Do you see what I see? Identification of child protection concerns by hospital staff and general dental practitioners

Abstract

Aim An exploration of the threshold that dentists, doctors and nurses recognise for dental and child protection (CP) actions in sample clinical cases, and any differences between these professional groups.Method We present a cross-sectional survey of dentists, doctors and nurses (50 each), who regularly examine children, utilised five fictitious vignettes, combining an oral examination image and clinical history reflecting dental and CP issues. Demographics were collected, and each participant gave their likely action for the cases presented.Results Dentists were significantly better at answering the dental element than the doctors and nurses, (P <0.0001) with no significant difference between these two; only 8% of the latter had undergone any training in assessment of dental health. Although 90.6% of all professionals had undergone CP training, dentists were significantly less accurate at identifying the CP component than doctors and nurses, (P <0.0001) between whom there were no significant differences. Those with higher levels of CP training were most accurate at identifying correct CP actions.Conclusions CP training is effective at improving recognition of child maltreatment, although there remains a worrying lack of knowledge about thresholds for action among dentists. Doctors and nurses have minimal training in, or knowledge of, dental health in children, thus precluding appropriate onward referrals.

'Bridging the gap' – A survey of medical GPs' awareness of child dental neglect as a marker of potential systemic child neglect

“…(19) A finding of the study was that knowledge around physical signs of potential child abuse was poorer amongst dentists, who may miss the opportunity to identify signs (in addition to dental health) of neglect and child abuse. (19) As was echoed in the results of the GPs in this study, hospital Paediatricians and nurses, whilst more aware of systemic signs of child neglect and abuse, lack specific training in dental health and as a result may fail to raise poor dentition as a potential concern and marker for neglect. The paper concluded with the recommendation that all health professionals would benefit from collaborative training.…”

“…The belief that some GPs in this survey expressed, that teeth are not important to child health and welfare, lacks an awareness of the potential pain and suffering that children with neglected dental decay experience and their increased risk of potential long term health consequences both of a physical and psychological nature. (4,19) What is more, such a belief also underestimates the potential risk for the development of acute lifethreatening sepsis as a consequence of the development of dental abscess. (2,20).…”

“…(43) At a community level this may be reflected by the ubiquitous presence of dental neglect within the general population, which may have led in itself to the desensitization of health practitioners to its wider social and health consequences. This factor was expressed by a dentist who in a study stated that whilst dental disease in children may be marker of neglect; it can be ubiquitous in some financially deprived populations and as such, if every time they saw a child with dental disease, they considered child neglect, it would result in raising this as a concern in every patient they examined (19).…”

“…We would not accept any other unmet health need in a child in the UK and as is demonstrated in this study, the lack of compliance with immunisations raises concern unanimously in the GP population surveyed and yet somehow dental disease in children does not raise such equal concern and would appear socially and medically accepted. Dental caries is one of the most prevalent chronic diseases worldwide (2,40) Whilst the financial cost to the NHS of paediatric hospital admissions for dental extractions is extensive (19), the personal cost to children is arguably much greater and yet dental caries is preventable and treatable (2).…”

“…However, many children face inequalities in access to dental care in the UK and often children who live in greatest deprivation, experience higher levels of dental disease, coupled with the greatest barriers of access to the care that they require. (5) The consequence of severe dental disease includes pain, (18) sleep disruption, difficulty eating, school absence (19) and could also result in psychological abuse due to poor dental appearance (4) further exacerbating school absenteeism.…”