This interactive Florida Dental Hygienist Ebook contains 26 hours of continuing education. To complete click the Complete Your CE button at the top right of the screen.
FLORIDA Dental Hygienist Continuing Education
Inside: Family Violence:
Implications for Dental Patients and Practice in Florida Protecting Patient Safety in the Dental Office: Preventing Medical/ Dental Errors
26-hour Continuing Education Package $144.00 ELITELEARNING.COM/BOOK Complete this book online with book code: DHFL2624
Chapter 1: Family Violence: Implications for Dental Patients and Practice in Florida (Mandatory) [2 CE Hours] Members of the dental team must become more aware of the problem of family violence to help prevent abuse and neglect. Clinical protocols can easily be modified to include identification and intervention for cases of suspected abuse and neglect. By applying the knowledge of symptomatology obtained in this basic-level course and providing appropriate intervention, every member of the dental team can help stem the epidemic of family violence. THIS COURSE FULFILLS THE REQUIREMENT FOR DOMESTIC VIOLENCE Chapter 2: Protecting Patient Safety in the Dental Office: Preventing Medical/Dental Errors (Mandatory) [4 CE Hours] This course discusses the current state of medical/dental errors and patient safety. Along with highlighting the different types and causes of medical/dental errors, strategies to prevent or control medical/dental errors are presented, and
methods of identifying, analyzing, and reporting medical/dental errors are discussed. THIS COURSE FULFILLS THE REQUIREMENT FOR PREVENTION OF MEDICAL ERRORS Chapter 3: Allergic Reactions to Metals in the Mouth, 2nd Edition
[1 CE Hour] This course reviews the importance of metals for human health, identifies common harmful metals and their role in disease, and discusses hypersensitivity reactions, with particular regard to metal allergies in medical and dental patients. Corrosion is also discussed relative to its role in the hypersensitivity reactions experienced by dental patients. Chapter 4: Dental Ethics and the Digital Age, 2nd Edition 44 [3 CE Hours] This course will help dental professionals gain a better understanding of dental ethics, professionalism, and current ethical challenges, with a particular emphasis on the impact of the digital age. A section of this course will address the ways that the law and ethics intersect. Through a systematic, case-based approach, this course will provide dentists, dental hygienists, and dental assistants with the tools to recognize and navigate the complex ethical issues that may arise in practice. Chapter 5: Dental Radiation Health: Safety and Protection in the Digital Age, 2nd Edition 69 [3 CE Hours] Radiation safety remains a top concern for the general public, and the dental professional needs to stay up to date on the latest research and current thinking on radiation safety and protection. This basic-level course reviews the biologic effects of radiation, the methods used in radiation measurement, and the potential sources of radiation exposure. This course discusses radiation safety and protection measures for both patients and dental healthcare workers. Perhaps most important, this course prepares all dental professionals – including dentists, dental hygienists, and dental assistants – to accurately respond to patient questions and concerns about radiation safety in dentistry. Chapter 6: Erosion-Related Tooth Wear 85 [1 CE Hour] Early recognition of tooth wear is essential to successful prevention and management of disease progression. The primary dental care team is in the ideal position to provide this care to patients with dental erosion and other forms of tooth wear. This intermediate-level course provides dentists, dental hygienists, and dental assistants with an overview of the etiology of tooth wear and explains the pathogenic processes involved in tooth erosion. It describes the necessary protocol for assessing erosion in patients and making a diagnosis. Preventive measures and treatment approaches are included. Chapter 7: Medication-Related Damage to Soft and Hard Dental Structures 93 [2 CE Hours] The purpose of this course is to prepare dentists, dental hygienists, and dental assistants to identify these medication- related adverse effects and treat or assist in treating them. This course begins by presenting conditions involving damage to the hard dental structures caused by fluoride, anticonvulsants, chemotherapeutics, and medications such as bisphosphonates that are associated with osteonecrosis of the jaw. Tooth discoloration is also discussed. Damage to oral soft tissues is then reviewed. Color changes to the oral mucosa, including mucosal pigmentation and black hairy tongue, are described. Drug-related gingival enlargement and other mucosal disorders, oral allergic reactions, drug-related white lesions, and conditions of the salivary glands are examined.
