Abuse

Abuse can involve children, women, men and the elderly. The dental team can assist in early detection of someone being abused when conducting an exam and looking for anything that may show signs of abuse within the oral cavity. The following are some signs the dental team can look for when conducting an exam:20

  • Fractured incisors – may be due to repeated trauma.
  • Burns on lips – due to forced feeding of hot food.
  • Bruises on lips – in children may be due to forced pacifier use.
  • Frenum bruising or tear – due to forced feeding of a non-ambulatory child, elderly.
  • Oral or perioral syphilis or gonorrhea (pathognomonic of sexual abuse, palatal petechiae or erythema) – probable sexual abuse.
  • Bite marks – 65% of bite marks are visible on unexposed areas that are not covered by the child’s clothes.20

Bite marks on abused children tend to come from individuals who have uncontrollable anger toward the child. Infants that are bitten by the perpetrator are more punitive in nature as the bites are basically driven by a specific behavior by the infant. Overall trends reveal the person who inflicted the bite is usually the abuser of the child.23

Dental professionals are called upon to actively participate in crimes related to children, especially if a bite mark is associated with the victim.23 Child abuse is any act that endangers or impairs a child’s physical or emotional health or development. Neglect occurs in 74.8% of child abuse cases and 74.6% of child abuse victims die from neglect.32 Dental neglect is one type of abuse because it is the willful failure by a parent or guardian to seek and obtain treatment for dental problems which cause pain, infection, or interfere with adequate function.

Elder abuse is an issue dental professionals need to be more aware of happening. Each year, millions of elders suffer from maltreatment.33,34 The elder population of 65 and older is increasing each year, so are the cases for elder abuse.35 Elder abuse can be put into six categories: physical abuse, sexual abuse, psychological abuse, financial exploitation and violation of rights.36,37 The United States Department of Justice indicates that violent crimes against people ages 65 and older are approximately 4 in 1,000.38 Figure 5 displays the relationship of the abuser and Figure 6 is a chart displaying the types of elder abuse. As you can see in Figure 6, neglect is number one with physical abuse number two.38

Figure 5. Relationship of Abuser.
Relationship of Abuser
Source: U.S. Department of Health and Human Services Administration on Aging32
Figure 6. Types of Elder Abuse.
Types of Elder Abuse.
Source: National Center on Elder Abuse, Bureau of Justice Statistics. July 7, 201438

Dental professionals may encounter clues that elders are being physically abused by bruises, lacerations, puncture wounds, or injuries with incompatible histories. The head and neck regions tend to be the common site of elder abuse; with other signs being traumatic hair and tooth loss, rope or strap marks indicating physical restraint and multicolored bruises indicating injuries at various healing stages.4 National Committee for Prevention of Elder Abuse also reports some of the indicators of elder abuse can include:4

  • Injuries that are unexplained or are implausible.
  • Family members providing different explanations of how injuries were sustained.
  • A history of similar injuries with numerous hospitalizations.
  • Victims brought to different medical facilities for treatment to prevent medical practitioners from observing pattern abuse.
  • Delay between onset of injury and seeking medical care.

Head and neck injuries are common in elder abuse.4 In fact, it was reported approximately 30% of known elder abuse cases were related to neck and facial injuries.39 Oral soft tissues, jaw fractures and fractured or avulsed teeth have been reported as indications of elder abuse.4

There are many of the indicators mentioned that are very similar to signs and symptoms of abuse and neglect seen in the younger population.4 It is imperative dental professionals are aware of the signs of intentional trauma that are often seen in the orofacial region.4 When a dental professional recognizes these signs, documentation is crucial and all the findings should be noted in the dental patient record. A description of the area, shape, size, color should be in the notes, including a picture either using the intraoral camera or digital camera to help with the documentation. This documentation assists the dental professional when determining patterns and also helps with the investigation of abuse cases. In addition, the forensic dentist is regularly consulted when either law enforcement or health care personnel recognize there is dental evidence connected to an incident.40