Research | Published:

Paediatric dento-facial infections – a potential tool for identifying children at risk of neglect?

BDJ volume 225, pages 757761 (26 October 2018) | Download Citation

Key points

  • Acute dento-facial/ cervico-facial infection in children may be an indicator of wider neglect.

  • 40.7% of children presenting dento-facial / cervico-facial infection were already know to social services.

  • More than 50% of children presenting with dento-facial infection were between 5-8 years old, suggesting this group is at greater risk of dental neglect

Abstract

Introduction

Child neglect has a significant impact on children's physical and emotional health and development with lifelong consequences. Dental decay can lead to maxillofacial space infections which can have life-threatening complications and may indicate that a child has suffered dental neglect.

Aims and method

In this retrospective audit, we reviewed children below sixteen years who were admitted under oral and maxillofacial surgery for incision and drainage of a dental/facial abscess, under general anaesthesia, between January 2015 and January 2017, to understand if they had experienced dental neglect. We also assessed if they were or had been known to Children's Social Services (SS) before hospital admission.

Results

Twenty-seven children were included in the study, eleven children (40%), were known to social services (SS). On average 3.2 teeth were extracted with an average hospital stay of 2.5 days.

Discussion

Our data indicate that a significant number of children admitted for maxillofacial space infection are already known to social services.

Conclusion

Our recommendation is that all children admitted with dental/maxillofacial space infections, where dental neglect may be present, should be discussed with the local safeguarding team.

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References

  1. 1.

    Department for Education. Characteristics of children in need: 2015 to 2016. 2016. Available at (accessed April 2018).

  2. 2.

    Department for Education and Skills. Working together to Safeguard Children: a guide to inter-agency working to safeguard and promote the welfare of children. London DfES, 2006.

  3. 3.

    American Academy of Pediatrics Committee on Child Abuse and Neglect, American Academy of Pediatric Dentistry, American Academy of Pediatric Dentistry Council on Clinical Affairs. Guideline on oral and dental aspects of child abuse and neglect. Pediatr Dent 2008; 30(7 Suppl): 86–89.

  4. 4.

    , , . British Society of Paediatric Dentistry: a policy document on dental neglect in children. Int J Paediatr Dent 2009; 10.1111/j.1365-263X.2009.00996.x.

  5. 5.

    , , . Prevalence of early childhood caries in a population of children with history of maltreatment. J Public Health Dent 2008; 68: 94–101.

  6. 6.

    , , . The prevalence and impact of dental pain in 8-year-old school children in Harrow, England. Br Dent J 1999; 187: 38–41.

  7. 7.

    . Dental caries affects body weight, growth and quality of life in pre-school children. Br Dent J 2006; 201: 625–626.

  8. 8.

    , , . Does caries in primary teeth predict enamel defects in permanent teeth? A longitudinal study. J Dent Res 2005; 84: 260–264.

  9. 9.

    , . Severe dental infections in the emergency department. Eur J Emerg Med 2012; 19: 208–213.

  10. 10.

    , , . Tracheotomy versus endotracheal intubation for airway management in deep neck space infections. J Oral Maxillofac Surg 2002; 60: 349–354; discussion 54–55.

  11. 11.

    , . Infection of the facial area, oral cavity, oropharynx, and retropharynx. Neuroimaging Clin N Am 2003; 13: 393–410, ix.

  12. 12.

    , , , , . A review of complications of odontogenic infections. Natl J Maxillofac Surg 2015; 6: 136–143.

  13. 13.

    , , . Pediatric Sepsis Secondary to an Occult Dental Abscess: A Case Report. J Emerg Med 2017; 52: 744–748.

  14. 14.

    , , , , . Descending necrotizing mediastinitis due to odontogenic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 89: 412–419.

  15. 15.

    , . Cervical cellulitis and mediastinitis caused by odontogenic infections: report of two cases and review of literature. J Oral Maxillofac Surg 1995; 53: 203–208.

  16. 16.

    , , , . Thoracic complications of deeply situated serous neck infections. J Craniomaxillofac Surg 1993; 21: 76–81.

  17. 17.

    , , , . Cervical necrotizing fasciitis of odontogenic origin: a report of 11 cases. J Oral Maxillofac Surg 2000; 58: 1347–1352; discussion 53.

  18. 18.

    , , . Bilateral septic cavernous sinus thrombosis following the masticator and parapharyngeal space infection from the odontogenic origin: a case report. J Med Assoc Thai 2010; 93: 1107–1111.

  19. 19.

    , , . Brain abscesses caused by oral infection. Endod Dent Traumatol 1999; 15: 95–101.

