journal of dentistry 42 (2014) 229–239

Available online at www.sciencedirect.com

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journal homepage: www.intl.elsevierhealth.com/journals/jden

Review

Characteristics of child dental neglect: A systematic

review

Shannu K. Bhatia a,*, Sabine A. Maguire b, Barbara L. Chadwick c,

M. Lindsay Hunter c, Jennifer C. Harris d, Vanessa Tempest b,
Mala K. Mann e, Alison M. Kemp b
a
University Dental Hospital, School of Dentistry, Cardiff University, Cardiff, UK
b
College of Biomedical and Life Sciences, School of Medicine, Cardiff University, Cardiff, UK
c
College of Biomedical and Life Sciences, School of Dentistry, Cardiff University, Cardiff, UK
d
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
e
Support Unit for Research Evidence, Cardiff University, Cardiff, UK

article info abstract

Article history: Objective: Neglect of a child’s oral health can lead to pain, poor growth and impaired quality
Received 29 April 2013 of life. In populations where there is a high prevalence of dental caries, the determination of
Received in revised form which children are experiencing dental neglect is challenging. This systematic review aims
7 October 2013 to identify the features of oral neglect in children.
Accepted 10 October 2013 Methods: Fifteen databases spanning 1947–2012 were searched; these were supplemented by
hand searching of 4 specialist journals, 5 websites and references of full texts. Included:
studies of children 0–18 years with confirmed oral neglect undergoing a standardised dental
Keywords: examination; excluded: physical/sexual abuse. All relevant studies underwent two indepen-
Neglect dent reviews (+/ 3rd review) using standardised critical appraisal.
Dental neglect Results: Of 3863 potential studies screened, 83 studies were reviewed and 9 included
Oral neglect (representing 1595 children). Features included: failure or delay in seeking dental treatment;
Child maltreatment failure to comply with/complete treatment; failure to provide basic oral care; co-existent
Systematic review adverse impact on the child e.g. pain and swelling. Two studies developed and implemented
‘dental neglect’ screening tools with success. The importance of Quality of Life tools to
identify impact of neglected dental care are also highlighted.
Conclusions: A small body of literature addresses this topic, using varying definitions of
neglect, and standards of oral examination. While failure/delay in seeking care with adverse
dental consequences were highlighted, differentiating dental caries from dental neglect is
difficult, and there is a paucity of data on precise clinical features to aid in this distinction.
Clinical significance: Diagnosing dental neglect can be challenging, influencing a reluctance to
report cases. Published evidence does exist to support these referrals when conditions as
above are described, although further quality case control studies defining distinguishing
patterns of dental caries would be welcome.
# 2013 Elsevier Ltd. All rights reserved.