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DENTAL CONTINUING EDUCATION
Chapter 8: Obstructive Sleep Apnea: A Comprehensive Review for Dental Professionals, 3rd Edition [2 CE Hours] This course reviews OSA from a dental perspective. It addresses current findings on the links between overall health and OSA and cites common presenting symptoms likely to be encountered in the dental practice. This intermediate- level course discusses the latest evidence-based diagnostic approaches for OSA and outlines recommended treatment strategies, including continuous positive airway pressure (CPAP), OAs, and surgical intervention, to mitigate the health impact of this common condition. Several resources listed at the end of this course can provide dental professionals with further opportunities for education and training in this area. Chapter 9: Oral Health Issues for the Female Patient, 3rd Edition 119 [2 CE Hours] This course explores the variables affecting women’s oral health and discusses the issues and concerns that dental professionals face in providing care to females across their life span. Chapter 10: Providing Oral Healthcare Services for People with Special Needs 131 [2 CE Hours] 106 This course addresses current thinking about the challenges dental professionals face with providing oral healthcare services for people with special needs. It identifies the factors that hinder access to dental care and presents strategies to improve the provision of care for the special needs population. The basic-level course includes recommendations for the management and treatment of special needs patients. Chapter 11: Three Drug Classes: Antibiotics, Analgesics, and Local Anesthetics Mod I: Antibiotics, 3rd Edition 141 [2 CE Hours] After completing this course, the participant will be able to discuss the differences among antibiotics typically prescribed for orofacial infections. In the case of special patient populations such as orthopedic, cardiac, and immunosuppressed individuals, the selection and timing of appropriate prophylactic antibiotics will be made clear. The principles learned will also be directly applicable to the appropriate selection of antimicrobial therapy for the pregnant or breastfeeding patient and will aid in recognizing those patients with a significant allergic history and how to best and safely treat them. This intermediate-level course is specifically designed for all members of the dental healthcare team: dentists, dental hygienists, and dental assistants. Chapter 12: Three Drug Classes: Antibiotics, Analgesics, and Local Anesthetics Mod II: Analgesics, 3rd Edition 159 [2 CE Hours] Upon completing this course, the learner will be able to discuss the differences among analgesics typically prescribed for orofacial pain. In the case of unique patient populations requiring adjuvant options, the selection and timing of appropriate medications will no longer constitute a gap in knowledge. The principles learned will also be directly applicable to the appropriate selection of analgesics for the pregnant or breastfeeding patient and will aid in recognizing those patients with a significant allergic history and determining how to best and safely treat them.
©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials. ii DENTAL CONTINUING EDUCATION
FREQUENTLY ASKED QUESTIONS
What are the requirements for license renewal? License Expires
CE Hours Required
2 hours - Prevention of Medical Errors 2 hours - Domestic Violence (Due every third biennium in addition to the 24 hour requirement) 2 hours - First biennium renewal, licensees are only required to complete 2 hours of HIV/AIDS
24 (All allowed through online courses)
Licenses expire February 28 of the even year
How much will it cost?
HOURS PRICE COURSE CODE
Family Violence: Implications for Dental Patients and Practice in Florida (Mandatory) Protecting Patient Safety in the Dental Office: Preventing Medical/Dental Errors (Mandatory)
Chapter 3: Chapter 4: Chapter 5: Chapter 6: Chapter 7:
Allergic Reactions to Metals in the Mouth, 2nd Edition
1 3 3 1 2
DFL01AR DFL03DE DFL03DR DFL01TW DFL02DS
Dental Ethics and the Digital Age, 2nd Edition
Dental Radiation Health: Safety and Protection in the Digital Age, 2nd Edition
Erosion-Related Tooth Wear
Medication-Related Damage to Soft and Hard Dental Structures
Obstructive Sleep Apnea: A Comprehensive Review for Dental Professionals, 3rd Edition
Oral Health Issues for the Female Patient, 3rd Edition
Providing Oral Healthcare Services for People with Special Needs
Three Drug Classes: Antibiotics, Analgesics, and Local Anesthetics Mod I: Antibiotics, 3rd Edition
Three Drug Classes: Antibiotics, Analgesics, and Local Anesthetics Mod II: Analgesics, 3rd Edition 2
Best Value - Save $115.40 - All 26 Hours
How do I complete this course and receive my certificate of completion? See the following page for step by step instructions to complete and receive your certificate. Are you a Florida board-approved provider?
Colibri Healthcare, LLC is designated as a Nationally Approved PACE Program Provider for FAGD/MAGD credit. Approval does not imply acceptance by any regulatory authority or AGD endorsement. Current approval period is 1/1/2022 to 12/31/2025; Provider ID# 217536. Colibri Healthcare, LLC is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Colibri Healthcare, LLC is an approved provider of continuing education by the Florida Board of Dentistry (Provider #50-4007). Are my credit hours reported to the Florida board? Yes. We will report your hours electronically to CE Broker within 1 business day. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Dental you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at email@example.com, or call us toll free at 866-344-0972, Monday - Friday 9:00 am - 6:00 pm, EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file.
Licensing board contact information: Department of Health Board of Dentistry 4052 Bald Cypress Way, Bin C-04 Tallahassee, FL 32399-3258
Phone (850) 488-0595 Fax (850) 921-5389 Website: https://floridasdentistry.gov/
DENTAL CONTINUING EDUCATION
Please read these instructions before proceeding. Read and study the enclosed courses and answer the final examination questions. To receive credit for your courses, you must provide your customer information and complete the evaluation. How to complete continuing education
Fastest way to receive your certificate of completion
Online IF YOU’RE COMPLETING ALL COURSES IN THIS BOOK: • Go to EliteLearning.com/Book and enter code DHFL2624 in the book code box, then click GO .
