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REVIEW ARTICLE  
Year : 2013  |  Volume : 3  |  Issue : 1  |  Page : 2-5
Child abuse and neglect: Role of dentist in detection and reporting


1 Department of Pedodontics and Preventive Dentistry, Saraswati Dental College, Lucknow, Uttar Pradesh, India
2 Department of Public Health Dentistry FODS, KGMU, Lucknow, Uttar Pradesh, India
3 Department of Pedodontics and Preventive Dentistry FODS, KGMU, Lucknow, Uttar Pradesh, India

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Date of Web Publication13-Feb-2014
 

   Abstract 

A literature search was conducted in MEDLINE (PubMed) and the Cochrane Central Register of Controlled Trials and Indian government website were conducted. In addition, reference lists of selected papers were hand searched for further relevant articles. The search was limited to articles and books in English. Different combinations of relevant keywords were used to identify articles. Child abuse is a condition that is often less identified. Abused child is deprived of its right, hence protecting children from maltreatment and neglect is part of the obligation of all health professionals. Dental professionals are in an exceptional position to identify and respond to these conditions. Therefore to create a child friendly community, it is prerequisite to transform not only the culture in which children are residing but also approaches and behavior toward them.

Keywords: Child abuse, dentist, society

How to cite this article:
Malhotra S, Gupta V, Alam A. Child abuse and neglect: Role of dentist in detection and reporting. J Educ Ethics Dent 2013;3:2-5

How to cite this URL:
Malhotra S, Gupta V, Alam A. Child abuse and neglect: Role of dentist in detection and reporting. J Educ Ethics Dent [serial online] 2013 [cited 2019 Dec 10];3:2-5. Available from: http://www.jeed.in/text.asp?2013/3/1/2/126934



   Introduction Top


It is thought-provoking that abuse and infanticide is existing over the centuries, but it is only recently due to change in social values have led to the identification of child abuse as a prevalent medico-social problem nationally and internationally. According to UNICEF [1] violence against children can be "physical and mental abuse and injury, neglect or negligent treatment, exploitation and sexual abuse." Child abuse is generally defined as non-accidental injury, sexual abuse, emotional abuse or trauma inflicted on a minor. [2]

Child abuse should be prevented, identified and reported with utmost urgency as child maltreatment is a cyclic disease with abused children often becoming abusive parents. [3]


   Consequences of Ghettoization of Disadvantaged Community Top


Polarization or assemblages of very disadvantaged individuals located in particularly deprived areas of towns, cities, or more rural areas with similar characteristics and backgrounds cause's substantial problems. A developmental-ecological framework of analysis for child abuse and neglect has recognized that factors at individual, family and community levels and interaction with one another possibly make a significant influence. [4] Graham 2000, [5] Power et al. in 1996 [6] observed that the presence of any form of disparity including relative poverty was associated with higher rates of child abuse. Social and economic consequences in adulthood is directly related to the disadvantaged conditions in childhood as they provide settings in which not only child abuse arise, but significant impairment transpires to children's health and development. [7] Ill-treatment during the formative years disrupts the development of the cerebral cortex and limbic system contributing to a host of later cognitive, academic, psychological and relationship problems that may persist well into adulthood. [8]


   Outlining Other Risk Factors for Child Abuse Top


  • Drug or alcohol abuse history of parents or caregiver.
  • History of parents or caregiver poor mental health.
  • History of parents or caregiver violence within the family.
  • Previous report of child abuse of other child in the same family.
  • Animals maltreated by the parent or caregiver.
  • Susceptible and unsupported parents or caregiver.
  • Child has pre-existing debility.



   Discreet Society: Condition in India Top


In a study carried out under the aegis of Ministry of Women and Child Development in 2007, [9] children between the ages of 5-12 are at the highest risk for abuse and exploitation. Maltreatment of caregivers has the potential to emotionally and mentally harm children to a very different degree.

The conclusions of the study were:

There were 50% children suffering abuse of one kind or other.

Physical abuse

Two out of every three children are physically abused. Nearly 72.2% children in the age group of 5-12 years were being physically abused. Over 50% children in all were being subjected to one or the other forms of physical abuse. Two out of three children were victims of corporal punishment. Over 50% of children in eight states reported corporal punishment, 56.37% of children in institutions were being subjected to physical abuse by staff members. One out of every two working children worked for 7 days a week. Nearly 58.8% of working children faced physical abuse either within the family or at the workplace. Nearly 22.9% of these children faced physical abuse in both situations.

Girl child neglect

In contrast to physical abuse neglect is insidious and may be harder to detect. [10]

This was assessed comparing themselves to their brothers on factors such as attention, food, recreation time, household work, taking care of siblings, etc. 70.57% of girls reported having been neglected by family members.

