Oral disease in vulnerable children and the dentist's role in child protection

Introduction :   In 2005 Cairns et al examined the role of Scottish general dental practitioners (GDPs) in child protection (Cairns et al., 2005a). In 2006 all UK dental practices were sent “Child Protection and the Dental Team” (Harris et al., 2006). There has been no published research since 2006 investigating whether the proportions of GDPs who suspect child abuse/ neglect and those who refer cases has changed. Additionally there is no published work in the UK on the oral health of children with welfare concerns. Aims To determine the proportion of Scottish GDPs who suspected child abuse/ neglect and the proportion that referred suspected cases, what factors influenced referral and the willingness of Scottish GDPs to be involved in detecting neglect. To establish dental input in comprehensive medical assessments (CMAs) and quantify the oral health of children “with a welfare concern”. Materials and methods A postal questionnaire was sent to 50% (n=1215) of Scottish GDPs. Children with welfare concerns in NHS Greater Glasgow and Clyde received a comprehensive oral health assessment (COA) as part of a CMA. The child’s age, dmft/dmfs scores, postcode, details of registration with dental services and soft tissue abnormalities were recorded. Results The questionnaire response rate was 52% (53% male). 30% and 55% of respondents had received undergraduate or postgraduate training in child protection respectively. 37% had suspected child abuse/neglect but only 11% had referred a case. The most common factor that affected referral was “lack of certainty of the diagnosis” (74%). 73% of dentists were willing to get involved in detecting neglect. 3 The age range for children who had a COA was 4 months to 16 years (mean 6 years). All resided in areas with SIMD quintiles ≤3. 32% of children ≤9 years and 17% of children ≥10 years were caries free. The mean number of decayed, missing and filled teeth (dmft) for children ≤9 years was 2.52 and 5.0 for those ≥10 years. For those ≤9 years with evidence of caries experience dmft was 3.7 and for those ≥10 years the DMFT was 6. 7.4% had evidence of trauma and 5.4% had enamel defects.

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