Human Abuse

Research studies continue to show the incredibly strong correlation of facial, peri-oral and oral injuries in those unfortunate victims of abuse. Studies have shown that a range of 58-86% of abused children have injuries associated with the face and mouth, yet dentists are responsible for reporting less than 1% of all cases of child abuse. Because all fifty states mandate that health care professionals must report cases of suspected abuse, the statistics clearly show that the dental profession is not doing its part in working to curtail this epidemic. Thus, dentistry has much work to do in increasing the awareness of the scope of the problem and supporting the legal system in its attempt to break the cycle of maltreatment against other human beings in our society.

In late July of 1998, the American Dental Association (ADA) sponsored a two day symposium called C.A.R.E., an acronym for Child Abuse Recognition Education. The hope of the ADA was to use the latest statistical information about the prevalence of abuse in the dental setting to further educate the profession about the scope of the problem, the clinical signs and symptoms associated with human maltreatment and the changes needed by the profession to address the underreporting of cases of human abuse by dentists. Much of the information that follows came from the C.A.R.E. symposium. The symposium identified three categories of abuse: physical, emotional and sexual as well as discussing at length the problem of neglect. The categories of the abused include children, spousal, geriatric and the disabled. ( Dr. Wright attended as the representative of the Ohio Dental Association.)

The statistics, in summary:

Child Abuse

Domestic Violence

Abuse and domestic violence transcend all economic, social and educational sectors of the population of the United States. Dentists have been reluctant to increase reporting of suspected abuse for several reasons. The first and most obvious is a lack of proper education in detection of the clinical signs and symptoms of human abuse. It is the goal of organized dentistry to increase the educational background of dental health care professionals to better understand the clinical signs and symptoms of human abuse AND report those suspected incidences of abuse. All fifty states in the US mandate that all health care professionals report suspected cases of human abuse with immunity from prosecution for those cases that are not actually abuse. The dental team is also mandated to report, even without the approval of the dentist in charge. Abuse is learned behavior and, as such, treatment to change the behavior must be sought. The epidemic of abuse strikes at the unempowered and vulnerable in our society. Every attempt must be made to break the circle of violence. "There are two categories of victims of abuse: those that survive and those that do not."

The second reason dentistry has not led in the reporting of abuse is the theory of "practicing in a vacuum". The dental office is usually not one of multiple dentists to consult with in cases of suspected abuse. Therefore, it becomes easier in the progression of the normal day of treating patients to simply ignore or postpone (indefinitely) the reporting.

The final reason for the massive underreporting is the "fear of the false positive". Dentists are afraid of reporting suspected cases of abuse they see because they fear they may be wrong and falsely accuse one of their patient populations. Again, "There are two categories of victims of abuse: those that survive and those that don't".

The reporting of suspect abuse cases should include information about the name, address and phone number of the victim, the name of the parents and/or primary care provider if a child abuse victim, the suspect injuries and the disposition of the situation when the abused victim left the office, if they left. The report to the proper agency for the suspected abuse should occur while the patient is still in the office, if possible. Photographs, radiographs and other necessary tests to document the suspected abuse should be considered. States differ in their laws regarding the collection of evidence in abuse cases, so each provider must become familiar with the laws of their own state. The state dental society can be of great help in providing information about specific laws.

Summary of clinical signs and symptoms of the abused child:

Summary of information about the abusers:

The solution to the underreporting of abuse seen in the dental office is through education. This requires a proactive approach, not continuing the status quo. There is a wonderful educational program has been developed in cooperation with Delta Dental of Missouri and goes by the acronym P.A.N.D.A., which stands for Prevent Abuse and Neglect through Dental Awareness. Most states now have a P.A.N.D.A. Coalition established that consists of trained dental professionals willing to present the program free of charge. Additionally, there are several textbooks on forensic dentistry that contain concise information on human abuse, including the Manual of Forensic Odontology, published by the ASFO and a newer textbook entitled Forensic Dentistry, published by CRC Press in Boca Raton, Florida.