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• If you already have an account created, sign in with your username and password. If you don’t have an account, you will need to create one now. • Follow the online instructions to complete your final exam. Complete the purchase process to receive course credit and your certificate of completion. Please remember to complete the online survey. IF YOU’RE ONLY COMPLETING CERTAIN COURSES IN THIS BOOK: • Go to EliteLearning.com/Book and enter code that corresponds to the course below, then click GO . • Each course will need to be completed individually.
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All 26 hours in this book
Family Violence: Implications for Dental Patients and Practice in Florida (Mandatory)
Protecting Patient Safety in the Dental Office: Preventing Medical/Dental Errors (Mandatory)
Allergic Reactions to Metals in the Mouth, 2nd Edition
Dental Ethics and the Digital Age, 2nd Edition
Dental Radiation Health: Safety and Protection in the Digital Age, 2nd Edition
Erosion-Related Tooth Wear
Medication-Related Damage to Soft and Hard Dental Structures
Obstructive Sleep Apnea: A Comprehensive Review for Dental Professionals, 3rd Edition
Oral Health Issues for the Female Patient, 3rd Edition
Providing Oral Healthcare Services for People with Special Needs DFL02SN Three Drug Classes: Antibiotics, Analgesics, and Local Anesthetics Mod I: Antibiotics, 3rd Edition DFL02AB Three Drug Classes: Antibiotics, Analgesics, and Local Anesthetics Mod II: Analgesics, 3rd Edition DFL02AG
DENTAL CONTINUING EDUCATION
Chapter 1: Family Violence: Implications for Dental Patients and Practice in Florida 2 CE Hours
Expiration Date : July 10, 2026
Release Date: July 10, 2023
Author Mark J. Szarejko, DDS , received his dental degree from the State University of New York at Buffalo in 1985 and received a fellowship from the Academy of General Dentistry in 1994. He has been in private practice for 16 years, with the balance involved in correctional (county jail) dentistry. In 2007 he received the Certified Correctional HealthCare Professional (CCHP) designation from the National Commission of Correctional Healthcare. He has authored and edited several dental continuing education courses and has given presentations How to receive credit ● Read the entire course online or in print. ● Depending on your state requirements you will be asked to complete: ○ A mandatory test (a passing score of 75 percent is required). Test questions link content to learning Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Disclaimer The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative Disclosures Resolution of conflict of interest After completing this course, the learner will be able to: Discuss the demographics, contributing factors, and reporting protocols of child abuse and neglect. Discuss the demographics, contributing factors, and reporting protocols of intimate partner violence. Discuss the demographics, contributing factors, and reporting protocols of abuse of people with disabilities. Discuss the demographics, contributing factors, and reporting protocols of elder abuse and neglect. Course overview Members of the dental team must become more aware of the problem of family violence to help prevent abuse and neglect. Clinical protocols can easily be modified to include identification and intervention for cases of suspected abuse and neglect. By Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity,
on varied topics to local, regional, and national audiences. He has been an examiner for the dental and dental hygiene licensure exams?for the Northeastern Regional Boards (NERBS), now the Commission on Dental Competency Assessments, since 1994. He has reviewed standard of care cases for the state of Florida and for private companies. Mark J. Szarejko has no significant financial or other conflicts of interest pertaining to this course. AGD Subject Code - 156 objectives as a method to enhance individualized learning and material retention. ● Provide required personal information and payment information. ● Complete the mandatory Course Evaluation. ● Print your Certificate of Completion. Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.
to diagnostic and treatment options of a specific patient’s medical condition.