  • Emotionally abused: More than two out of every three girls reported facing neglect. Every second child reported facing emotional abuse. Emotional abuse of children begins at 5 years, it gains momentum in 10 years, goes on to peak in 12 years (14.12%) and after 14 years it starts going down steadily 48.37% children reported emotional abuse of one form or the other. In 83% of the cases parents were the abusers.
  • Sexual abuse 53.22% children reported having faced one or more forms of sexual abuse, 5.69% reported being sexually assaulted. Children on street, children at work and children in institutional care had the highest incidence of sexual assault. 50% abuses are persons known to the child or in a position of trust and responsibility. 42% children faced at least one form of sexual abuse or the other.



   Abusers  Top


In the study it was observed that over 85% of the offenders are those whom the children know and trust and blackmail was found to be the most popular tool used by abusers. [11]


   Apathy of Indian Government Top


Children under the age of 18 constitutes 42% of India's population. [9] Around 5.3 paisa to children is allocated in the union budget 2010-2011 and child protection has received 9.50 crores (0.04% of the budget), in spite of the fact that India has the highest number of working children and the highest number of sexually abused children in the world. [12] Despite the recognition of protection of children in the 11 five year plan and reiteration in the working group report of the Ministry of Women and Child Development for the 12 th plan, there is an 18% decline in the allocation from 2011 to 2012. [13] In India unfortunately, there is a paucity of policy and interventions for maltreated children and for problems stemming from discrimination in relation to gender, class, caste, race, religion and legal status. There are major gaps in the legal provisions pertaining to cases of trafficking, sexual and forced labor, child pornography, sex tourism and sexual assault on male children. India does not have a law that protects children against abuse in the home.


   Dental Neglect Top


Dental neglect is present at a high occurrence, in spite of this little importance is ascribed to it. [14] Indicators can be summarized as untreated rampant caries which are easily noticeable by lay person, untreated pain, infection, bleeding or trauma pertaining to the orofacial region; in existence of any observable pathology no treatment has been introduced. Such a state of dental neglect suffered by a large number of children is indeed deplorable. Even after the parent/guardian has been adequately informed of the child's condition and course of treatment, their callous attitude illustrates their negligence and calls in for intervention. [15]


   Dentist as Child Abuser Top


Dentist himself can be labeled as an abuser if he resorts to hitting/slapping, use of offensive language and inappropriate gestures, misuses/overuse drug and applies physical restraint without parental consent.


   Dentist Responsibilities Top


Dental professional are in a better position to recognize child abuse and neglect because 50-70% of reported lesions involve Craniofacial, head and face. [16],[17],[18] Oral cavity is a frequent site of sexual abuse of children. [19] Child abused injuries may be observed during the course of dental treatment and in some cases even before the child is seated in the dental chair. [20]

The oral cavity due to its importance in communication and nutrition, may be a central focus for physical abuse. [21]


   Presentation Top


Abuse or neglect may present to the dental professional in a number of different ways: [22],[23]

  • Through a direct allegation made by the child, parent or some other person,
  • Through signs and symptoms that are suggestive of physical abuse or neglect; or
  • Through observations of child behavior or parent-child interaction.


If child abuse is suspected then health history, demographic information history including detailed sequence of events, physical examination, orofacial examination and intraoral radiographic survey is done. Treatment of abuse or neglect related to orofacial region is initiated, documentation and reporting of abuse or neglect.


   Failure to Respond by Dentist Top


This could be due to their lack of familiarity of child abuse or neglect, difficulty in diagnosis, fear of legal hassle and disruption of dentist/patient relationships and indifference to family matter or their belief that reporting and further investigations by the concerned authority of child abuse can destroy families and careers. [24]


   Dentists Responsibly and Reporting Top


Many studies concluded that identifying and reporting of child abuse was less among dental professionals. [25],[26],[27],[28] A marked increase in reported cases of suspected child abuse by the dental profession can occur by educating dentists and also when child protection teams comprise of a dentist. Dentists who have been educated to recognize signs of abuse and neglect are 5 times more likely to make a report than dentists who are not. [29] Moral professional and legal responsibilities call for instant child protection and reporting of cases of abuse or neglect. [30]

All dental professionals should understand the seriousness of the problems of child's maltreatment. Victims of child's abuse and neglect fall into only two categories - those who lived through it and those who did not. [31],[32]


   Prevention Top


Our beliefs rejects not only the magnitude, but the mere presence of child abuse as we as the society is of the opinion that children design stories or visualize about abuse. For assertive steps toward prevention of child abuse there is a need of more than legislation and the formal procedures that complement it. It is imperative to create child friendly communities in which there is a positive environment for listening to children and understanding them. Accomplishing moderate levels of change in the circumstances, attitudes and conduct of the general population, rather than concentrating on individual cases such problems can be tackled to a large extent. [33] The transformation in the society in which children are acknowledged and cherished will provide a conducive environment for the child to live with dignity.


