Dental neglect

Until January 2015 Martyn gave lectures about child protection to dentists and Dental Care Professionals in the south west. While he is in no doubt there is a greater awareness of child protection because of tragic cases such as Victoria Climbie and Baby P, he worries that some dental professionals are still reluctant get involved.

One complex aspect of child protection that causes particular difficulty is dental neglect. It was recognised by NICE in 2009that 'when parents persistently fail to obtain NHS treatment for their child's tooth decay' it should prompt healthcare professionals to consider whether the child is being neglected.² Dental neglect is defined by the British Society of Paediatric Dentistry 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'.³ It's often hard, at least initially, to determine whether advanced dental disease in children has been caused by ignorance, poor parenting, being unable to cope, or something more sinister. Dental professionals should consider each case in the context of factors like access to dental treatment and the impact on the patient.

'The term dental neglect should be reserved for the failure to respond to a known significant dental problem or persistently and deliberately ignoring advice,' explains Martyn. 'For example, if a child has an abscess and you refer them to local hospital but they don't attend - it's up to you to follow up and find out why. If the family say they didn't receive the appointment or the car broke down, that is unfortunate. But if they clearly couldn't be bothered, you should consider dental neglect.

'We should be alert to signs that the parents are struggling to cope,' he adds. 'A common failing among all dental professionals is that we only look at the teeth but child protection shows the importance of a more holistic approach.'

Identifying abuse

Besides dental neglect, dental professionals might also encounter victims of physical, emotional and sexual abuse during their career. Martyn warns against preconceptions about the types of families where abuse takes place. 'There are risk factors for child abuse such as alcoholism, domestic violence and mental illness, but it's wrong to think that abuse is confined to any particular socioeconomic group. It's also much more common than you'd think. I have raised concerns a couple of times during my career but there may have been other children who were victims and I didn't know.'

Child Protection and the Dental Team gives examples of possible non-accidental injuries that are suggestive of abuse, such as frenum tears in non-ambulant babies and blunt trauma resulting in damage to the permanent or primary teeth. It also sets out three stages in the assessment of any physical injury - evaluating the injury itself, taking a history and exploring the broader picture (for example, the child's behaviour or the parent-child interaction).

Bear in mind also that abusers are often adept at covering their tracks and may delay bringing children for an appointment. Any delay in attendance following an accident should therefore be regarded as a warning sign.

If a child presents with an injury, Martyn recommends asking open questions rather than interrogating the child or parent. 'For example, say to a young child, 'that's an interesting bruise, how did you do that?', not, 'did daddy hit you'? Does the explanation fit the injury? Why was there a delay in coming for treatment?

'Child protection should be a team effort'

'Child protection should be a team effort'