©2023: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Colibri Healthcare, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers. Learning objectives
Differentiate the physical signs of family violence from accidental injuries or other physical conditions. Describe education and prevention efforts to combat family violence. Explain Florida state laws and regulations governing the roles and responsibilities of dental professionals on issues of child abuse and maltreatment. Discuss statistics related to family violence in Florida. applying the knowledge of symptomatology obtained in this basic-level course and providing appropriate intervention, every member of the dental team can help stem the epidemic of family violence. gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender,
Book Code: DHFL2624
or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased Family violence includes child abuse and neglect as well as intimate partner violence (also referred to as domestic violence or spousal abuse). Family violence may also include abuse and neglect of disabled persons (persons with significant physical disabilities or mental or functional impairments), vulnerable adults, and the elderly. Individuals of all age groups can be affected by family violence because multigenerational abuse frequently occurs. In 2009, a Department of Justice (DoJ) study reported that more than 25% of U.S. children had been exposed to family violence in their lifetimes (DoJ, 2017). From 2003 to 2014, more than half of the murders of women in the U.S. were related to intimate partner violence (Petrosky et al., 2017). Approximately one in ten people age 60 and over have experienced some form of abuse, with most of the abuse being perpetrated by family members (National Council on Aging, 2021). In 2015, of violent crime victimizations of people age 65 and older, 44% were committed by someone the victim knew, often a relative or intimate partner (National Center for Victims of Crime, 2017). Approximately 60% to 75% of physical abuse involves injuries to the head, neck, and mouth (Singh & Lehl, 2020). Orofacial injuries resulting from family violence should be easy to identify in the dental setting. Dental professionals also have an advantage over other healthcare professionals because almost two-thirds of all adults in the U.S. have regularly scheduled dental visits at least once a year (Centers for Disease Control and Prevention, [CDC] 2022a). Healthcare providers in the medical field do not have this unique opportunity because victims of family violence often avoid medical appointments. Historically, however, many in the dental profession have been unable or unwilling to properly identify these injuries. Equally disconcerting are cases in which a provider may suspect maltreatment but is uncertain of how to properly intervene. The steps in dealing with
approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
abuse or neglect are easy to learn and even easier to incorporate into the dental practice. All members of the dental team should be knowledgeable about the physical and behavioral signs and symptoms of family violence. They should also know how to assess whether symptoms are indicators of trauma as opposed to normal conditions or accidental injuries. Just as important is the knowledge of how to provide appropriate intervention for victims of any age. Although dentists are required to report suspected child abuse and neglect in every state, and to report elder abuse and neglect in most states, there is no universal requirement to report adult victims of intimate partner violence. It is important to note that in 30% to 60% of families experiencing intimate partner violence, child maltreatment also takes place (U.S. Department of Health and Human Services, Administration for Children and Families, n.d.). Members of the dental team must become more aware of the problem of family violence to help prevent abuse and neglect. Clinical protocols can easily be modified to include identification and intervention for cases of suspected abuse and neglect. By applying the knowledge of symptomatology obtained in this basic-level course and providing appropriate intervention, every member of the dental team can help stem the epidemic of family violence. The parallels between the four types of abuse should not be lost on the practitioner. Although an abuser may target different victims, the abuse— be it of a child, an intimate partner, a disabled person, or an elderly individual—follows a pattern, and it is a chain that must be broken. The dental healthcare team is in an excellent position to detect such injury and help prevent future harm.
Definition, data, and demographics Child abuse is defined by state laws, and its definition varies somewhat from state to state. (See Appendix A for legal definitions of child abuse and neglect in Florida.) Statutes typically define child abuse as nonaccidental physical, sexual, or emotional injuries, or trauma inflicted on a minor child by a parent or other caregiver (FindLaw, 2019; Singh & Lehl, 2020). Therefore, child abuse can take many different forms and can present in different ways in the dental office. It is important to note that child abuse includes injuries inflicted by anyone who cares for a child or has custody of or control over the child. These individuals can include not only parents and guardians, but also teachers, day care workers, and babysitters. They do not include injuries inflicted by strangers. National statistics show that more than 7.8 million children in the U.S. were reported as abused or neglected in 2018 and approximately 678,000 of these children were confirmed victims Contributing factors First and foremost, it is important to remember that people who abuse children may love their children very much . It is just that they do not love their children very well . Abusers are not necessarily motivated by hatred or cruelty, but sometimes by a warped sense of right and wrong in child- rearing.
of maltreatment (Pekarsky, 2022). Very young children are the most vulnerable. Homicide is the second leading cause of death for maltreated children younger than one year of age, with a fatality rate of 2.2 per 1,000 children annually (Brown et al., 2022). Child abuse and neglect know no geographic or class boundaries. Members of the dental team are cautioned against thinking that abuse and neglect occur only in large cities, in certain neighborhoods, or among certain ethnic groups. Across the nation, cases of child abuse and neglect happen in all socioeconomic groups. The victims come from all ethnic groups. Cases of abuse are spread out geographically, with victims in rural as well as urban settings. It has been said repeatedly that abused and neglected children exist in every dental practice. Unfortunately, these children are often not properly identified. Child maltreatment can undoubtedly be considered a breakdown in the parenting skills of the child’s caregivers. Many factors can lead to this failure to parent properly. It is most useful to understand that child abuse and neglect may be among many symptoms of a dysfunctional family (American Academy of Pediatrics, 2022; CDC, 2022b; Brown University,
Book Code: DHFL2624
n.d.). One theory holds that parents’ unrealistic expectations for the child and for themselves can contribute to the abuse (Smith, Robinson, et al., 2018). Another theory is that the abusers’ attitude toward children is based on the conviction that children exist to satisfy parental needs. Characteristics of a parent, legal guardian, or caregiver that can increase their risk of being abusive toward a child include having been abused as a child themselves, having difficulty in bonding with a newborn, having unrealistic expectations of child development, suffering from poor impulse control, having low self-esteem, and having employment and financial problems (World Health Organization, 2022). Some parents may have unrealistic expectations of their children and view their children as a source of constant, unconditional affection and as a source of support that the parents themselves never received (Pekarsky, 2022). This combination of unrealistic parental expectations of their child/ children and the aforementioned parental characteristics can increase the potential for child abuse. Other abusers explain the maltreatment of children as a suitable means of parenting. In one notable study, researchers interviewed abusers about their feelings subsequent to the
abuse. Of those adults interviewed, 62.5% felt justified in injuring the child, 58.9% felt no remorse for their actions, and 50.7% blamed the victim for the abuse. Combining the three factors studied, fully one-third of the adults felt justified, blamed the victim, and felt no remorse (Dietrich et al., 1990). It is well understood that several social factors contribute to child abuse. The most cited contributing factor in child abuse is substance abuse (Kaliszewski, 2022; Smith, Robinson, et al., 2018). Although substance abuse does not cause family violence, it may contribute to making a bad situation worse. The abuse of alcohol or other drugs can be an indicator of other risk factors, including poverty, unemployment, depression, and feelings of hopelessness. Other common contributing factors include stress, lack of a family support network, and the cyclic problem of abuse as a learned behavior (i.e., abusers are likely to have been abused as children; Smith, Robinson, et al., 2018). Intrafamily violence is a learned behavior—people parent the way they were parented, they treat spouses/intimate partners the way they saw their parents interact, and they treat their elders the way they saw their parents treat them. Intrafamily violence is a cycle that needs to be broken.
