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The recognition and reporting of child abuse and neglect continues to be a challenge in the healthcare setting. All healthcare providers, including dentists, should be aware of the high prevalence of orofacial injuries and conditions that are concerning for abuse and neglect. Sentinel injuries may appear trivial and do not require medical attention, but are unlikely caused by accidental mechanisms and, if not properly identified, often precede more severe abusive injuries. Concerning orofacial findings can manifest as bruising, eye injuries, intraoral injuries, pharyngeal perforations, facial bone fractures, and sexually transmitted infections. Abusive caregivers are likely to give inadequate explanations or no history at all to explain concerning findings. Medical providers' failure to make mandated reports about their concerns to the appropriate agencies can have significant long-term impacts on the physical and psychological well-being of children., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Historically, the law, dental and forensic literature has included numerous articles concerning abused children. The orofacial structures are injured frequently in the maltreated child. Injuries of the neck, head, face, and oral cavity represent the most affected areas of the victim's body that routinely sustain physical trauma in child maltreatment cases. This literature review aimed to report the state of art of child abuse from the point of view of the dentist with focus on studies in dental aspects of child abuse and neglect of the last ten years. Considering the time slot, 20 papers were included with the following inclusion criteria: papers published in English, all keywords included in the title, articles available on PubMed. Many of the injuries are within the scope of dentistry or easily observed by the dental professional during routine dental treatment, and it is essential that the dentist recognizes them. Concerning neglect, it is appropriate to make a distinction between deliberate parental behavior that has the consequence of unavoidable and voluntary neglect towards their children and those conditions of involuntary carelessness determined by socio-economic and cultural factors such as family isolation, lack of finances, parental ignorance, or lack of perceived value of oral health. Therefore, it is relevant that the dentist pays attention to the cases to report and those that only need help.

Background: Oral injuries in young children may indicate physical abuse. The prevalence of oral injuries in young children presenting to the emergency department is unknown. These data would assist providers in making decisions about the need for further abuse evaluation., Objective: To determine the prevalence of oral injuries, associated chief complaints and characteristics, and frequency of abuse evaluations in children younger than 24 months presenting to a pediatric emergency department (PED)., Participants and Setting: Twelve pediatric emergency medicine physicians consecutively enrolled children younger than 24 months in a tertiary care PED., Methods: We performed a prospective observational study. Enrolled patients underwent a complete oral examination. Providers recorded patient demographics, type of chief complaint, oral injury details, developmental ability, and the presence of an abuse evaluation., Results: Oral injuries occurred in 36/1303 (2.8%, 95% CI 1.9-3.8%) and were more common in patients with traumatic (26/200, 13%) versus medical chief complaints (10/1,103, 0.9%) (p < .001). Of patients with oral injuries (36), 78% were mobile and 72% had traumatic chief complaints. Nine (25%) children with oral injuries were evaluated for abuse. Oral injuries in children 0-11 months old were more likely to be evaluated for abuse than children 12-24 months old (70.0% vs. 7.7%, p < .001)., Conclusions: The prevalence of oral injuries in children <24 months old presenting to a PED was low. Most occurred in mobile children and in children with traumatic chief complaints. Younger, non-mobile children with oral injuries had a higher likelihood of having an abuse evaluation., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Competing Interests: Competing interests: None declared.

