Year : 2007 | Volume
: 25 | Issue : 4 | Page : 191--193
Primary identification of an abused child in dental office: A case report
JF Santos1, AL Cavalcanti2, KS Nunes1, EC Silva1,
1 Faculty of Dentistry, Centro Universitario do Triangulo, Uberlandia, MG, Brazil
2 Faculty of Dentistry, State University of Paraiba, Campina Grande, PB, Brazil
A L Cavalcanti
Avenida Manoel Morais, 471/802 Manaira, 58038-230 Joćo Pessoa, PB
Although the injuries of child abuse are many and varied, several types of injuries are common to abuse. Many of these injuries are within the scope of dentistry or easily observed by the dental professional in the course of routine dental treatment. The authors present a case of child abuse with multiple bruises. The child had been spanked in the previous night and the morning of the attendance by his mother. This case emphasized that all practitioners should be vigilant when patients present with abnormal injuries which may be the result of abuse and further investigation should be instigated.
|How to cite this article:|
Santos J F, Cavalcanti A L, Nunes K S, Silva E C. Primary identification of an abused child in dental office: A case report.J Indian Soc Pedod Prev Dent 2007;25:191-193
|How to cite this URL:|
Santos J F, Cavalcanti A L, Nunes K S, Silva E C. Primary identification of an abused child in dental office: A case report. J Indian Soc Pedod Prev Dent [serial online] 2007 [cited 2013 Jun 19 ];25:191-193
Available from: http://www.jisppd.com/text.asp?2007/25/4/191/37017
In recent years, the community has become increasingly aware of the problem of child abuse in society. Child abuse is prevalent in every segment of society and is witnessed in all social, ethnic, religious and professional strata. 
Maltreatment of children includes physical, sexual or emotional abuse as well as child neglect. Physical abuse can be defined as any nonaccidental injury or trauma to the body of a child inflicted by a parent, guardian or sibling. It can either be the result of an occasional trauma or of a continuous behavior pattern. Examples include whipping, biting, burning, scalding and severe shaking. 
It is sometimes difficult to distinguish accidental injury from abuse or to distinguish abuse from diseases and other conditions that produce similar signs. 
The indicators that may be noticeable to the dental professional include trauma to the teeth and injuries to the mouth, lips, tongue or cheeks that are not consistent with an accident.  Other common signs of child abuse include fractures of the maxilla and mandible and oral burns. Injuries to the upper lip and maxillary labial frenum may be a characteristic in severely abused young children. 
When an individual is attacked for whatever reason, the head, neck and facial areas are often involved. Dental professionals are in a unique position to identify possible cases of child abuse and neglect. Dental care providers are more likely to see evidence of physical abuse than are the other health care workers, as it has been reported that orofacial trauma is present in approximately 50-75% of all reported cases of physical child abuse.
Whenever suspicions of child abuse arise, a routine protocol should be followed, which includes questions about patient history and how the accident occurred, and all relevant information should be documented with radiographs, photographs and impressions when necessary. 
This paper describes a case of child abuse, which was diagnosed at dental office.
A 9-year-old boy presented with his mother to the Dental Department at the Centro Universitario do Triangulo, Uberlandia, Minas Gerais, Brazil, for routine evaluation and treatment.
The boy had severe bruises on his face, neck, back, arms, elbows, wrists, buttocks, knees and ankles [Figure 1],[Figure 2],[Figure 3].
On questioning the child, it was evident that he had been spanked in the previous night and in the morning of the attendance by his mother with a belt. We reported the case to a social worker and counseling of the patient's mother was carried out.
Bruising is the most common injury in physical child abuse. Abusive bruises often carry the imprint of the implement used. These include single or multiple linear bruising due to being struck with a rod-like instrument, banding where the hand has been tied and an imprint of the implement such as an electrical cord or studded belt. 
When a child is seen with bruises, it is a professional responsibility to determine whether these injuries are consistent with the history and the child's age, development and level of activity. If they are not, child protection issues must be considered. 
It is obvious that all cases of child abuse should be detected as soon as possible. Therefore, dental health professionals have to be alert to a variety of physical and behavioral indicators to identify child abuse. If the dentist suspects physical abuse with a young patient, then he or she should have another dental staff member witness the injuries and assist in their documentation.
Although reports show that the majority of victims sustain head and neck injuries, few dentists recognize domestic violence as a problem that their patients encounter and fewer have protocols in place to facilitate intervention. Reasons commonly cited for dentists' failure to report are lack of education about the signs and symptoms of abuse and neglect, ignorance of the reporting procedure and concern about making a false accusation and disrupting the dentist's relationship with the family. 
Recognizing the wider environmental and family contexts, within which children are growing, could lead to more effective preventive work to protect vulnerable children and the delivery of appropriately targeted services for children in need. 
Dentists who treat children or are interested in aiding the prevention of child abuse and neglect certainly have several options. The staff can be trained to recognize and report suspected abuse. Attending a presentation on child abuse recognition may be helpful. Another suggestion is to provide literature, posters, handouts, etc. in the reception room to assist in educating parents. Information also is available for spousal and elder abuse. The local child abuse prevention council has a number of resources and training courses for those who want to become a volunteer community educator. Those volunteers speak to local groups such as childcare providers and pre-school teachers. 
The involvement of dentists in child protection teams would be beneficial in two ways: dentists would become aware of their role and would assist in the training of physicians and other professionals. In turn, non-dental practitioners would benefit from consultations with dentists in the evaluation of physical and sexual abuse or neglect, especially those dentists who have experience or expertise with children. 
Parents spank their children because it's a "quick fix" for them. But it results in a lot of psychological problem for the child when he/she becomes an adult. Parents should be encouraged and assisted in developing methods other than spanking in response to undesired behavior.
Reported cases of child abuse and corporal punishment, both new and under management and treatment, require continual monitoring. It is becoming increasingly important for dentists to recognize some of the more obvious manifestations of physical abuse.
|1||Naidoo S. A profile of the oro-facial injuries in child physical abuse at a children's hospital. Child Abuse Negl 2000;24:521-34|
|2||Swaelen K, Willems G. Reporting child abuse in Belgium. J Forensic Odontostomatol 2004;22:13-7|
|3||Carpenter RF. The prevalence and distribution of bruising in babies. Arch Dis Child 1999;80:363-6|
|4||Cavalcanti AL. Child abuse: Oral manifestations and their recognition by dentists. Rev Odontol UNICID 2003;1:123-8.|
|5||Sibbald P, Friedman CS. Child abuse: Implications for the dental health professional. J Can Dent Assoc 1993;59:909-12|
|6||Sfikas PM. Does the dentist have an ethical duty to report child abuse? J Am Dent Assoc 1996;127:521-3.|
|7||Sidebotham P, Heron J. ALSPAC Study Team. Child maltreatment in the "children of the nineties": A cohort study of risk factors. Child Abuse Negl 2006;30:497-522|
|8||Spencer DE. Child abuse: Dentists' recognition and involvement. J Calif Dent Assoc 2004;32:299-303|
|9||Cairns AM, Mok JY, Welbury RR. Injuries to the head, face, mouth and neck in physically abused children in a community setting. Int J Paediatr Dent 2005;15:310-8|