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

Orofacial signs of child or adolescent maltreatment identified by dentists and dental hygienists: A scoping review

BACKGROUND

Child maltreatment, the abuse or neglect of children aged 0-18 years, is a severe and underreported global problem. Compared with other body parts, the orofacial region displays more signs of child maltreatment. Dentists and dental hygienists are therefore well situated to identify orofacial signs of child maltreatment.

AIM

To map the current literature on orofacial signs of child maltreatment identified by dentists or dental hygienists.

DESIGN

A scoping review was conducted based on systematic searches of Medline (Ovid), Embase (Ovid), and CINAHL (EBSCOhost) for primary qualitative and quantitative studies through June 6, 2022.

RESULTS

Twenty-nine studies were included in this scoping review. Though all child maltreatment types were identified in dental settings, physical abuse and dental neglect were most commonly identified. Reports of caries dominated the orofacial signs, followed by bruises (intra- and extraoral), poor oral hygiene, dental trauma, and lacerations (intra- and extraoral). Case reports were used most commonly to describe orofacial signs of child maltreatment.

CONCLUSION

Dental clinicians identify orofacial signs of all child maltreatment types intraorally. Dentists identify the same extraoral signs as do other healthcare professionals, with bruising being the most common.

Knowledge, awareness and attitude of dental professionals regarding child maltreatment

BACKGROUND

Dental professionals could play a significant role in identifying, documenting and reporting child maltreatment to appropriate authorities as children are exposed to various maltreatments that can present in the head and neck region.

AIM

The aim of this paper is to assess the level of knowledge, awareness and attitude among dental professionals regarding child maltreatment and to identify the barriers that prevent reporting suspected maltreatment.

METHODOLOGY

The present cross-sectional questionnaire-based study was conducted on dental professionals practising in India by emailing a self-structured questionnaire to assess knowledge, awareness and attitude regarding child maltreatment.

RESULTS

422 dental professionals participated in the survey of which 270 were females. A significant difference was observed in mean knowledge (p=.015), awareness (p=.014) score of the participants with regard to place of work and mean knowledge score (p=.024) of the participants with regard to educational qualification. 300 participants reported that lack of adequate knowledge and awareness about the role of dental professionals regarding child maltreatment is one of the major barriers that prevent reporting child maltreatment.

CONCLUSION

Findings of the study showed that 43.8% of participants had good knowledge and 44.8% were fairly aware regarding child maltreatment. 86.7% of participants showed a very good attitude towards learning more about the role of dental professionals in the management of child maltreatment.

Adaptation measures in dental care for children with history of Adverse Childhood Experiences: A practical proposal

Adverse Childhood Experiences (ACEs) such as maltreatment, abuse, or neglect can disrupt childhood development and increase the risk of health issues, including dental health. Such a vulnerable population frequently may deny dental treatment due to fear of intimate contact in the oral cavity, resulting in a vicious cycle that further leads to detrimental oral health. It is important for dentists, particularly pediatric dentists, to not only understand how to identify potential cases of abuse or maltreatment but also how to treat these patients so that the dental treatment does not become a negative experience. The purpose of this paper is to understand the psychological and physical implications of pediatric patients who have had ACEs and to identify the best methods to manage these patients during the dental treatment.

Impact of Alcohol Outlet Density on Reported Cases of Child Maltreatment in Japan: Fixed Effects Analysis

Background: Parental drinking habits or binge drinking are a known risk factor of child maltreatment. Though drinking habits are affected by alcohol outlet density, the direct association between alcohol outlet density and child maltreatment is still controversial.

Purpose: This study aimed to examine the impact of off-premises alcohol outlet density on child maltreatment cases reported to Child Guidance Centers in Japan.

Methods: A fixed effects model was used to investigate the association between a change in off-premises alcohol outlet density and a change in child maltreatment cases in each unit. Time-series of cross-sectional ecological data collected from across Japan over 16 years (2000 to 2015) was used, and maltreatment cases were further sub-grouped by type of maltreatment (physical, sexual, psychological abuse and neglect) and by perpetrators (father, stepfather, mother, and stepmother).

Results: The association between alcohol outlet density and total cases of child maltreatment was not observed (coefficient = 0.98, 95% confidence interval: −6.30, 8.25). However, alcohol outlet density was shown to be positively associated with neglect (coefficient = 3.08, 95% confidence interval: 0.54, 5.62), which indicates that 1 alcohol outlet per 1,000 adults increase would lead to 3 more neglect cases per 10,000 children. Also, a negative association was observed between a change in the incidence of total child maltreatment by father and a change in alcohol outlet density (coefficient = −3.03, 95% confidence interval: −5.78, −0.28).

Conclusion: The findings suggest that off-premises alcohol outlet density may have a causal effect on the increasing cases of neglect and decrease in maltreatment by father in Japan.

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.