Objective: To determine the frequency of occult trauma in children with oral injury evaluated for physical abuse., Design: This was a retrospectively planned secondary analysis of a prospective, observational study., Setting: Emergency departments supported by 20 US child abuse teams in the Examining Siblings to Recognize Abuse (ExSTRA) network., Patients: Children <120 months old evaluated for physical abuse., Interventions: Analysis of index children with oral injury on initial examination., Main Outcome Measures: Rates of physician-recognised oral injury, as well as frequency and results of occult injury testing. Perceived abuse likelihood was described on a 7-point scale (7=definite abuse)., Results: Among 2890 child abuse consultations, 3.3% (n=96) of children had oral injury. Forty-two per cent were 0-12 months old, 39% 1-3 years old and 18% >3 years old. Oral injury was the primary reason for evaluation for 32 (33%). Forty-three per cent (42/96) had frenum injuries. Skeletal surveys were obtained for 84% and 25% of these identified occult fractures. Seventy-five per cent had neuroimaging; 38% identified injuries. Forty-one per cent of children with oral injuries had retinal examinations; 24% of exams showed retinal haemorrhages. More occult injuries were found in children with oral injuries than other ExSTRA subjects. A high level of concern for abusive injury was present in 67% of children with oral injury versus 33% without., Conclusions: Children with oral injury are at high risk for additional occult abusive injuries. Infants and mobile preschoolers are at risk. Young children with unexplained oral injury should be evaluated for abuse., Competing Interests: Competing interests: KWF and JBM’s institution has received payments for legal consultation and testimony in child abuse cases. KWF and DML have provided free child abuse legal consultation. All other authors declared no competing interests., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

In all 50 states, health care providers (including dentists) are mandated to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this report is to review the oral and dental aspects of physical and sexual abuse and dental neglect in children and the role of pediatric care providers and dental providers in evaluating such conditions. This report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, and diseases that may raise suspicion for child abuse or neglect. Oral health issues can also be associated with bullying and are commonly seen in human trafficking victims. Some medical providers may receive less education pertaining to oral health and dental injury and disease and may not detect the mouth and gum findings that are related to abuse or neglect as readily as they detect those involving other areas of the body. Therefore, pediatric care providers and dental providers are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions in children., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2017 by the American Academy of Pediatrics and American Academy of Pediatric Dentistry.)

In all 50 states, physicians and dentists are required to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this report is to review the oral and dental aspects of physical and sexual abuse and dental neglect and the role of physicians and dentists in evaluating such conditions. This report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, and diseases that may be suspicious for child abuse or neglect. Physicians receive minimal training in oral health and dental injury and disease and, thus, may not detect dental aspects of abuse or neglect as readily as they do child abuse and neglect involving other areas of the body. Therefore, physicians and dentists are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions.

Objectives: The objective of this study was to identify the incidence of oral, jaw, and neck injury secondary to endotracheal intubation in young children., Methods: This prospective observational study was conducted in the pediatric intensive care unit at a level 1 trauma center. From October 1998 to January 1999 and November 2007 to April 2008, all intubated patients younger than 3 years with no prior oral procedures were examined within 24 hours of intubation. A standardized form was used to record injuries. Separately, medical records were reviewed for prior injuries. Chi-square/Fisher exact test was used for statistical analysis., Results: Of 105 patients included in the study, 12 had oral, jaw, or neck injury. One patient had a hard palate injury from a pen cap in his mouth during a seizure. Another broke a tooth biting the laryngoscope blade (the only injury directly attributable to intubation). The remaining 10 patients were determined to be those who experienced abusive trauma. The overall incidence of injury directly from intubation was 0.9%. Oral, jaw, and neck injuries were all significantly associated with abusive trauma (P < 0.001). Eleven patients had difficult intubations: 9 had no injuries, 1 experienced abusive trauma and the second was the patient who broke his tooth during intubation., Conclusions: Oral, jaw, or neck injury in young children is rarely caused by endotracheal intubation, regardless of difficulty during the procedure.

Unlabelled: Knowledge of child protection is essential in everyday practice for the whole dental team as they are well placed to take part in the shared responsibility of protecting children. Physical abuse, neglect, sexual abuse and emotional abuse may all present to the dental team in various ways. This article aims to provide some top tips for general dental practitioners who have concerns regarding possible child abuse/neglect and remind them of what observations to make and what questions to ask themselves when they are concerned about a child's welfare., Clinical Relevance: Abuse and neglect are areas in child protection that the dental team can provide important information about to the local child protection team. All members of the dental team need to be aware of the signs and symptoms of child abuse/neglect and where to go for help.

Child abuse and neglect are prevalent issues that permeate all ethnic, cultural and socioeconomic segments of society. Parents of abused children frequently change physicians in order to prevent detection, but they are more likely to continue to visit the child's dentist. Most states recognize four major types of maltreatment: neglect; physical abuse; psychological maltreatment; and sexual abuse. The American Academy of Pediatric Dentistry defines dental neglect as "the willful failure of parent or guardian to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection." The oral health practitioner must uphold his or her legal and ethical responsibility if there is suspicion, record and report the incidence. It may help save a child from further abuse.