Definition, data, and demographics Child abuse occurs among all races, ethnicities, single and dual parent families and socioeconomic levels. (Gonzalez et al., 2022). State legislatures have provided definitions of child neglect to help differentiate it from simple lack of care. Although what is considered child neglect, the most common form of child abuse, varies considerably among the states (see Appendix A Confounding factors A diagnosis of suspected child neglect must consider multiple factors that involve the child and their parents or caregivers (Oliván Gonzalvo & de la Parte Serna, 2021). Because neglect may involve many factors, making a report of suspected neglect may require more consideration than a case of suspected abuse. For example, a parent who cannot access dental care or the financing of that care may not be neglecting the child. Lack of transportation or access to healthcare, inability to take time off from work, lack of providers of medical assistance (e.g., for patients who have Medicaid), and lack of insurance programs may all contribute to a child not receiving appropriate healthcare. However, if the dental professional determines that the resources are available but the child is not receiving proper care, they will need to report a suspected case of neglect. Dental neglect Although dental professionals often see children who have gone without adequate dental care yet differentiating dental caries as a component of dental neglect can be very difficult (Spiller et al., 2020). Dental neglect is the willful failure of parent or guardian to seek and obtain treatment for dental problems that cause pain or infection or those that interfere with adequate function (Voelker, 2022). Studies on caries rates and maltreatment have shown higher rates of disease and early childhood caries in children who are abused or neglected compared with the general population (Hartung et al., 2019; Smitt et al., 2018; Spiller et al., 2020).
for Florida’s legal definitions of child abuse and neglect), all definitions specify acts of omission, including failure to provide adequate care, support, nutrition, shelter, and medical or other care necessary for a child’s health and well-being (Gonzalez, et al., 2022; Pekarsky, 2022).
Another area of concern, on a smaller scale, is child neglect stemming from strongly held religious beliefs. Several states have enacted legislation that provides religious exemptions for various medical and dental procedures, some of which are basic while others could prevent high morbidity or even death (Swan, 2020). Florida has a religious exemption. However, according to Florida statute §39.01(34)(f), this exemption does not: ● Eliminate the requirement that such a case be reported to the department. ● Prevent the department from investigating such a case. ● Preclude a court from ordering, when the health of the child requires it, the provision of medical services by a physician, as defined in this section, or treatment by a duly accredited practitioner who relies solely on spiritual means for healing in accordance with the tenets and practices of a well- recognized church or religious organization. (Florida Senate, 2022) Questions often arise concerning when to report a suspected case of child neglect following missed dental appointments. State statutes do not give any guidelines for when these cases should be reported. The clinician must carefully evaluate the seriousness of the child’s untreated condition, the family’s resources, and other factors affecting access to care when deciding to make a report. Where one case may not need to be reported even after two or three missed appointments, another case may require a report after just a single broken appointment if the child is in imminent danger of serious physical sequelae from lack of care.
