Diagnosis of Child Abuse in Pediatric Dentistry – a Case Report

Abstract

Trauma to the teeth and the oral cavity is a common reason for a patient to seek dental assistance. Apart from accidental damage, a doctor may come across injuries resulting from an intentional action. To diagnose the so-called non-accidental injuries is not easy and requires careful examination with special attention paid to a detailed history directed at the circumstances in which the injury was sustained. Such data should be collected both from a child and their caregivers. Moreover, a careful physical examination is necessary and -very often -accessory investigations. Risk factors and social data should also be considered.The term "child abuse" comprises four categories: physical abuse, sexual abuse, emotional abuse, and neglect, i.e. abandonment of the child's care. These types of child abuse are usually concurrent. Victims of sexual abuse may also be small children who cannot defend themselves due to physical weakness, fear, difficulty to communicate and lack of awareness. Although sexual abuse occurs commonly in the oral cavity, the signs are not always visible or easy to observe. The role of a dentist in diagnosing the effects of abuse is not a simple one and involves great professional and social responsibility. A doctor's reaction should not only involve implementing treatment but also reporting the case to specific institutions in order for them to take action in the situation a child experiences and to prevent recurrence AbstractThe paper highlights the dentist's role in detecting child abuse, as well as the necessity to create a system of medical and legal support in such situations. On the basis of the presented case of sexual abuse, showing itself in the oral cavity, we want to emphasize the duty of the dentist team to take action in the situation a child experiences, and to prevent a recurrence. A patient aged 5 years old reported to the Department of Pediatric Dentistry, University of Medical Sciences to have her teeth treated. During the physical examination performed on the day the patient reported to the clinic, bruising was noted around the upper lip. The girl confessed she was kissed by a drunk neighbor, which resulted in the lip discoloration. Following an appropriate conduct procedure, the dentist informed the police who initiated explanatory proceedings. Identification of sexual abuse victims and providing help is a duty of the dentist, apart from treating oral diseases. It is important to develop standard procedures for medical professionals of various specialties as well as programs and procedures for administrative units and the national legal system (Dent. Med. Probl. 2016, 53, 2, 296-298).

Orofacial signs of child or adolescent maltreatment identified by dentists and dental hygienists: A scoping review

“…A single orofacial sign at a single location was rare and only described in two reports. 51,52 In terms of sex distribution among victims with orofacial signs, females were slightly overrepresented. Four studies, however, did not categorize abuse signs based on the sex of the victims.…”

“…In these dental settings, physical abuse was identified by a wide variety of orofacial signs in all orofacial regions, whereas sexual abuse was identified exclusively in the mouth and on the lips. 51 Emotional abuse and general neglect were only identified in combination with other forms of child maltreatment. Dental neglect was described within the largest cumulative sample (n = 1296).…”

“…68 The most commonly described intraoral signs of sexual abuse were warts (condyloma acuminata), in three studies, 24,63,64 typically located in the labial mucosa, interproximal gingiva at the dorsal surfaces of the posterior tongue, and palate. Two studies 51,64 reported bruises of the oral mucosa or lips because of child sexual assault.…”

Child sexual abuse as an etiological factor of overweight and eating disorders — considerations for primary health care providers

“…With regard to dental profession, visible oral signs of this type of abuse are considered rare [2,20,21]. In cases of oral gonorrhea or human papillomavirus warts, injuries or petechiae of the palate, oro-genital contact might be suspected [22].…”

“…In cases of oral gonorrhea or human papillomavirus warts, injuries or petechiae of the palate, oro-genital contact might be suspected [22]. Bite marks or suction-type bruises in an ovoid pattern may be also related with CSA [20][21][22].…”