Objective: Relatively minor abusive injuries can precede severe physical abuse in infants. Our objective was to determine how often abused infants have a previous history of "sentinel" injuries, compared with infants who were not abused., Methods: Case-control, retrospective study of 401, <12-month-old infants evaluated for abuse in a hospital-based setting and found to have definite, intermediate concern for, or no abuse after evaluation by the hospital-based Child Protection Team. A sentinel injury was defined as a previous injury reported in the medical history that was suspicious for abuse because the infant could not cruise, or the explanation was implausible., Results: Of the 200 definitely abused infants, 27.5% had a previous sentinel injury compared with 8% of the 100 infants with intermediate concern for abuse (odds ratio: 4.4, 95% confidence interval: 2.0-9.6; P < .001). None of the 101 nonabused infants (controls) had a previous sentinel injury (P < .001). The type of sentinel injury in the definitely abused cohort was bruising (80%), intraoral injury (11%), and other injury (7%). Sentinel injuries occurred in early infancy: 66% at <3 months of age and 95% at or before the age of 7 months. Medical providers were reportedly aware of the sentinel injury in 41.9% of cases., Conclusions: Previous sentinel injuries are common in infants with severe physical abuse and rare in infants evaluated for abuse and found to not be abused. Detection of sentinel injuries with appropriate interventions could prevent many cases of abuse.

Physical abuse is a problem of epidemic proportions. Pediatric nurse practitioners (PNPs) will most likely encounter physically abused children in their practice. This continuing education offering will help PNPs develop the skills necessary to recognize an injury that raises the concern for abuse based on characteristics of the injury such as appearance, location, or severity and characteristics of the history given for the injury. The link between corporal punishment and physical abuse will be discussed. Cutaneous findings of abuse, oral injuries, skeletal injuries, abdominal trauma, and abusive head trauma will also be discussed., (Copyright © 2012 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.)

Aims: The aim of this study was to analyze medical professional, perception, attitude, knowledge, and experience about child abuse and neglect in Bagalkot district, north Karnataka, India., Materials and Methods: Two hundred medical professional, working in both public and private sectors in the province were interviewed by a single operator. Descriptive analyses were carried out by using the obtained data., Results: Medical professional's perception about child abuse and neglect (CAN) is low and these professionals have poor attitude and knowledge toward CAN in accordance with the code of conduct and law. The available information and education is also poor., Conclusions: The results obtained from the study showed that there is lack of knowledge and poor attitude and perception about CAN among medical professionals that prevents them from detecting and identifying suspected cases. Continuing medical education is required to enhance the ability of professionals to detect CAN cases.

Making the decision as to whether an injury is a result of child abuse or not is stressful for both the family involved and the clinical team. It is not a decision that is taken lightly, and with an increasing expectation by the investigating agencies, lawyers and the public in general, to ensure that it is based on explicit 'evidence', clinicians need to be up to date with the latest scientific publications in the field. This article aims to summarise the current evidence in relation to all physical injuries except those pertaining to the central nervous system, which will form a separate article. It will examine the pattern of accidental and abusive bruises, fractures, burns, abdominal injuries and oral injuries focusing on discriminating features and necessary investigations.

The aim of this paper was to identify the main oral and dental aspects of childhood abuse and dental neglect, contributing to the identification of these victims in a dental office. A bibliographic research was carried out, in ADOLEC, MEDLINE, LILACS and BBO databases. The following key words were used: child abuse, oral manifestations, dentists; role; liability, legal. It was verified that violence against children happens in general at home and the resulting orofacial injuries encompass: injuries, burns and lacerations on soft and hard tissues, bite marks and gradually-healed wounds. It can have wounds in other parts of the body next to the oral cavity, such as periorbital wound and nasal injury. Regarding sexual abuse, many victims do not present any associated physic signs; therefore, behavioral indicators must be observed. The immediate recognition and report of childhood abuse and dental negligence by dental surgeon are essential for children protection. Therefore, it is critical to define more effective action from those professionals, by registration and denunciation of suspect cases to child protection agencies.

