FAMILY ABUSE &

NEGLECT
By: Ashley Mayeux & Christine Read

Definitions:
Family abuse, also known as domestic violence, is the abuse by one

individual of another in an intimate relationship. It is the nonaccidental physical, emotional, or nonconsensual sexual act against
a child, adult, or elderly person.
Neglect is the intentional or unintentional failure to provide for a

childs basic physical, emotional and medical/dental needs.

Dental neglect is the willful failure of a 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.

Identification:
Abuse can be detected during the initial assessment of a

patient, particularly during the extraoral and intraoral

examination.
Head and facial injuries, oral trauma, lesions, and

abnormal pathology can lead to a suspicion of abuse and

neglect.
Those most at risk for maltreatment are children, the

elderly, persons with disabilities and women.

 Several thousands of children a year die as a result of

severe physical damage, and others suffer permanent

brain damage or physical deformities as well as emotional
trauma. As much as 65-75% of child physical abuse
involves injuries to the head, neck, or mouth.

General Signs of Abuse & Neglect

Overall Appearance:
Clothing with long sleeves & long pants, even in warm

weather, may suggest that bruises and lacerations are

being covered.
Uncleanliness and other signs of lack of care.
Failure to thrive; malnutrition.
Infestation of lice.

Behavioral:
May be very fearful and cry excessively or will show no fear at all.
May appear unhappy and withdrawn.
May not exhibit normal behavior consistent with the present age of

the child.
May act differently when the parent is present than when alone, which

may provide clues to the type of relationship that exists.

May exhibit evidence of developmental delays, including those of

language or motor skills.

Extraoral Wounds and Signs of Trauma

Abrasions and lacerations may be present at

varying degrees of healing inconsistent with

explanations given by the caregiver. Recognizing
injuries to the head and neck and connecting
them to suspected maltreatment can save the
lives of the children involved.
Deliberate or inflicted injuries usually occur on
both sides of the face, whereas accidental injuries
usually occur only on one side.

Common sites
of deliberate
injuries:
-Skull injuries ; edema,
combined with ecchymosis
of varying states.
-Bald spots (traumatic
alopecia); caused by pulling
the hair out at the roots.
-Raccoon sign: bilateral
periorbital ecchymosis.
-Nose fractures or
displacement.
-Lip bruises &lacerations;
angular bruising,
lichenification (thickened &
leathery skin), or scarring,
which can be caused from
gags applied to the mouth.
-Marks on the skin that form
a pattern of an object like a
belt buckle or hand print.
-Human bite marks.

Intraoral
Signs of
Abuse
-Care must be given to
the assessment of
intraoral traumatic
injuries. Many injuries of
the mouth in children
can be caused by
accidents.
-Lacerations of the
tongue, buccal mucosa,
or palate.
-Lingual or labial frenal
tears.
-Teeth that are
fractured, displaced,
avulsed, or nonvital.
-Radiographic evidence
of fractures in different
degrees of healing.

Signs of Sexual
Abuse:
-Bruising or
petechia of the
palate can indicate
forced oral sex.
-Sexually
transmitted genital
lesions found
intraorally.
-Exhibits difficulty in
walking or sitting.
-Extreme fear of the
oral examination.
-Pregnancy,
especially in the
early adolescent
years.

Intraoral Signs of Neglect

Failure of the caregiver to seek dental

care for the child can be considered

intentional or unintentional neglect.
Neglect becomes intentional when the
caregiver is negligent in following
through with the recommended
treatment.

Signs of Oral
Neglect:
-Signs of lack of

personal daily
care.
-Untreated
disease, including
rampant caries,
pain, gingival
inflammation, &
bleeding.
-Lack of regularity
of dental care;
appointments may
have been made
primarily for tooth
or mouth pain.

Responsibilities of Dental Professionals

Provide education to the caregivers and age

appropriate children in the required personal oral

health care and disease prevention procedures.
Inform the caregiver of the total treatment plan

necessary to control oral diseases.

Provide information about access to care,

financial aid, and transportation, when needed.

Elder Maltreatment
Mistreatment occurs in institutional settings as well as in

family home environments.

General Signs of Abuse & Neglect:
-Appears withdrawn, anxious, & shy and has low selfesteem.
-Gives an illogical explanation of how an injury occurred.
-Depression & hostility may be evident.
-May seem to dodge a motion of another person as if
expecting to be hit.
-Overly eager to please & to be compliant.

Physical Signs of Abuse & Neglect

Same as for children.

Intraoral Signs:
-Lip trauma.
-Bruising of facial tissues.
-Eye injuries.
-Fractured or bruised mandible.
-Tempromandibular joint pain.

Intraoral Signs:
Same as for children, with the addition of:

-Lesions or sores from ill-fitting dentures.

-Fractured denture.
-Untreated periodontal disease.

Intimate Partner Abuse & Violence

The majority of cases have female victims. Such abuse

often goes unreported.

Signs & Attitudes of the Abused:
-Same injuries listed for children & the elderly. They involve
most frequently the face, eyes, & neck.
-Battered partner may be very reluctant to admit abuse
because of threats of more serious harm.
-Abused may deny the abuse, defend the abuser, or
provide excuses.
-Types of abuse or physical, sexual, emotional,
psychological & economic deprivation.

Dental Hygienists Approach

Provide support ; encourage open communication; be a source of

reassurance.
Discuss findings in a nonjudgemental manner.
Respect and maintain confidentiality.
Provide references for counseling.
Respect patients autonomy; ask about plans for future safety.
Prepare to share your findings with authorities, if necessary.
When it is known that the interview will be used in a legal setting, a
witness needs to be present.
Document clinical findings, including extra/intraoral photographs of
injuries.

Reporting Maltreatment
Proper training in the recognition and reporting of abuse and neglect

need to be implemented in every dental practice. Abusers may avoid

the same physician but return to the same dentist.
Many state governing boards require completion of CE hours on
abuse and neglect.

Reporting Laws
-Vary from state to state.
Texas law requires anyone with knowledge of suspected child abuse
or neglect to report it to the appropriate authorities. All persons are
required to make the report immediately, & individuals who are licensed
by the state and have contact with children as a result of their normal
duties, such as teachers, nurses, doctors, & day-care employees, must
report the abuse or neglect within 48 hours.

Texas law broadly defines abuse & neglect so that every

action in which a childs physical or mental health or
welfare has been or may be adversely affected is
potentially covered. However, if there is a question, always
err on the side of the childs safety and report the incident.
A person acting in good faith who reports or assists in the
investigation of a report of child abuse or neglect is immune
from civil or criminal liability. Failure to report is a Class A
Misdemeanor, punishable by imprisonment of up to one
year and/or a fine up to $4,000. Merely reporting the
incident to your supervisor or manager is insufficient.

Test Questions:
1.What percentage of child physical abuse involves injuries

to the head, neck, or mouth?

a.5-10%
b.20-30%
c.40-45%
d.65-75%

2. Who does Texas law require to report suspected abuse

or neglect?
a. Healthcare professionals
b. Anyone with knowledge of suspected abuse or neglect
c. Physicians only
d. Physicians & teachers

3. Abuse or neglect must be reported in

a. 8 hours
b. 24 hours
c. 48 hours
d. 1 week

References
dentalcare.comChildAbuseandNeglect:ImplicationsfortheDentalProfe

ssional
www.smu.edu/ola/BriefingPapers/Dutyto

ReportSuspectedChildAbuseintheStateofTexas

Wilkins, Esther M. Clinical Practice of the dental Hygienist.

Philadelphia: Walters Kluwer Health/Lippincott Williams &

Wilkins, 2013. Print.