How Dentists Recognize Signs Of Child Abuse

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What Clues To Dentists Look For To Recognize Child Abuse?

Subjects > Health > Child Abuse

Following is a partial listing of possible signs and symptoms of child abuse and neglect. Keep in mind that many of the injuries described can occur accidentally to a child and may not be abuse related. Use your professional judgment and knowledge of the child to discern whether what you observe is accidental in nature or suspicious.

• Do they seem to be in pain as they walk into your room or climb into the dental chair? Children whose ribs have been injured or whose bones have been fractured, for instance, may exhibit hindered movement or walk with a limp.
• Do they appear uncomfortable as they sit down? This may indicate sexual abuse. Is your young, female patient pregnant? This may be an additional indicator of sexual abuse.
• Check for facial symmetry - are there swellings, bruises or other types of injuries from trauma?
• Observe their hands. Are there burns from cigarettes, lighters or "glove-like" burns from immersion in a hot liquid? Do the hands exhibit the effects of trauma - injuries from being slammed in a car door, or rope marks from being bound? Injuries to the dorsal surface of the hand may indicate non-accidental trauma, as this is not a typical exploring surface like the palm is.
• Carefully observe the child's head. Are there any swellings of the scalp from trauma or fracture? You may need to palpate the head to determine whether swelling is present. Are there bald spots where hair was traumatically removed? If this is the case, there will be no loose hairs at the periphery of the bald area and no inflammation or scaling of the scalp associated with hair loss due to disease. Also, there may be a few petechiae present at the hair roots.
• Does the child's neck appear to have rope burns or hand marks from choking or strangling? Bruises on the back of the neck may result from the child having been shaken.
• Does the child have several bruises in various stages of resolution? Different colored bruises may indicate chronic abuse over several days or weeks?
• Are there elliptical or oval ecchymoses, abrasions or lacerations that indicate the child has been bitten? Individual marks where the incisal or occlusal surfaces of the teeth may be apparent may allow an observer to identify the exact teeth used to bite the child. For example, if the intercuspid space can be measured, and this distance is greater than three centimeters, the bite probably was caused by an adult. Bite mark analysis can provide an important link between a victim and the suspected perpetrator of the crime. Particular characteristics of a bite mark, such as rotated, fractured, or missing teeth; or diastemas can be consistent or inconsistent with the suspected abuser. A forensic odontologist may possibly be able to match up casts made of the suspect with casts made of the bite mark itself.
• Are there lesions on their ears that may indicate blows, punching, slapping, pulling, twisting or pinching? It has been noted that lesions on the ears, particularly if they are on both ears, are rarely accidental in nature.
• Does their nose appear broken or are there blood clots in the nostrils?
• Does the child have a deviated gaze, black eye, drooping eye lid, pupils of unequal size, or scleral hemorrhage from trauma?
• Does the child appear "overdressed" for the climate, in other words, are they wearing long sleeves, a turtleneck sweater, long pants and other heavy clothing in the heat of the summer? This may suggest a conscious attempt to hide bruises or injuries on arms or legs.
• Is the child clean, tidy and apparently well nourished, or dirty, disheveled and gaunt from neglect and malnourishment?
• If the child was brought in for treatment of an oral injury that seems to be abuse related, does it appear there was an obvious delay in seeking treatment?

Examining inside the mouth for child abuse:

• Begin by examining the child's lips. Are there lacerations or scars from trauma, burns from heated implements, or rope marks in the corners of the mouth from a gag being placed over the mouth?
• View the palate, particularly at the junction of the hard and soft palate, for any unexplained petechia or bruises that may be indicative of forced oral sex (fellatio). Contusions in the floor of the mouth also suggest this type of sexual abuse.
• Are there fractured or non-vital teeth that appear to be from non-accidental trauma?
• Are there bruises on edentulous ridges or severe lacerations of the oral mucosa?
• Are any teeth missing or displaced for which there is no obvious explanation?
• Is the labial frenum lacerated from forced feeding or from blunt trauma from an instrument or hand? Frenum tears may be common in small children learning to walk and falling frequently. However, this same injury in a child adept at walking or in an infant not yet walking should arouse suspicion of abuse.
• Are there burns in the mouth from caustic substances or scalding liquids? This will appear as a white slough from necrotic epithelium. In addition, the child may salivate excessively, drool and have difficulty swallowing.
• Do the radiographs exhibit healed or recent fractures?
• Are there venereal warts (condyloma acuminatum) present that may indicate sexual abuse? These pedunculated, cauliflower-like warts may be present on the child's lips, palate, gingiva or tongue. Syphilis may present as a mucous patch or a papule which ulcerates to form a chancre, while gonorrhea can appear as pharyngitis, tonsillitis, gingivitis or may even be asymptomatic in the oral cavity. Sexually-transmitted herpes may also be present.
• Are HIV-associated lesions present, such as oral candidiasis? These lesions also may indicate sexual abuse.
• Does the child's tongue have scars or abnormal mobility from repeated trauma or damage from forcibly biting down?

• More information: http://www.azdhs.gov/cfhs/ooh/oohmaterials/abuse_reporting4.htm

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