Introduction: A torn labial frenum is widely regarded as pathognomonic of abuse., Methods: We systematically reviewed the evidence for this, and to define other intra-oral injuries found in physical abuse. Nine studies documented abusive torn labial frena in 27 children and 24 [corrected] were fatally abused: 22 were less than 5 years old. Only a direct blow to the face was substantiated as a mechanism of injury., Results: Two studies noted accidentally torn labial frena, both from intubation. Abusive intra-oral injuries were widely distributed to the lips, gums, tongue and palate and included fractures, intrusion and extraction of the dentition, bites and contusions., Conclusions: Current literature does not support the diagnosis of abuse based on a torn labial frenum in isolation. The intra-oral hard and soft tissue should be examined in all suspected abuse cases, and a dental opinion sought where abnormalities are found.

Many children die as a result of abuse and neglect each year. Early recognition and effective intervention are crucial factors in the fight against this. Child mortality rates increased in South Africa between 1998 and 2004, with child abuse deaths constituting part of these statistics. Autopsies on children who have died of unnatural causes are often not specific as to the possibility of child abuse. This article presents the extra-oral and intra-oral signs of child abuse from a study of the autopsies of child mortality cases seen at Salt River Medico-Legal Laboratory in Cape Town from 1998 to 2004 with reference to the South African child mortality rates.

Objectives: The aims of the present study were to identify the incidence of orofacial injuries found within a cohort of physically abused children, and examine demographic data surrounding the alleged perpetrator, the location in which the alleged assault occurred, the mechanism of injury and the actual orofacial injury incurred., Methods: The research took the form of a retrospective study of clinical case records of children with suspected physical abuse from 1 June 1998 to 31 May 2003. Seven hundred and fifty case records were identified and 390 (46.7%) were available for data extraction., Results: Fifty-nine per cent (n = 230) of children had signs of abuse on the head, face or neck. The alleged perpetrator was the mother in 104 cases (26.7%), the father in 100 (25.6%) and mother's partner in 49 other cases (12.6%). More than half (53.3%) of the alleged abuse occurred in the child's home; in 32.3% of cases, the location was not recorded. Other locations included outside in a public place, school and at the home of the alleged abuser. Some 23.4% (n = 54) had been punched or slapped around the head, neck or face, 17.4% (n = 40) had been struck by an object, and 15.2% (n = 35) had allegedly sustained multiple modes of injury. Bruising to the head, neck or face was seen in 95.2% (n = 219) of children, and 32.6% (n = 75) had abrasions; 65.2% (n = 150) of the bruises and 22.9% (n = 53) of the abrasions were on the face., Conclusions: Fifty-nine per cent of physically abused children in the present cohort had orofacial signs of abuse which would be easily visible to a dental practitioner. The commonest injuries were bruises and abrasions. This concurs with previous reports in the literature and highlights the important role of dental practitioners in the recognition of children who have been abused.

In all states, physicians and dentists recognize their responsibility to report suspected cases of abuse and neglect. The purpose of this statement is to review the oral and dental aspects of physical and sexual abuse and dental neglect and the role of physicians and dentists in evaluating such conditions. The statement also addresses the oral manifestations of sexually transmitted diseases and bite marks, including the collection of evidence and laboratory documentation of these injuries. In all 50 states, physicians and dentists are required to report suspected cases of child abuse and neglect to social service or law enforcement agencies. Physicians receive minimal training in oral health and dental injury and disease, and thus may not detect dental aspects of abuse or neglect as readily as they do child abuse and neglect involving other areas of the body. Therefore, physicians and dentists should collaborate to increase the prevention, detection, and treatment of these conditions.

