Human Abuse Seen in the Dental Practice Environment

Human abuse in the United States has been described by Donna Shalala, former Secretary of Health and Human Services under President Bill Clinton, as a national epidemic.7 Human abuse is generally described as physical harm against any person. Categories of the types of human abuse include child abuse, intimate partner abuse (also known as domestic violence), disabled abuse, geriatric abuse, sexual abuse as well as other forms of assault, battery and homicide (Figure 8). The most detailed reported information involves cases of child abuse.

Figure 8.

Forensic dentistry’s role in detecting and reporting episodes of human abuse, specifically child abuse, is two-fold. First, health care providers are legally mandated to report suspected cases of child abuse in all 50 states. Secondly, clinical signs and symptoms of the abused are often discovered in the medical and dental office environment (Figures 9‑10). Forensic odontologists are charged with the task of informing practicing dentists and other healthcare providers about the duties of reporting suspected abuse.

Figure 9.
Figure 10.
Two cases of child abuse with visible injuries that could be recognized and reported in the dental office.

While child maltreatment is the most widely followed and reported, all categories of human abuse continue to experience significant increases in the number and frequency of the reported incidents of abuse year-over-year. This course will focus on child abuse.

Child abuse has four main elements: physical abuse, sexual abuse, emotional abuse and neglect. Overt signs and symptoms of sexual abuse are unlikely to be seen in the dental practice environment. However, the other three categories are regularly seen but severely under-reported by dental health care providers (Figures 11‑12).

Figure 11.
Child abuse and neglect victim. Bitemarks on the face, slap marks on the chest, among other injuries including severe diaper rash with open sores.
Figure 12.
Child abuse homicide with signs of neglect. This young child endured a tortured shortened life. Note the bed sores on the child buttocks (neglect) (A) and the many injuries in various stages of healing (B).

It is estimated that 43-75% of abused children present with signs and symptoms of injuries on the head, neck and mouth yet dentists report less than 1% of all cases. Many of the victims have experienced multiple abusive episodes that, if go unheeded, can increase in frequency and violence, up to child's death. Often, child abuse victims will appear with multiple injuries in different stages of healing (Figure 13). These factors underscore the role of the forensic odontologist both as an educator to the profession as well as an expert witness in cases of suspected abuse (Figures 14‑15).

Figure 13.
Child abuse victim with bitemark on the right cheek. The child survived this abusive episode.
Figure 14.
Child abuse homicide victim with bitemarks and other injuries in various stages of healing. The child did not survive this episode. A forensic dentist assisted with the documentation of the injuries.
Figure 15.
Victim of child on child biting sustained at a daycare facility. The obvious lack of supervision led to a criminal case. A forensic dentist assisted with the documentation of the injuries. The forensic odontologist was able to identify many of the injuries as having been produced by primary dentition.