Child Abuse: Dentist as Oral Physician

Dr Mandeep Kaur
Child abuse (CA) is defined as those acts or omissions of care that deprive a child from the opportunity to fully develop his/her unique potentials as a person either physically, socially or emotionally. Child abuse is not limited to certain social class. In the middle- to lower-class society, many CA are often caused by poverty. There are five factors that trigger CA, namely moral degradation, abnormal nurturing pattern, media exposure, low level of economy, and low level of education. There are 4 major types of CA, physical abuse, sexual abuse, emotional abuse, and neglect. Dentist has a strategic position to identify and report children who experienced CA since he/she often observes interaction between children and parents/caregiver during treatment visit and in a long period of time.
Physical abuse
Physical abuse is a physical injury experienced by children, not caused by accidents. Craniofacial, facial, head and neck injuries are found in more than a half of CA cases. Careful intraoral and perioral examination is needed in every suspect of CA. Dental practitioners are able to identify physical evidence of injuries to children, especially in the head and neck region and oro-facial structures. When such injuries are of suspicious origin, the dentist has an obligation to document and report his/her findings to appropriate authorities so that proper action may be taken to protect the child while the problem is investigated.
Sexual abuse
The acts can be called sexual abuse if the one who does the act is the caregiver, family members, father, mother, nanny, or teacher, either at home or outside the child’s house. Oral cavity is one of the locations of sexual abuse often found in children. The existence of gonorrhea or syphilis in the oral or perioral region in prepubertal children is one of the signs of sexual abuse. Cement detection in the child’s oral cavity can be performed in a few days period after the abuse. Therefore, during an investigation towards a child who is suspected as a victim of sexual abuse, cotton swab should be performed to get the buccal mucosa and tongue smear. Erythema or petechiae, especially in the junction between soft and hard palate can become a proof of forced oral sex action. Bite marks are also a visual expressions of active child abuse. Bite marks should be suspected as the signs of echymoses, abrasion, or laceration in elliptical or ovoid patterns.
Emotional abuse
It is defined as every attitudes or behaviors that can disturb mental health or social development of a child. Emotional abuse does not leave trauma signs on the child’s body, but it leaves psychological trauma on the child. The children become scared of everything, apathetic, depressed or rebellions. If this situation keeps going on, it can create serious behavior disorders, cognitive disorders, emotional or mental disorders for the children. Dentist should be able to recognize signs in children who are the victims of emotional abuse and apply appropriate new approaches.
Neglect is an ignorance towards the child either in the form of nurturing, supervising, care, and education that can cause destructive effect on the child’s physical condition and his/her psychological development. In the dentistry area, a dental neglect is a part of physically neglect. Dental neglect can be seen as the appearance of caries, periodontal disease, and other oral cavity diseases. The dentist should be certain that the caregivers understand the explanation of the disease and its implications. If, despite these efforts the parent is fail to obtain therapy, the case should be reported to appropriate child protective services.
Prevention of child abuse
Children are a nation’s next generation. Therefore, CA should be prevented because it can affect the long life process of a child. The dentist should look at overall hygiene as well as dental hygiene and adequacy of clothing. Suspicion of poor nutrition, apparent lack of medical care, and absence of previous dental care are situations that should alert the dentist to consider neglect.
(The author is Assistant Professor Dept of Oral Pathology & Microbiology Indira Gandhi Govt Dental College, Jammu)