The initial steps in the prevention of child maltreatment are early recognition and reporting. Reporting laws were not made to punish offenders, rather to help those children in need. Statistics indicate that among previously abused children who were returned home without intervention (reporting or counseling for the family), 5 percent were killed and 25 percent were seriously re-injured (22). While the nation's overall crime rate declined more than 21 percent from 1993 to 1997, the number of reports of child maltreatment increased by 8 percent with confirmed cases growing 4 percent during this same period (1). The dental profession must take a more active role on behalf of children in the prevention of this problem. When an incident arises that may result in a conflict between the dentist's personal interests and the well being of a patient, the dentist must always act in the best interest of the patient. Children have the right to grow up in a loving and nurturing environment. As dentists, we have the moral, ethical, and legally mandated responsibility to help protect this right through the recognition and reporting of child abuse and neglect.

Objective: The aim of the present study was to determine the head, face and neck injuries associated with child abuse cases in the Cape Peninsula, Cape Town. South Africa., Method: A retrospective, record-based analysis (n = 300) of non-accidental injuries at a Children's Hospital over a 5-year period (1992-1996) was carried out., Results: The mean age of the sample was 4.75 years--54.3% were boys and 45.7% were girls. Most of the crimes were committed in the child's own home (88.7%). Crimes were reported by mothers (48.7%), grandmothers (11.7%) and day hospitals (13%). Ninety percent of the perpetrators were known to the victim. The majority of the perpetrators were male (79%)--20% the perpetrators were the mother's boyfriend; 36% the father or step father, and in 12% the mother was responsible. Thirty-five percent of perpetrators were under the influence of alcohol or drugs when they committed the offence: 64.7% of cases suffered serious injuries, 48.7% had to be hospitalized, four children were critically injured and died. The head, face, neck, and mouth were the sites of physical injury in 67% of the 300 cases reviewed. The face was the most frequently injured (41%) part of the body, with the cheek being the most common site for the injury. The range and diversity of the oro-facial injuries included skull fractures, subdural hematomas, retinal hemorrhages, bruises, burns, and lacerations. Injuries to the mouth included fractured teeth, avulsed teeth, lacerations to the lips, frenum, tongue, and jaw fractures., Conclusions: The main conclusions of this study were (i) under 2-year-old children were most at risk from abuse (36%); (ii) the number of the reported injuries to the oral cavity was extremely low (11%); and (iii) no dentists participated in the examination of any of the patients. Intra-oral injuries may be overlooked because of the medical examiner's unfamiliarity with the oral cavity. Oral health professionals should be consulted for diagnosis, advice and treatment.

Child abuse is a disturbingly common finding in society today. In view of the high proportion of orofacial injuries seen in victims of child abuse, dentists are in a strategic position to recognize and report suspected cases. The present study of 347 dentists in Victoria, Australia, assessed the level of knowledge and attitudes among dental professionals on the important issue of child abuse. While a high level of interest was shown by the participants towards this issue, a need for further information and training in the recognition and reporting of child abuse was seen in the survey findings. While dentists at present are not legally mandated in all states of Australia to report suspected cases of child abuse, the dental profession is in a key position to play an active role in the identification and reporting of this substantial community problem.

The types of prevalence of the various orofacial injuries that may be sustained in child abuse have been presented. Table 2 gives the dental practitioner a summary check-list of five questions they must ask themselves and five observations they must make whenever doubts and suspicions of child abuse arise.

The incidence of physical injury to the head, face, mouth, and neck of 266 suspected cases of child abuse was studied at Texas Children's Hospital in Houston, Texas, from January 1993 through December 1994. While there was an even distribution of physical abuse by gender, 74.8 percent of the children were under the age of three. A hospital physician performed every examination. The most frequently occurring injury was contusion or ecchymosis of soft tissue, while the face was the part of the body injured most often. Although 66.2 percent of the children reviewed had some type of injury to the head, face, mouth, or neck, only seven cases (2.6 percent) of intraoral injury were mentioned. These results point out the need for dentists to become active participants on multidisciplinary child maltreatment teams.

The dental profession has a legal, ethical and moral responsibility to report suspected cases of abuse and neglect. The risk to the child is significant. In non-fatal cases of abuse, 35 percent will be abused again within one year. To this end, dentists should discuss child abuse and neglect at staff meetings and establish office procedures if a case is identified. Encourage staff to discuss concerns they have regarding possible abuse they suspect in the office. Keep the child abuse hotline number or local agency responsible for receiving reports in the office rolodex. Abuse and neglect is a real problem in all neighborhoods and dentistry can make a difference.