CHILD ABUSE AND NEGLECT REPORTING PROTOCOL
Dentists in every state and the District of Columbia are mandatory reporters of child abuse. In Florida, anyone who suspects child abuse is expected to report child abuse, though only mandated reporters must leave their names when calling the hotline (Florida Department of Children and Families, 2019c). Based on the child’s condition, a decision must be made about
whether members of the dental staff should visit with the parent or caregiver before making the report. If it is in the child’s best interest to speak with the adult(s) before making a report, the dentist will need to speak with them in private, but with another member of the staff present as a witness. In that confidential setting, the dentist should express his or her concern for the
Book Code: DHFL2624
abused or neglected child or children; unemotionally state the requirement to report suspected abuse and neglect; and then state the conditions, behavior, or history presented. No one Professional consultation Dentists and dental staff are not the professionals who have to make the determination of whether abuse and neglect have actually occurred. Their responsibility is to report suspected cases (Burgette et al., 2020). Dental auxiliaries may want to talk privately with the dentist or other staff members about conditions or problems they see. It may be beneficial, but is not mandatory, for the dentist to consult with the child’s physician The role of child protective services If a report needs to be made, it should be made immediately; anyone in the dental office can file a report. Reporting is easy. The first step involves calling the state or local child protective services (CPS) agency, in accordance with state law, and speaking with a trained social worker, who will determine the necessary action. Calling CPS does not necessarily mean you will have to file the report. The call can be a professional consultation to help the clinician decide whether a report needs to be filed. Most importantly, a call to CPS is not an accusation, but rather an inquiry prompted by concern for the well-being of Immunity from liability The issue of liability does not come into play in reporting cases of suspected abuse or neglect. State laws contain language that protects mandated reporters from criminal and civil liability arising from good-faith reports. Unfortunately, this does not mean that someone cannot sue a clinician for making a good- Confidentiality Most states, including Florida (Statute §39.204), restrict privileged communication in cases of suspected child abuse or neglect. Therefore, claiming privileged doctor-patient communication is generally not a defense for failing to report Penalties for failure to report All jurisdictions have laws that deal with child neglect and provisions for criminal penalties for failure to report suspected cases of child abuse or neglect (Burgette et al., 2020). In Florida, failure to report can result in being charged with a third-degree felony (2020Florida Statutes, §39.205; Florida Senate, 2022). It
should be judgmental. Even if the child is a victim, it may not be at the hands of the adults present, and the maltreatment may be totally unknown to them.
to discuss his or her concerns. The physician may have useful information about the patient’s condition. Some state protective service agencies provide consultative services along with reporting via a hotline. A clinician who is unsure about whether a report needs to be made should contact protective services about any concerns. The agency may provide guidance on whether a formal report needs to be made. the child and the family. If an investigation is warranted, it is up to CPS to investigate the case. Based on its investigation, the CPS agency determines whether the case is “substantiated,” meaning that credible evidence was found to indicate abuse or neglect, or “unfounded,” meaning that there was insufficient evidence to substantiate the maltreatment. Even if the case is determined to be “unfounded,” there is still a possibility that the child may be at risk. This finding may mean only that insufficient evidence was found in this particular instance; the information provided at this time may be used in future investigations to benefit the child. faith report. It does mean that, unless bad faith is proven, the clinician cannot be held liable. The reality of modern American society is that anyone can sue another person for anything. But in reporting suspected child abuse or neglect, such suits generally have no foundation in law.
suspected child abuse or neglect as required (Kenton & Boyle, 2020). Information given to a dentist by a patient may be shared with CPS in its investigation of child abuse or neglect.
is important for mandated healthcare professionals to note that malpractice insurance does not cover criminal acts. Because failure to report can be a crime, injuries resulting from such failure might expose a healthcare professional to uninsured professional liability.
INTIMATE PARTNER VIOLENCE
Definition, data, and demographics Intimate partner violence (IPV) occurs between two people in a close relationship. The term intimate partner includes current and former spouses and dating partners. Intimate partner violence exists along a continuum from a single episode of violence to ongoing battering. Approximately one in four women and one in ten men have experienced some form of IPV during their lifetimes (Smith, Zhang, et al., 2018). One in five women have been raped at some time in their lives (Smith, Zhang, et al., 2018). Of women who reported having been raped, approximately 51% reported that at least one perpetrator was an intimate partner (California Department of Public Health, 2020). According to the Centers for Disease Control and Prevention (CDC), between 2003 and 2014, of homicides of adult women, more than half (4,442) were IPV related (Petrosky et al., 2017). What is now called IPV was previously termed domestic violence or spousal abuse . It is important to note nomenclature variations among state statutes. For example, Florida law refers to the problem of family violence and maltreatment of family member victims of any age as domestic violence (Houseman & Semien, 2022).
IPV includes four types of behavior: ● Physical violence : Involves hurting or trying to hurt a partner by hitting, kicking, or using other types of physical force. This type of violence frequently occurs during pregnancy. According to the American College of Obstetricians and Gynecologists (ACOG), the reported prevalence of domestic violence during pregnancy includes 30% emotional abuse, 15% physical abuse and 8% sexual abuse (Huecker et al., 2022). ● Sexual violence : Involves forcing a partner to take part in a sex act when the partner does not consent. About 18% of U.S. women and 8% of U.S. men have experienced contact sexual violence by an intimate partner (Smith, Zhang, et al., 2018). ● Threats of physical or sexual violence : Include the use of words, gestures, weapons, or other means to communicate an intent to cause harm. ● Emotional abuse : Is threatening a partner or their possessions or loved ones or harming a partner’s sense of self-worth. Examples are stalking, name-calling, intimidation, and not letting a partner see friends and family. Family pets may also be the target of this intimidation. (Marques, 2021; National Sheriffs’ Association, n.d.)