  20. 20.

    . A nationwide survey of deaths from oral and maxillofacial infections: the Taiwanese experience. J Oral Maxillofac Surg 1999; 57: 1297–1299; discussion 300.

  21. 21.

    , . Deep neck abscesses-changing trends. J Laryngol Otol 1994; 108: 138–143.

  22. 22.

    , , . Ludwig's angina in the pediatric population: report of a case and review of the literature. Int J Pediatr Otorhinolaryngol 2000; 52: 79–87.

  23. 23.

    , , , , . Risk Factors for Life-Threatening Complications of Maxillofacial Space Infection. J Craniofac Surg 2016; 27: 385–390.

  24. 24.

    , , , . An investigation of the relationship between untreated decayed teeth and dental sepsis in 5-year-old children. Br Dent J 2006; 200: 45–47; discussion 29.

  25. 25.

    Department for Education. Working together to safeguard children: a guide to inter-agency working to safeguard and promote the welfare of children. 2015.

  26. 26.

    , , , . Safeguarding children in dentistry: 1. Child protection training, experience and practice of dental professionals with an interest in paediatric dentistry. Br Dent J 2009; 206: 409–414.

  27. 27.

    Greater London Authority: London Borough Profiles and Atlas. 2017. Available at (accessed April 2018).

  28. 28.

    , , , , . Trust for London: London's Poverty Profile. 2017. Available at (accessed April 2018).

  29. 29.

    . Rationale for restoration of carious primary teeth: a review. Eur Arch Paediatr Dent 2012; 13: 281–292.

  30. 30.

    , , , , . Rapid treatment reduces hospitalization for pediatric patients with odontogenic-based cellulitis. Am J Emerg Med 2010; 28: 668–672.

  31. 31.

    , , , , , . Burden and consequences of child maltreatment in high-income countries. Lancet 2009; 373: 68–81.

  32. 32.

    , , et al. Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. Br J Psychiatry 2010; 197: 378–385.

  33. 33.

    , . Shedding light on the long shadow of childhood adversity. JAMA 2013; 309: 1777–1778.

  34. 34.

    , , et al. Measuring childhood maltreatment to predict early-adult psychopathology: Comparison of prospective informant-reports and retrospective self-reports. J Psychiatr Res 2018; 96: 57–64.

  35. 35.

    , , , , , . The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. PLoS Med 2012; 9: e1001349.

  36. 36.

    , , et al. Evaluation of a dental care program for school beginners in a Paris suburb. Community Dent Oral Epidemiol 2003; 31: 285–291.

  37. 37.

    , , , , . Dental neglect as a marker of broader neglect: a qualitative investigation of public health nurses' assessments of oral health in preschool children. BMC Public Health 2013; 13: 370.

  38. 38.

    , , et al. Characteristics of child dental neglect: a systematic review. J Dent 2014; 42: 229–239.

  39. 39.

    , , . Systematic review highlights difficulty in clearly identifying dental neglect in children. Evid Based Dent 2014; 15: 3–4.

  40. 40.

    NICE. Child maltreatment: when to suspect maltreatment in under 18s. National Institute for Health and Clinical Excellence. 2009. Available at (accessed: April 2018).

  41. 41.

    , , , . Safeguarding children in dentistry: 2. Do paediatric dentists neglect child dental neglect? Br Dent J 2009; 206: 465–470.

  42. 42.

    , , . Understanding child neglect. Current perspectives in dentistry. Prim Dent Care 2010; 17: 105–109.

  43. 43.

    , . Some clarification of trigger signs for dental neglect. Evid Based Dent 2014; 15: 2–3.

  44. 44.

    Public Health England. Delivering better oral health: an evidence-based toolkit for prevention. 2014. Available at (accessed April 2018).

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Acknowledgements

The authors thank the child safeguarding team at King's College Hospital for their support and contribution to this work and Juli Davis for her help with the figures.

Author information

Affiliations

  1. Department of Oral and Maxillofacial Surgery, King's College Hospital, Denmark Hill, London, SE5 9RW, UK

    • J. Schlabe
    • , D. Chapireau
    •  & K. Fan
  2. Guy's and St Thomas NHS Trust, Great Maze Pond, London, SE1 9RT, UK

    • J. Schlabe
  3. King's College Dental Institute, Bessemer Rd, Camberwell, London, SE5 9RW, UK

    • M. Kabban
  4. King's College London, School of Tissue Engineering & Biophotonics Dental Institute

    • K. Fan

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Corresponding author

Correspondence to K. Fan.

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DOI

https://doi.org/10.1038/sj.bdj.2018.862

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