Child abuse and neglect is now recognised as an international issue and the reported frequencies of mortality vary considerably. Dental personnel has an important role in suspecting abuse and diagnosing non-accidental injury, because oro-facial trauma occur in approximately half of all cases. The critical steps to ensure adequate professional response in suspected child abuse cases are the development of diagnostic criteria, curriculum and treatment guidelines.

Child abuse is more common than previously supposed, and non-accidental injuries may also present in the oral cavity. Results of physical abuse are most commonly diagnosed as such, but injuries from sexual abuse and results of neglect may be observed in the mouth. Bruises are the most common types of non-accidental injuries, the lips and frena being specially exposed, through burns may be cause by over-hot food or caustic liquids. The teeth may fracture, be avulsed, displaced or discoloured as a result of non-accidental injury. Sexually transmitted diseases in children's mouths are strong indications of sexual abuse. Children exposed to oral sexual activities over a considerable period of time may develop higher caries rates and erosion on the palatal surface of the maxillary teeth. Dental neglect may be part of general neglect. The dentist's role is to treat the oral injuries and take appropriate action to prevent continued abuse.

Survey results on the subject of child abuse from the American Society of Dentistry for Children membership are reported. The survey results reflected the need of a documentation protocol for the dental office. A protocol is proposed which reviews the need of thorough assessment of orofacial lesions before concluding that child abuse exists. A data- and diagnostic-assessment form has been made using guidelines of the American Dental Association and other related referenced articles. The diagnostic-assessment form is presented to guide the practitioner through the documentation process and to develop a step-by-step decision on the probability of child abuse in any individual case.

The number of reported cases of child abuse has increased dramatically over the past several years. Maltreatment of children can take several forms including neglect, sexual abuse, physical assault and psychological trauma. Five cases of child abuse presenting initially to the Otolaryngology Service are outlined: bilateral auricular hematomas, recurrent tympanic membrane lacerations, a pharyngeal laceration with retropharyngeal abscess and medical neglect of a patient with a parotid malignancy and one with laryngeal papillomatosis. Characteristic presentations and risk factors in family background are discussed toward the goal of early recognition and appropriate intervention.

The dentist's role primarily involves awareness of the problem of maltreatment, a method of approach to identify and report suspected cases, the documentation of the injuries or neglect which have been observed, and follow-up of any orofacial injuries. Orofacial trauma is present in up to one half of the reported cases of child abuse and consists of bruises, burns, lacerations, and fractures of teeth and jaws. Further studies in the dental field are needed to delineate the types and incidences of orofacial injuries and their relationship to child abuse. Dentists and all professionals must work together, if adequate services are to be provided to protect children and rehabilitate families.

Orofacial trauma was found in 49% of 260 documented cases of child abuse seen during of five-year period at the Children's Hospital Medical Center, Boston. An additional 16% of the cases involved head trauma; the total percentage of head and facial trauma was 65%. Head or facial trauma was the principal reason for admission to the hospital in 45% of the cases. A survey of 537 dentists in Massachusetts showed that the majority were unaware of their legal and social responsibilities to report suspected cases of child abuse. Eleven percent of all dentists surveyed saw orofacial trauma cases that were of a suspicious nature, by only 22 confirmed cases of child abuse were noted by the dentists. Of these, only four were reported to social agencies. In general, oral surgeons and pedodontists saw a higher percentage of these cases and were more aware of their responsibilities than were general practitioners.

The Silverman's syndrome or "child abuse syndrome" consist in several symptomes whose about 50% are maxillo-facial ones. These which are must often unknown at the initial stage, are responsible for an after effect syndrome, involving very significant nasal, oral, labial and buccal lesions. The anomalies of facial growth are the results of chronic lesions of cartilagenous septum and of nose bone area. A better understanding of this syndrome should held to diagnose it as quickly as possible. Indeed children are endangered by a lack of protective measures.