Documentation The dental office should have firm protocols in place for documentation of all patients of record. The patient chart continues to be the basis for all documentation, whether in hard copy or electronic format. When family violence is suspected, a specific entry should be made in the patient chart, with proper notation of both the clinical and behavioral indicators that were observed. The entry should then be countersigned by a second staff member. Radiographs of affected oral structures should be taken when dentally indicated and when the appropriate parent, patient, or patient’s caregiver has given consent. Clinical Accidental injuries Foreheads, chins, hands, feet, elbows, and knees are the most typical sites for the bumps and bruises that children sustain as a result of accidental injuries. However, children can get hurt anywhere and apparently in an infinite number of ways. Abused adults (intimate partners or elders) must be individually Conditions that mimic abuse As with accidental injuries, many normal conditions may mimic injuries resulting from abuse. A thorough health history, updated regularly, will help clinicians make a proper diagnosis. Bleeding disorders such as hemophilia and idiopathic thrombocytopenia purpura (ITP) make children and adults more susceptible to bruising. If these disorders are not adequately controlled through hematologic therapies, patients bruise easily and sometimes bruise spontaneously. Bruises on older adults may also take a longer time to dissipate and eventually heal. Conditions that cause discoloration of a child’s skin, such as the “port-wine stains” typical of Sturge–Weber syndrome, slate-gray spots of infancy (formerly known as Mongolian spots ), or even simple birthmarks, can be confused with abuse injuries. Although these types of marks may eventually fade with time, they are essentially permanent discolorations. Some folk medicine remedies also cause marks similar to abuse. Cao gio, or Southeast Asian coin rubbing, can cause extensive bruising to the skin. Cupping, a practice from Central and South America in which hot ceramic cups are placed on the skin to
photographs should also be taken as appropriate, and with parental permission, if necessary, under applicable state law. Patient chart entries should be factual, clear, and objective/ nonjudgmental, and they should provide documentation of oral and dental lesions (Oliván Gonzalvo & de la Parte Serna, 2021). Patient and adult statements should be quoted verbatim. Useful phrases to employ in patient chart entries include “consistent with the use of force,” “reason to suspect,” and “patient relates that.”
evaluated based on the nature of the injury, the history related, and the behavior of the patient when questioned about the injury. Therefore, the dental professional must use clinical judgment to weigh the facts and the presenting symptoms.
draw out fever, causes round suction marks. A modern take on cupping involves plastic cups and handheld suction devices, which are used for the same purpose. These practices are not intended to harm the patient, and in some cultures, these procedures are considered to be suitable therapy for children’s illnesses. All clinicians must be familiar with the cultural diversity of their patients and understand these practices. In older adults, conditions that may mimic abuse include venous lakes and stasis, such as purpuric lesions seen in patients who are on warfarin (Coumadin) therapy. Other, rarer ailments may also mimic child abuse. Ehlers–Danlos syndrome, a genetic disorder that affects collagen formation, may present with numerous marks that resemble multiple bruises (Brown et al., 2022). Other systemic medical conditions that can mimic bruising patterns associated with child abuse include hemophilia, hemangiomas, idiopathic thrombocytopenic purpura, collagen vascular disorder, and malignancies (Gonzalez et al., 2022). Again, a good health history will help clinicians differentiate these conditions from abuse injuries.
INDICATORS OF ABUSE AND NEGLECT
Patterned injuries Clinicians should always be wary of human bite marks on a child, as they carry a high suspicion of child abuse (Fisher-Owens et al., 2017). Human bites tend to compress the flesh whereas animal bites are more likely to tear the flesh (Fisher-Owens et al., 2017). These injuries ought to be easily identifiable by all dental professionals, who should be aware of the differences between animal and human dentition and arch forms in order to properly identify the cause of the marks. Actual identification of the perpetrator through bite-mark analysis must be left to experts in forensic odontology. Bite marks may also occur in cases of IPV and elder abuse. Serial photography of a bite mark (over a period of days) is often accomplished by the odontologist to Burns Burns are a common occurrence in life, but certain burns should make any observer consider the possibility of abuse. Cigar or cigarette burns on the palms of the hands or elsewhere, or multiple circular burn marks, should be a red flag during physical assessment. Multiple injuries and stages of healing All these injuries have to be considered in light of the fact that all patients get accidentally injured from time to time. When analyzing bruises, it is important to be aware of the color
see additional detail that will become visible over time (Fisher- Owens et al., 2017). Every member of the dental team should be able to see and recognize most abuse-related bite marks. Bite marks caused by an adult human are typically ovoid or elliptical in shape, have an approximate intercanine width of about 3 cm and often have a central area of ecchymosis (Oliván Gonzalvo & de la Parte Serna, 2021). About 65% of all abuse bite marks can be seen while the child is clothed (Voelker, 2022). Human bites are painful and represent an assault with a weapon that carries a significant possibility of morbidity or even mortality. It must be remembered that the infection potential of the human bite is significant and serious (Drugs.com, 2022). Immersion burns by scalding water can produce a sock-like or glove-like pattern on the hands and feet. Patterned burns from hot objects such as a radiator, floor furnace, or hot instrument are often easy to identify. The difficulty lies in determining whether the burn is accidental or nonaccidental. Scaled photos of the injury may be useful for comparison with the object involved in the burn.
changes that occur during healing. Individual healing may differ markedly, and the appearance of bruises may differ based on the amount of trauma incurred. However, evaluating the color
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Book Code: DFL3024
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