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AAP warns that oral, dental injuries may indicate child abuse
Pediatric and dental providers are encouraged to collaborate in documenting and reporting suspicious oral/dental injuries and diseases that may be indicative of child maltreatment, according to a recent report from the AAP Section on Oral Health and the Committee on Child Abuse and Neglect.
“It is important for all health care providers, including dental providers, to be alert to and knowledgeable about signs and symptoms of child abuse and neglect and to know how to respond,” Susan A. Fisher-Owens, MD, MPH, FAAP, from the departments of pediatrics and preventive and restorative dental sciences from the University of California, San Francisco, and colleagues wrote. “Because different communities have different resources, not all providers of a certain job specification may be available everywhere, and thus, job roles may sometimes overlap.”
To examine the oral and dental aspects of abuse in children, and to assess the role that pediatric and dental care providers play in prevention and treatment, the researchers discussed injuries, infections and diseases that may arise due to neglect and/or physical or sexual abuse.
According to the Fisher-Owens and colleagues, over 50% of abuse cases involve craniofacial, head, face and neck injuries, which should be assessed by appropriate care providers, in addition to oral trauma, carries, gingivitis and other oral health problems. The researchers suggest that abuse may result in contusions; burns, lacerations of the tongue, lips buccal mucosa, soft and hard palate, gingiva, alveolar mucosa or frenum; fractured, displaced or avulsed teeth; or facial bone and jaw fractures. All should be reported for investigation if reasonable suspicion is found.
Sexual abuse in children commonly involves the oral cavity; however, infections and injuries are rarely visible. Universal testing for sexually transmitted infection is controversial, so risk factors should be considered first, including chronic abuse or a perpetrator with a known infection. Additionally, unexplained injuries to the petechiae of the palate, especially where the hard and soft palate meet, may be a result of forced oral sex. If abuse is suspected, it must be reported to child protective services and/or law enforcement.
Fisher-Owens and colleagues suggest the following actions be taken by health care providers and dentists concerning abuse:
- Health care providers, including dental providers, are required to report injuries that are concerning for abuse or neglect to child protective services in accordance with local or state legal requirements.
- Sexual abuse may involve the mouth, and thus, health care providers should know how to collect a history to elicit this information, as well as how to appropriately collect lab tests to support forensic investigations.
- Bite marks found on skin are challenging to interpret because of the distortion presented and the time elapsed between injury and analysis. The pattern, size, contour, and color of the mark should be evaluated by a forensic odontologist.
- Health care providers are encouraged to ask their patients about bullying and advocate for antibullying programs.
- Health care providers should be aware of the risk factors for human trafficking, identify victims among their male and female patients, safely connect the patients to resources and advocate for antitrafficking efforts.
- If parents fail to obtain therapy after barriers to care are addressed, the case should be reported to the appropriate child protective services agency as concerning for dental neglect.
- Providers are encouraged to work with colleagues to provide support to families if any maltreatment has occurred. — by Katherine Bortz
Disclosure: The researchers provide no relevant financial disclosures.
