Safeguarding is everyone’s business and the dental team is uniquely placed to spot particular signs and symptoms of the abuse of children and vulnerable adults.

Definition of dental neglect

Dental neglect is defined as ‘…the persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development.’[1]

Indicators of dental neglect

Your concerns may centre around issues such as;

  • Irregular attendance and repeatedly failed appointments.
  • Failure to complete planned treatment.
  • Returning in pain at repeated intervals.
  • Requiring repeated general anaesthesia for dental extractions. Or maybe what you see or what you hear in the course of a routine appointment worries you.

Your worries might be heightened if;

  • there had been a delay in the presentation
  • discrepancies between the history and examination findings
  • developmentally inappropriate findings (does not fit with the age of the child)
  • previous concerns about the child or siblings.

Dental neglect may occur in isolation or may be an indicator of a wider picture of child maltreatment.

Abuse or neglect may present to your team in a number of different ways:

  • through signs and symptoms which are suggestive of abuse or neglect
  • or through observations of child behaviour or parent – child interaction
  • through direct allegation (‘disclosure’ made by child, parent or some other person)

It is worth recalling that the post mortem of Peter Connolly ( Baby P) who died aged 17 months revealed a broken back, eight broken ribs and a missing tooth, which he had swallowed.

Identifying possible abuse or neglect is a complex process requiring and understanding of normal child development, and knowledge of potential risk factors.

Dental History and examination

The Child protection and the dental team website provides some very useful information about history taking and examination.

More information here

”Assessing a child with an injury or with possible signs of abuse or neglect starts with a thorough history, including:

  • details from the child and carer of any injury or presenting complaint
  • past dental history
  • medical history
  • family and social circumstances including the household composition (particularly in relation to unrelated adults living in the household as research indicates that children living in households with unrelated adults, particularly males, often mother’s boyfriend, are at significantly higher risk of abuse and neglect).

A full examination should note in particular:

  • any dental, oral or facial injuries, their site, extent and any specific patterns
  • the general appearance of the child, their state of hygiene, whether they appear to be growing well or are ‘failing to thrive’
  • their demeanour and interaction with their parents or carers and others (e.g. look particularly for signs of ‘frozen watchfulness’ where the child seems to take in everything going on, but in a detached, wary or fearful manner.”

Research suggests many professionals feel unprepared for their safeguarding responsibilities. Whilst you are not responsible for making a diagnosis of abuse or neglect, you are responsible for passing on your concerns appropriately, which you can only do if fully informed.

We can provide a bespoke training package for your staff group, based on current best practice.

[1] British Society of Paediatric Dentistry: a policy document on dental neglect in children 2009

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