Book Code: DHFL2624
Contributing factors Several factors can increase the risk that someone will hurt their partner. However, the simple presence of these risk factors does not always mean that IPV will occur. Risk factors for perpetration (hurting a partner) include (CDC, 2021b): ● Having been violent or aggressive in the past. Appropriate intervention for intimate partner violence Reporting requirements Although the reporting of child maltreatment and elder maltreatment by healthcare professionals is required in most states, some states require that all incidents of domestic violence inclusive of intimate partner violence are reportable (Walker, 2017). Risks of reporting It is important to acknowledge some disagreement among advocates on the idea of mandatory reporting in cases of IPV. Some argue that mandatory reporting is more likely to provide assistance for families in need of intervention. Others say that mandatory reporting places the victim of IPV at increased risk. In disclosing suspected IPV to public authorities, mandatory reporting may offer the victim an opportunity to extricate themselves from the relationship. However, a person who has been the victim of IPV may fear that their abuser may become more violent or threaten to kill them, their children, or other family members. (Women against Abuse, 2022). Although about half of the episodes of intimate partner violence result in bodily injury only about a third of those injured seek medical attention (Parish Carrigan et al., 2018). Although our society views children’s rights to privacy as secondary to their safety, this is not the case for adults. Healthcare professionals’ codes of ethics, including that of
● Having witnessed or been a victim of violence as a child. ● Using drugs or alcohol, especially drinking heavily. ● Being unemployed or experiencing other life events that result in high levels of stress.
the American Dental Association (ADA; 2020), generally list patient autonomy as a major principle. Mandatory reporting of IPV is complicated by the victims having to give up their autonomy when a report is filed and not being likely to have given informed consent for pertinent health information to be shared. Also, mandatory reporting most often is made to law enforcement authorities rather than social services agencies. Some victims may be afraid to report IPV because of their immigration status (U.S. Department of Health and Human Services [HHS], 2021). It is suggested that dental offices establish a protocol for such cases. If the victim is alone at the office, a discussion with the dentist and a staff member witness may be possible. If the abusive partner is present in the office or even in the operatory, such a conversation may not be possible. Posting a sign for a woman’s shelter or IPV hotline in the stall of the women’s restroom in the dental office or building is recommended. Tear-off strips with only the phone number can be part of the sign. Because of screening procedures employed by shelters and hotlines, perpetrators who may find and call such phone numbers will be unaware that they have reached a shelter or IPV hotline. Proper documentation, including consented x-rays and photographs, should be included in the patient file. Danger to the abused partner and the children always exists (see Table 1).
Table 1. Dealing with Intimate Partner Violence in the Dental Setting Do
• Assure patients of confidentiality to the extent allowed under the state’s mandatory reporting laws. • Listen to the patient. • Respond to the patient’s feelings. • Acknowledge that disclosure is scary for the patient. • Tell the patient that you are glad they told you. • Provide the patient with options and resources. • Document the information in the patient’s chart. • File mandatory reports. • Schedule a follow-up visit. • Discuss the abuse in front of the suspected perpetrator. • Violate confidentiality, unless it falls under the state’s mandatory reporting laws. • Give advice or dictate an appropriate response. • Shame or blame the patient. • Grill the patient for excessive details of the abuse. • Lie about the legal and ethical responsibilities to report suspected abuse. Note . From K. Littel. (2004). Family violence: An intervention model for dental professionals. OVC Bulletin , U.S. Department of Justice. https://ovc. ojp.gov/sites/g/files/xyckuh226/files/media/document/ncj204004.pdf DISABLED PERSONS ABUSE Definition, data, and demographics • Joke about the violence. • Minimize the issue or try to change the subject.
The statutory definition of “disabled persons” varies from state to state; it can include individuals with cognitive, physical, sensory, emotional, mental, or other impairments, including autism, AIDS, or other chronic medical conditions that make daily living difficult or impossible. Because of the differences in definitions, reporting mechanisms, and case disposition, there is little reliable and comparative statistical research available on abuse of people with disabilities. Research has shown, however, that people with developmental disabilities are four to ten times more likely to be victims of crime (CDC, 2020a). Some individuals with disabilities reside in nursing homes along with elderly individuals, whereas others reside in specialized care facilities. Some live at home with family or private caretakers, whereas others live in group homes and work in sheltered facilities. Crimes involving interpersonal violence, including physical and sexual assaults, may occur at home, at the group workplace, in group homes, or in care facilities.
Some government data report on the prevalence of child abuse victims with a reported disability. Categories include individuals with behavioral problems, emotional challenges, learning disabilities, intellectual challenges, physical disabilities, and visual or hearing impairments. According to Grant and colleagues (2022), who were working for the U.S. Department of Justice Office of Victims of Crime, “[C]hildren with disabilities are at least three times more likely to be abused or neglected than their peers without disabilities, and they are more likely to be seriously injured or harmed by maltreatment.” In 2013, almost 13% of child victims had an identified disability. Of those children, the most frequently victimized had behavioral problems (24%), and 19% had emotional disturbances (DoJ, 2018). Almost 95% of people with disabilities who were victims of violent crime were able to identify the perpetrator, and 15% were victimized by an intimate partner (DoJ, 2018).
