DCA02CA The California Dental Practice Act ____________________________________________________
reporter knows or reasonably suspects has been the victim of child abuse or neglect. The mandated reporter shall make an initial report by telephone to the agency immediately or as soon as is practicably possible, and shall prepare and send, fax, or electronically transmit a written follow-up report within 36 hours of receiving the information concerning the incident. The mandated reporter may include with the report any nonprivileged documentary evidence the mandated reporter possesses relating to the incident. Section 11165.9. Reports of suspected child abuse or neglect shall be made by mandated reporters, or in the case of reports pursuant to Section 11166.05, may be made, to any police department or sheriff’s department, not including a school district police or security department, county probation depart- ment, if designated by the county to receive mandated reports, or the county welfare department. Any of those agencies shall accept a report of suspected child abuse or neglect whether offered by a mandated reporter or another person, or referred by another agency, even if the agency to whom the report is being made lacks subject matter or geographical jurisdiction to investigate the reported case, unless the agency can immediately electronically transfer the call to an agency with proper jurisdic- tion. When an agency takes a report about a case of suspected child abuse or neglect in which that agency lacks jurisdiction, the agency shall immediately refer the case by telephone, fax, or electronic transmission to an agency with proper jurisdiction. Agencies that are required to receive reports of suspected child abuse or neglect may not refuse to accept a report of suspected child abuse or neglect from a mandated reporter or another person unless otherwise authorized pursuant to this section, and shall maintain a record of all reports received.
• Forced feeding injuries caused by eating utensils, bottles, hands, fingers, and other objects; scalding liquids; or caustic substances. These may be responsible for burns, contusions, or lacerations of the lips, tongue, buccal mucosa, gingival alveolar mucosa, frenum, or palate (soft and hard). Objects forced into the face/mouth may also cause facial bone and jaw fractures and avulsed, displaced, or fractured teeth. • Mouth gagging injuries resulting in bruises, lichenification, or scarring at the corners of the mouth • Strangulation injuries resulting in bruising, a hoarse or raspy voice, and difficulty breathing • Discolored teeth from previous trauma • Serious trauma (e.g., retropharyngeal abscesses, posterior pharyngeal injuries) resulting from caregivers with factitious disorder (i.e., Münchausen syndrome) by proxy • Injury to the petechiae of the palate (particularly at the junction of soft and hard palate) resulting from forced oral sex • Sexually transmitted oral/perioral infections (e.g., gonorrhea, human papillomavirus warts), although these can be transmitted by other means as well • Bite marks or bruises on the head or face, strangulation marks, or black eyes • Missing hair from hair pulling • Welts in the shape of objects (e.g., belt buckle, clothes iron) • Other suspicious trauma/bruises indicative of abuse (e.g., rope marks) During examination, excessive caries, gingivitis, and oral infec- tions/diseases should be noted as possible signs of neglect. (Parents or caretakers with an ignorance of proper oral care, who have no perceived value of oral health, with limited access to health care or insurance, and/or geographic isolation should be differentiated from those with a willful disregard for the child’s health [6].) Perioral and intraoral injuries and infections in various stages of healing, especially those that seem inappropriate for the child’s developmental age, should be documented. Additionally, abuse and neglect are more prevalent (up to four times more common) in individuals with developmental or physical disability [12]. Although accidental injuries are common in pediatric patients, the history of trauma, including mechanism and timing, must be weighed against the injury features. Characteristics of the injury that do not seem to match the reported history should spur suspicion of abuse. The acronym RADAR is commonly used to assist in the routine abuse screening of patients [29]:
IDENTIFYING, DOCUMENTING, AND REPORTING ABUSE AND NEGLECT
Preventing serious morbidity and mortality involves interven- ing at the first suspicion or indication of abuse and/or neglect. Dentists and dental hygienists are often the healthcare profes- sionals who have the most frequent interactions with children and should be attentive to any signs of neglect and physical abuse—as abusive injuries commonly involve the face, jaw, mouth, teeth, and tongue [4]. One study found that orofacial trauma was concurrent with 49% of documented cases of child physical abuse [5]. Other studies show that craniofacial and neck injuries occur in 50% to 65% of child abuse victims and that the lips are a site for abusive injury in 54% of cases [6; 7]. Clinical Signs of Abuse The American Academy of Pediatrics (AAP) Committee on Child Abuse and Neglect and the California Dental Associa- tion have published useful articles regarding the identifica- tion of the orofacial signs of abuse and particular injuries of concern. According to these sources, possible signs of abuse include [6; 7; 12]:
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