   Approaches to Tackle Abuse Top


At the primary level, due attention can be given on removing the causes, strengthening the child's capability to recognize and respond, enhancing parental awareness, consolidation social care and bringing in concrete and punitive penal strategy. "Extended schools" [34] providing adult education, sports and arts facilities, childcare, parenting support, access and on-site health and social care services might lessen the negative influence of families residing in marginalized community as they may encourage neighborhood rejuvenation and boost the children's well-being.

At the secondary level, the stress should be on early recognition, quick mediation and provision of a compassionate atmosphere in schools and families. There is a serious dearth of information regarding steps to be taken when someone is abused or are facing problems. Young people dread to tell anyone. Easily reachable, personal advice for an individual to keep control of the situation and the care and treatment of a particular child should be available to abused children and young people. Services need to flexible for the varying needs. Often communities have resources such as counseling, information linkages and maintenance services which remain unexploited, unacknowledged or underdeveloped.

Tertiary intervention should encompass synchronization among the police, courts, counselors, doctors and social workers.


   Conclusion Top


The way forward in child protection is through joint and collaborative action engaging statutory authorities and voluntary agencies. The existing skills in this area need to be honed and developed and simultaneously efforts should be made to develop them in significant contributors. Whereas review has underlined some practical measures/steps that can be taken immediately, it is strongly felt that most important areas for consideration are relationship building and refining multidisciplinary functioning. It must be recognized that time spent on these areas is an indispensable investment, which will help in safeguarding children.

 
   References Top

1.United Nations Children's Fund, Measuring and Monitoring Child Protection Systems: Proposed Core Indicators for the East Asia and Pacific Region, Strengthening Child Protection Series No. 1. Bangkok: UNICEF EAPRO; 2012.  Back to cited text no. 1
    
2.Mouden LD, Bross DC. legal issues affecting dentistry,s role in preventing hild abuse and neglect. J Am Dent Assoc 1995;126:1173-80.  Back to cited text no. 2
[PUBMED]    
3.US department of health and human services,Administration for children and families. Child Welfare Information Gateway .www.child welfare.gov dec 2013.  Back to cited text no. 3
    
4.Belsky J. Etiology of child maltreatment: A developmental-ecological analysis. Psychol Bull 1993;114:413-34.  Back to cited text no. 4
[PUBMED]    
5.Graham H. The challenge of health inequalities. In: Graham H, editor. Understanding Health Inequalities. Buckingham: Open University Press; 2000. p. 3-24.  Back to cited text no. 5
    
6.Power C, Matthews S, Manor O. Inequalities in self rated health in the 1958 birth cohort: Lifetime social circumstances or social mobility? BMJ 1996;313:449-53.  Back to cited text no. 6
[PUBMED]    
7.Poulton R, Caspi A, Milne BJ, Thomson WM, Taylor A, Sears MR, et al. Association between children's experience of socioeconomic disadvantage and adult health: A life-course study. Lancet 2002;360:1640-5.  Back to cited text no. 7
[PUBMED]    
8.Glaser D. Child abuse and neglect and the brain - A review. J Child Psychol Psychiatry 2000;41:97-116.  Back to cited text no. 8
[PUBMED]    
9.Study on Child Abuse: India 2007. Ministry of women and child development Govt of India. Ministry of Women and Child Development, New Delhi 2007 India.  Back to cited text no. 9
    
10.Sidebotham PD, Harris JC. Protecting children. Br Dent J 2007;202:422-3.  Back to cited text no. 10
[PUBMED]    
11.Barge S. Situation analysis of child care, neglect & abuse in India Centre for operations research and training Vadodara, India. Available from: http://www.svri.org/situationanalysis.pdf. [Accessed on 2014 Jan 7].  Back to cited text no. 11
    
12.Expenditure Budget. Vol. I, 2010-2011. p. 103. Available from: http://www.indiabudget.nic.in. [Accessed on 2014 Jan 7].  Back to cited text no. 12
    
13.Available from: http://www.thehindu.com/news/national/article3006913.ece., [Accessed on 2012 Mar 18].  Back to cited text no. 13
    
14.Manea S, Favero GA, Stellini E, Romoli L, Mazzucato M, Facchin P. Dentists' perceptions, attitudes, knowledge and experience about child abuse and neglect in northeast Italy. J Clin Pediatr Dent 2007;32:19-25.  Back to cited text no. 14
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15.Oral and dental aspects of child abuse and neglect. American Academy of Pediatrics. Committee on Child Abuse and Neglect. American Academy of Pediatric Dentistry. Ad Hoc Work Group on Child Abuse and Neglect. Pediatrics 1999;104:348-50.  Back to cited text no. 15
    
