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Abstract
Background Neglect is the most common form of child abuse in the UK. One area of neglect that is frequently overlooked is dental neglect. This rarely occurs alone and is part of a wider picture. Referrals for dental neglect are made infrequently by dentists; Possibly because no clear threshold for referral exists and they perceive concerns about the “Safeguarding” referrals system. Paediatric staff have limited oral health knowledge, and this combined with dentists reluctance to communicate concerns surrounding child protection, means that there is ample potential for dental neglect to be missed.
Aims We explored whether dentists, doctors and nurses, could agree on a threshold to act with regard to suspected dental neglect or child protection issues.
Methods A cross-sectional survey of hospital and community: doctors, dentists and nurses was conducted. Semi-structured interviews using a series of 5 vignettes involving oral health and child protection, focused on the following issues;
An unkempt 4 year old with extensive dental caries who came on the third calling for a dental check up
A 6 year old requiring one filling
An obese, bullied, 14 year old with multiple carious cavities and dental erosions
Bottle caries in a 4 year old whose 2 sisters have previously required dental extractions under general anaesthetic
A 4 year old with substantial ear bruising who requires one filling
Participants were asked to select from a list their dental and safeguarding actions. There was no child protection action required for case 2.
Results 150 responses (50 doctors, 50 dentists, 50 nurses) were obtained from 171 professionals approached. Just 3/14 dental practices agreed to participate. Less than 50% of doctors identified appropriate dental actions for 4/5 cases, and < 50% dentists identified appropriate safeguarding actions for 4/5 cases (Figures 1 and 2).
Percentage of optimal child protection action selected by profession
Percentage of optimal dental action selected by profession
Conclusion Many dentists are uncertain about child protection issues and may not act upon abuse that appears obvious to other healthcare professionals. Likewise, doctors are uncertain about dental neglect. Minimal joint standards for dental neglect thresholds and the appropriate response need to be agreed.