Child Abuse and Neglect: Implications for the Dental Professional
Identification: Physical Abuse

For the dental professional to be able to identify the signs of maltreatment that a child may present with, he or she must be knowledgeable of not only the types of abuse or neglect, mentioned previously, but the various physical and behavioral manifestations that may be exhibited. The ability to properly identify suspicious injuries to the head, face, mouth, and neck of a child is imperative for dentists. The following information outlines the signs and symptoms or the four types of child maltreatment with emphasis placed on the locations on the child where they may occur.

Physical Abuse may result in numerous types of injuries including contusions, ecchymosis, abrasions, lacerations, fractures, burns, bites, hematomas, retinal hemorrhaging, traumatic, and dental trauma. A list of head and orofacial injuries that dentists should be alert for include:

Head Injuries^15,17,19

• Scalp and hair – subdural hematomas (cause more serious injuries and deaths than any other form of abuse), traumatic alopecia, subgaleal hematomas, and bruises behind the ears
• Eyes – retinal hemorrhage, ptosis, and periorbital bruising
• Ears – bruising of the auricle and tympanic membrane damage
• Nose – nasal fractures or an injury resulting in clotted nostrils

Orofacial Injuries^17,20,21

• Lips – lacerations, burns, abrasions, or bruising
• Mouth – labial or lingual frenum tears (characteristic of more severely abused children), burns or lacerations of the gingiva, tongue, palate, or floor of the mouth
• Maxilla or mandible – past or present fractures to facial bones, condyles, ramus, or symphysis of mandible. Malocclusion may be a result of this type of injury

Bite marks

This type of injury is usually associated with physical or sexual abuse. In such suspected cases, a forensic pathologist or odontologist should be contacted.^22,23

• Many times misdiagnosed as simple childhood bruises
• Typically oval or circular configuration
• An area of hemorrhage, representing a “suck” or “thrust” mark, may be found between tooth marks, suggesting physical or sexual abuse
• Although marks may occur anywhere on a child’s body, the most common sites are the cheeks, back, sides, arms, buttocks, and genitalia