedures and fear of anger from family members were the main causes of underreporting. In conclusion, this study showed that dentists have insufficient knowledge about child physical abuse but positive attitudes towards their role in detecting and reporting it. This topic should be covered and emphasized in dental schools' curricula, and healthcare and academic institutes must have a clear protocol to be followed if a case of abuse is suspected.

Croatian dentists' knowledge, experience, and attitudes in regard to child abuse and neglect

BACKGROUND

Child abuse and neglect (CAN) is a widespread social phenomenon encompassing all forms of maltreatment with serious lifelong consequences. Dentists and dental team members are in the unique position to identify the symptoms of CAN often visible in craniofacial region.

AIM

To evaluate Croatian dentists' level of knowledge, experience, and attitude towards CAN issue.

DESIGN

Investigation was conducted in five major Croatian cities (Zagreb, Varaždin, Osijek, Rijeka, and Split). A previously used questionnaire regarding knowledge and experience in child protection was adopted to Croatian terminology and distributed to 544 dentists.

RESULTS

A total of 510 dentists who returned a questionnaire with valid data 26.27% reported to have had suspicion of CAN during professional career and 5.1% reported their suspicion within the last 6 months, mostly to social services and police. Fear of violence towards the child and uncertainty about observations were the most frequently reported barriers towards referring and only 11.4% knew the procedure. About 80% of respondents want further training in identifying and reporting of physical abuse.

CONCLUSIONS

Study showed a lack of knowledge and uncertainty in recognizing and reporting CAN cases in Croatian dentists. They expressed the need for undergraduate and post-graduate continuing education on this issue.

Child abuse: Cross-sectional survey of general dentists

BACKGROUND

Child abuse continues to be a social menace causing both physical and emotional trauma to benevolent children. Census has shown that nearly 50-75% of child abuse include trauma to mouth, face, and head. Thus, dental professionals are in strategic position to identify physical and emotional manifestations of abuse.

AIM

A cross-sectional survey was undertaken to assess knowledge and attitude of dental practitioners regarding child abuse and to identify the barriers in reporting the same.

METHODS

With prior consent, a 20-question survey including both multiple choice and dichotomous (Yes/No) questions was mailed to 120 state-registered general dentists, and the data collected were subjected to statistical analysis.

RESULTS

Overall response rate to the questionnaires was 97%. Lack of knowledge about dentist's role in reporting child abuse accounted to 55% in the reasons for hesitancy to report. Pearson chi-square test did not show any significant difference between male and female regarding reason for hesitancy to report and legal obligation of dentists.

CONCLUSION

Although respondent dentists were aware of the diagnosis of child abuse, they were hesitant and unaware of the appropriate authority to report. Increased instruction in the areas of recognition and reporting of child abuse and neglect should be emphasized.

Dentist attitudes and responsibilities concerning child sexual abuse. A review and a case report

According to the World Health Organization, child abuse and neglect is “every kind of physical, sexual, emotional abuse, neglect or negligent treatment, commercial or other exploitation resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power”. The aim of the present report is to inform about the most relevant aspects of child abuse and the characteristics of injuries to the head, neck, and orofacial regions, in addition to the suggested role of, and management by, the dentist for the evaluation of this condition, and also for reporting a case of a physically and sexually abused girl aged 5 years 8 months. Throughout the appointments, some type of abuse in this patient was suspected by the treating dentists at the clinic, mainly due to the initial behavior exhibited by the patient in the dental chair. Based on the clinical diagnostic an intensive preventive plan and restorative treatment was realized. The timely detection of the signs and symptoms of sexual abuse, often present in the orofacial region, place the pediatric dentist in a strategic situation, with the capacity to recognize, register, and later report those cases considered as suspect, including the dental treatment delivered and the intensive behavioral-psychological management, in order to achieve acceptation by the otherwise very anxious patient of the indicated restorative and preventive dental procedures.

Key words:Child abuse, dentistry, behavior management.

[Cross-cultural adaptation and reproducibility of a questionnaire to assess the knowledge and attitude of health professionals in cases of child physical abuse]

The scope of this study was to conduct cross-cultural adaptation and evaluate the reproducibility of a questionnaire designed by a team from the University of London to assess knowledge and attitudes of health professionals during primary care when faced with cases of child physical abuse. The translation rigorously followed the criteria described by Herdman (1998), to maintain maximum functional equivalence. The adapted questionnaire was tested on 107 health care professionals from Belo Horizonte. Standard and Weighted Kappa tests were used to evaluate the reproducibility of the instrument. Most of the questions achieved Kappa test values above 80% (excellent). The Brazilian version of the questionnaire was, therefore, adapted and had proven reproducibility.