April 2017Vol. 18, No. 2Oral and Dental Aspects of Child Maltreatment

The oral and dental aspects of child maltreatment are the focus of a 2016 report from the American Academy of Pediatrics Committee on Child Abuse and Neglect and the American Academy of Pediatric Dentistry. The report reviews the oral and dental characteristics of physical abuse, sexual abuse, and dental neglect and how physicians and dentists can evaluate bite marks, oral injuries, infections, or diseases that might suggest child abuse or neglect. The report notes that physicians receive limited training in oral health and dental injury and, therefore, might not be as likely to detect the oral and dental symptoms of child maltreatment as readily as other physical symptoms. Pediatric dentists and maxillofacial surgeons are required to go through oral and dental-specific child maltreatment training and, as a result, can assist doctors in assessing related symptoms of potential child maltreatment. For example, pediatric and forensically trained dentists can assist physicians in identifying bite marks indicative of abuse and neglect. Physicians and dentists are encouraged to collaborate to increase prevention and detection of possible child abuse and neglect.

More than half of child maltreatment cases involve some injury to the head, face, or neck, according to the report, which recommends a thorough oral examination in all suspected cases of child maltreatment. Eating utensils, bottles, hands, fingers, scalding liquids, and caustic substances can all be used forcefully and maliciously to inflict oral damage. Providers should look for contusions, burns, or lacerations on the lips, cheek, tongue, palate, and gums and for discolored or infected teeth or gums.

The report calls upon pediatricians to be aware of oral and dental injuries as signs of potential maltreatment and the need for follow-up testing. Pediatricians are also encouraged to be aware of bite marks, document them carefully, and consult a pediatric or forensic dentist for appropriate testing, diagnosis, and treatment when questions arise. The report notes that children suspected to have been sexually abused may require specialized forensic testing and that forensic odontologists or pathologists may need to be consulted to evaluate bite marks or infection.

The report points to the Prevent Abuse and Neglect Through Dental Awareness (PANDA) coalition as an important resource for physicians, encouraging physicians with child maltreatment experience to make themselves available to dentists and dental organizations as educators and consultants.

Guideline on Oral and Dental Aspects of Child Abuse and Neglect is available at http://www.aapd.org/media/Policies_Guidelines/G_Childabuse1.pdf (95 KB).