Book Code: DHFL2624
Contributing factors Children and adults with disabilities can become easy targets for abuse. This vulnerability may stem from the additional and ongoing daily needs of the individual with disabilities; frustration experienced by the caregiver; or the lack of respite afforded to the caregiver by other family members, friends, or social services agencies (CDC, 2019). There may be a feeling of self-pity on Reporting Although dentists are mandatory reporters of child abuse in all states, this is not the case with the reporting of disabled persons abuse. However, reporting such abuse is becoming increasingly required by individual state laws. In Massachusetts, for example, dentists are among the mandatory reporters of abuse of people with disabilities (Commonwealth of Massachusetts, 2022). According to Florida’s Agency for Persons with Disabilities,
the part of the caregiver, a “Why me?” attitude. As with other forms of abuse, external forces will also contribute. Financial stress, other emotional duress, lack of caregiving skills, and lack of support all can play a part in the abuse or neglect of a child or adult with disabilities.
any person who suspects that a person with developmental disabilities is being abused, neglected, or exploited must report these suspicions via the Florida Abuse Hotline (APDCares, n.d.). Not to make such a report is a misdemeanor in the second degree (2022 Florida Statutes, Title XXX, §415.111). Suspicions of self-neglect must also be reported.
ELDER ABUSE AND NEGLECT
Definition, data, and demographics Elder abuse is a term that refers to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult. The specificity of laws varies from state to state, but broadly defined, abuse may be the following: ● Physical abuse : Inflicting, or threatening to inflict, physical pain or injury on a vulnerable elder, or depriving them of a basic need. ● Emotional abuse : Inflicting mental pain, anguish, or distress on an elder person through verbal or nonverbal acts. ● Sexual abuse : Nonconsensual sexual contact of any kind with a vulnerable elder. ● Exploitation : Illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder, including failure to use the elder’s own resources for their necessary care. ● Neglect : Refusal or failure by those responsible to provide food, shelter, healthcare, or protection for a vulnerable elder. ● Abandonment : The desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person. ● Confinement : Restraining or isolating the vulnerable elder when it is not medically necessary. (CDC, 2021a; National Council on Aging, 2021; Patel et al., 2021) Contributing factors Elder abuse, like other types of family violence, is extremely complex. Generally, a combination of psychological, social, and economic factors, along with the mental and physical conditions of the victim and the perpetrator, contribute to the occurrence of elder maltreatment. Risk factors for elder abuse can include intimate partner violence, in which the previously battered partner is now in a relative position of strength and able to exact “revenge” for prior instances of abuse. The risks for elder abuse can also be exacerbated by personal problems of the abusers. Factors related to living with others or living in isolation can contribute to elder maltreatment. Caregiver stresses can also be a contributing factor (CDC, 2020b). Elder abuse may in some cases reflect a continuous cycle of violence in which individuals Reporting The requirement to report abuse or neglect of elders or other vulnerable adults varies widely from state to state. All members of the dental team must become familiar with the appropriate laws in their state pertaining to reporting. Typically, reports are made to an adult protective services (APS) agency within the state departments of social services or senior services. Reports may also be made to law enforcement or, in the case
Elder abuse is a serious and ongoing problem in the U.S. for which there is limited prevalence data. In 2008, one in ten elders reported emotional, physical, or sexual mistreatment or potential neglect in the previous year (CDC, 2016). It is unclear whether this figure includes victims of elder maltreatment in institutional settings or is limited to community-residing elders. Indicators of elder abuse can include: ● Unexplained or implausible injuries. ● Family members providing different explanations of how injuries were sustained. ● A history of similar injuries, numerous hospitalizations, or both. ● Victims brought to different medical facilities for treatment to prevent medical practitioners from observing a pattern of abuse. ● Delay between the injury and the seeking of medical care. (Aging & Disability Resource Center of Broward County, n.d.) Head and neck injuries are often seen in victims of elder abuse. It has been reported that approximately 30% of elder abuse cases present with head, neck or facial injuries (Voelker, 2022). who were abused as children grow up to abuse their spouses, their children, and their parents. In addition to physical cruelty, elder abuse can also include mental, financial, emotional, and sexual exploitation. Emotional mistreatment is frequently overlooked because the patient seems to be in good health and shows no physical signs of any wrongdoing. During patient visits, dental professionals should ask older clients if they have been left alone or are in confinement. Seniors may suddenly seem reserved or unhappy when they were usually more sociable and outgoing during previous visits and may be fearful, be anxious or have difficulties in trusting others (CDC, 2016; National Council on Aging, 2021). of abuse or neglect within an institutional setting, to a long- term care ombudsman service, an independent intermediary that investigates complaints and mediates between parties. In Florida, where reporting is mandated, reports are made to the Florida Abuse Hotline (Florida Department of Children and Families, 2019a).
Book Code: DHFL2624
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