16.Jessee SA. Physical manifestations of child abuse to the head, face and mouth: A hospital survey. ASDC J Dent Child 1995;62:245-9.  Back to cited text no. 16
[PUBMED]    
17.World Health Organization. Report of the Consultation on Child abuse and Prevention. Geneva, Switzerland: WHO; 1999. (29-31March). (Document WHO/HSC/PVI/99-1).  Back to cited text no. 17
    
18.Needleman HL. Orofacial trauma in child abuse: Types, prevalence, management and the dental profession's involvement. Pediatr Dent 1986;8:71-80.  Back to cited text no. 18
[PUBMED]    
19.Kenney JP, Clark DH. Child abuse. In: Clark DH, editor. Practical Forensic Odontology. London: England Wright; 1992.  Back to cited text no. 19
    
20.American Dental Association. Council on Dental Practice: The Dentist's Responsibility in Identifying and Reporting Child Abuse. 3 rd ed. Chicago, IL: ADA; 1995.  Back to cited text no. 20
    
21.Vadiakas G, Roberts MW, Dilley DC. Child abuse and neglect: Ethical and legal issues for dentistry. J Mass Dent Soc 1991;40:13-5.  Back to cited text no. 21
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22.Harris J, Sidebotham P, Welbury R. Child protection and dental team: An introduction to safeguarding children in dental practice. Committee of Postgraduate Dental Deans And Directors, 2006-13. Available from: http:/www.cpdt.org.uk/index.htm. [Accessed on 2009 Nov].  Back to cited text no. 22
    
23.Vale GL. Dentistry's role in detecting and preventing child abuse: In: Stimsom PG, Mertz CA, editors. Forensic Dentistry. BocaRaton, NY: CRC Press; 1997. p. 161-2.  Back to cited text no. 23
    
24.Renke WN. The mandatory reporting of child abuse under the Child Welfare Act. Health Law J 1999;7:91-140.  Back to cited text no. 24
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25.El Sarraf MC, Marego G, Correr GM, Pizzatto E, Losso EM. Physical child abuse: Perception, diagnosis and management by Southern Brazilian pediatric dentists. Pediatr Dent 2012;34:e72-6.  Back to cited text no. 25
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26.Azevedo MS, Goettems ML, Brito A, Possebon AP, Domingues J, Demarco FF, et al. Child maltreatment: A survey of dentists in southern Brazil. Braz Oral Res 2012;26:5-11.  Back to cited text no. 26
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27.Sonbol HN, Abu-Ghazaleh S, Rajab LD, Baqain ZH, Saman R, Al-Bitar ZB. Knowledge, educational experiences and attitudes towards child abuse amongst Jordanian dentists. Eur J Dent Educ 2012;16:e158-65.  Back to cited text no. 27
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28.Owais AI, Qudeimat MA, Qodceih S. Dentists' involvement in identification and reporting of child physical abuse: Jordan as a case study. Int J Paediatr Dent 2009;19:291-6.  Back to cited text no. 28
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29.Kassebaum DK, Dove SB, Cottone JA. Recognition and reporting of child abuse: A survey of dentists. Gen Dent 1991;39:159-62.  Back to cited text no. 29
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30.Mouden LD. The role Kentucky's dentists must play in preventing child abuse & neglect. Ky Dent J 1997;49:10-4.  Back to cited text no. 30
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31.Schwartz S, Woolridge E, Steage D. Role of dentist in child abuse.Quintessence int 1976;7:79-81.  Back to cited text no. 31
    
32.Mouden LD. The dentist's role in detecting and reporting child abuse. Quintessence Int 1998;29:452-5.  Back to cited text no. 32
[PUBMED]    
33.Rose G. The Strategy of Preventative Medicine: The Distribution of Social Problems in Society. Oxford: Medical Publications; 1992.  Back to cited text no. 33
    
34.Gordon J. Child protection at the community level. Child Abuse Rev 2004;13:368-83.  Back to cited text no. 34
    

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Correspondence Address:
Seema Malhotra
Department of Pedodontics and Preventive Dentistry, Saraswati Dental College, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7761.126934

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    Abstract
   Introduction
    Consequences of ...
    Outlining Other ...
    Discreet Society...
   Abusers
    Apathy of Indian...
   Dental Neglect
    Dentist as Child...
   Presentation
    Failure to Respo...
    Dentists Respons...
   Prevention
    Approaches to Ta...
   Conclusion
    Dentist Responsi...
    References

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