The Tribune

By Dr Andre Clarke

In the Bahamas, medical doctors and dentists are required to report suspected cases of child abuse and neglect to the Ministry of Labour and Social Development and/or the Royal Bahamas Police Force.

The phrase "child abuse and neglect" is described many ways by many authorities, but I like how the Federal Child Abuse Prevention and Treatment Act (CAPTA) in the United States describes it.

It describes "child abuse and neglect" as, at minimum, "Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act which presents an imminent risk of serious harm."

Dentists are the mouth doctors, and generally, medical doctors receive minimal training in mouth disease and/or injury; as such, it is very important for there to be constant collaboration between dentists and doctors in the prevention, detection and management of child abuse and neglect as it pertains to the mouth.

Let us explore specifically how physical abuse, sexual abuse and dental neglect affect the mouth.

Physical abuse and the mouth

Injuries to the head and to the face are very common in cases of physical abuse. In fact, because of the possible significance in communication and nutrition, some authorities believe the mouth can be a central focus in physical abuse. It is, therefore, very important that the mouth and areas around the mouth are examined.

Injuries to the mouth and face are commonly caused by blunt trauma, utensils, scalding liquids, open flames or fists. These injuries include soft and hard palate damage; broken or knocked out teeth; broken facial and/or jaw bone; and damaged lips. Many injuries on one child at different stages of healing, or that are not appropriate for a child's stage of development, should arouse suspicion. When a disconnect exists between the explanation for an injury and the pattern of the injury, there should also be cause for concern.

Sexual abuse and the mouth

In children, sexual abuse occurs as frequently as physical abuse. Infections that are usually seen below the waist, but appear in the mouth and on the face, need to be investigated at length. Gonorrhea found in the mouth of a pre-pubertal child, strongly suggests sexual abuse and the authorities should be alerted.

When forced oral sex is suspected, the tongue and cheek will be swabbed and the swab sent to a lab for analysis. In addition to the swab being taken, photographs of any bruising of the soft and hard palate will be taken.

Please note that bite marks on the skin may be a sign of abuse. Dentists specially trained in forensics may be of special help to medical doctors when analyzing bite marks as they relate to physical and sexual abuse.

Dental neglect

Dental neglect is of particular concern to me. It saddens me that a parent or guardian would willfully allow the mouth health of their child or ward to deteriorate.

What is dental neglect? 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."

Are any of you guilty of dental neglect? It is no laughing matter. Mouth disease left untreated can easily lead to pain and loss of mouth function. If these things happen, learning, nutrition and communication can be adversely affected.

Sometimes a lack of finances, a parent's ignorance, or a low perceived value of mouth health, may keep a parent or guardian from seeking appropriate dental care. This is forgivable. What is unforgivable is when a parent or guardian has been properly informed by a dentist about the nature and extent of a child's mouth condition; about the specific treatment needed, and about how best to achieve this, and they willfully refuse to seek care.

When a dentist fully explains the mouth disease to a parent and guardian; tries to help a family find financial aid; and advises around transportation issues, it is only reasonable to expect that the parent or guardian would act with the child's best interest in mind. Otherwise, he or she would be guilty of dental neglect.

Mother's Day was celebrated on May 13 and on that day, mother's throughout the Bahamas were honored. It is unconscionable that any mother would harm her child and commit any form of child abuse and neglect. It is difficult, but it is more common than we may want to believe. Dental neglect does happen.

Let us care for our children. Let us bring an end to child abuse and neglect. Let us bring an end to dental neglect. It is important to keep our children's smiles alive.