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When does childhood dental caries become neglect or abuse: do parents think what we think?


Introduction Poor oral health in children may be a marker for wider neglect and abuse, but there is no universally recognised threshold for social services intervention.

Aim To compare families' thresholds for referral for social services intervention with those of healthcare workers.

Intervention Five standardised vignettes, used previously to investigate the views of healthcare workers on the need for social services intervention, were used to determine the threshold of 250 families for intervention.

Results For an unkempt four-year-old girl with extensive dental caries frequently not brought to appointments, 63.6% families suggested a child in need (CIN) referral, against 9% (3/32) dental professionals (p <0.001) and 38% (38/100) paediatric healthcare professionals (PHCPs) (p <0.001). For a bullied, obese 14-year-old boy with extensive dental caries, similar proportions of families (37%; 93/250) and PHCPs (40%; 40/100) advised a CIN referral (p = ns); significantly fewer dental workers did (15.6%; 5/32; p = 0.017). Concerning a four-year-old boy with a bruised ear, over 64% of families and 68% of PHCPs correctly felt engagement with social services was necessary (p = ns) compared to just 12.5% (4/32) of dental practitioners (p <0.001).

Conclusion Many parents felt social services involvement would be helpful in these hypothetical cases, often more frequently than healthcare workers.

Key points

  • There is currently no recognised threshold for dental neglect.

  • Families have a lower threshold for social services involvement, either as a child in need or child protection referral, than dental professionals.

  • Neglect and abuse must be considered for children with high levels of dental caries.

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We are grateful to all the families who participated and gave their time for this survey. Thanks are also due to Maria Morgan for the Welsh data.

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Correspondence to Emma J. Hingston.

Ethics declarations

EH - nil. DT - nil. GGR was paid from a paediatric endowment fund supervised by DT to perform this work as a dental student. No commercial funding or influence was received.

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Tuthill, D., Guest-Rowlands, G. & Hingston, E. When does childhood dental caries become neglect or abuse: do parents think what we think?. Br Dent J (2021).

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