* Corresponding author at: University Dental Hospital, School of Dentistry, Cardiff University, Cardiff CF14 4EA, UK. Tel.: +44 029 203 03950.
E-mail address: bhatiask@cardiff.ac.uk (S.K. Bhatia).
0300-5712/$ – see front matter # 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jdent.2013.10.010
230 journal of dentistry 42 (2014) 229–239
1. Introduction
The United Nations Convention on the Rights of the Child,1
ratified by all countries other than Somalia and the United
States of America (USA), states that children have a right to be
protected from all forms of negligent treatment, and enjoy the
highest attainable standards of health. In addition, the UK
government has identified the key outcomes, which matter
most to children,2 including being healthy and staying safe (i.e.
being protected from harm and neglect).
Unfortunately child maltreatment, including abuse (physi-
cal, emotional and sexual) and neglect remain a tragic reality
in our society. Neglect is the most common type of maltreat-
ment, and is recorded in 44% of all children on child protection
registers or the subjects of child protection plans in the UK3
and 78.3% in the USA.4 In Australia, emotional abuse and child
neglect are the most commonly substantiated forms of harm
to children.5 Radford and co-workers3 reported that one in 20
(5%) children under 11 have been neglected at some point, and
one in 30 (3.7%) have been severely neglected. Furthermore,
almost one in 10 young adults (9%) report a history of severe
neglect by parents or guardians during childhood.
Young children are reliant upon their carers to maintain
their oral health. This includes managing oral hygiene and
diet, and seeking treatment when needed. Untreated dental
disease can have a significant adverse impact on the health,
wellbeing, and quality of life of the child.6–11 Consequences of
untreated dental disease include pain,8,12 sleep deprivation,8
interference with performance at school13,14 and social
activities.6 A reduction in body weight10,15,16 and head
circumference,16 and an effect on nutrition17 have also been
demonstrated. From a purely dental viewpoint, caries in
primary teeth may cause developmental defects of enamel in
succeeding permanent teeth.18 In addition, some young
children may require general anaesthesia (GA) for removal
of painful or infected carious teeth. This is a procedure that is
never without risk.19 In recent years, there has been an
increase in the number of children being admitted for dental
extractions under GA in the UK, a 66% increase in England
being reported between 1997 and 2007.20 Of particular concern
is the observation that some young children are having
repeated GA for dental extractions.21,22
During the year 2011–2012, up to 71% of children in the UK
(7.8 million estimated) were seen by a National Health Service
(NHS) dentist.23 General dental practitioners will, therefore,
encounter cases of child neglect in their daily practice. The
General Dental Council (GDC) states that dentists have an
ethical responsibility to find out about, and follow local child
protection procedures.24 In the UK, dental neglect has been
defined as ‘‘the persistent failure to meet a child’s basic oral health
needs, likely to result in the serious impairment of a child’s oral or
general health and development’’.25 Despite guidelines issued by
the National Institute for Health and Care Excellence (NICE)26
and the British Society of Paediatric Dentistry (BSPD),25 studies
have shown that dentists and dental care professionals are
reluctant to report suspected cases of child abuse and neglect
in the UK27–31 and worldwide.32–38 Lack of certainty of
diagnosis has been identified as an important contributory
factor towards the failure of this professional duty.
As dental caries is one of the most common chronic
diseases in the world, the mere presence of dental caries or
other oral pathology cannot be considered to constitute dental
neglect. Regrettably, there is no ‘threshold’ number of carious
teeth, beyond which a diagnosis of dental neglect is made25
and the question as to what oral and dental features should be
considered sufficient to constitute a diagnosis of dental
neglect warranting referral from dental professionals to
appropriate health or social care services remains unan-
swered. The aim of this systematic review of the international
literature was to determine the scientific evidence underpin-
ning the characteristics of dental neglect in children.
2. Methods
For the purpose of this review of the world literature, the
authors developed a definition based on internationally
agreed definitions,2,25,39–41 which was: ‘‘Neglect refers to the
failure of a parent or guardian to meet a child’s basic oral
health needs, such that the child enjoys adequate function
and freedom from pain and infection, where reasonable
resources are available to the family or caregiver’’ (Fig. 1). An
all-language literature search across 15 bibliographic data-
bases was conducted to identify original articles published
between 1947 and September 2012. Online Appendix 1 shows
the databases and websites searched. The initial search
strategy (Online Appendix 2) was developed across OVID
Medline databases using keywords and Medical Subject
Headings (MeSH headings) and was modified appropriately
to search the remaining bibliographic databases.
The search strategy was augmented by a range of
supplementary ‘snowballing’ techniques including consulta-
tion with subject experts and relevant organisations, hand
searching selected websites, non-indexed journals and the
references of all full-text articles (Online Appendix 1).
Identified citations, once scanned for duplicates and relevan-
cy, were transferred to a purpose-built Microsoft Access
database to coordinate the review and collate critical appraisal
data. Abstracts and selected full-text articles were scanned by
the Principal Investigator and eligible studies identified for
review (Fig. 2). Relevant foreign language articles were
considered for translation, though none was required. Where
applicable, authors were contacted for primary data and
additional information.
The systematic review was carried out by Core Info Cardiff
Child Protection Systematic Reviews; this group has con-
ducted 21 Systematic Reviews of all aspects of physical child
abuse, and early child neglect.42–45
A panel of 22 reviewers comprising community and
paediatric dentists, paediatricians, child protection practi-
tioners, a lecturer in dental public health, a social worker and a
pathologist were trained in critical appraisal, using a training
programme specifically designed for this review. Each relevant
article was independently reviewed by two reviewers drawn
from this panel of 22, using strict inclusion and exclusion
criteria (Fig. 1). Reviews were undertaken using a standardised
critical appraisal form (Online Appendix 3) based on criteria
defined by the National Health Service’s Centre for Reviews
and Dissemination,46 and supplemented by systematic review
 journal of dentistry 42 (2014) 229–239 231

Definition of Dental Neglect Developed for the Purpose of this Review

“Neglect refers to the failure of a parent or guardian to meet a child’s basic oral
health needs, such that the child enjoys adequate function and freedom from pain
and infection, where reasonable resources are available to the family or caregiver”
Inclusion Criteria
• Primary studies of children aged 0 to < 18 years
• Confirmed cases of oral neglect
(A-C2 Quality Standards for Confirmation of Oral Neglect)
• Adequate data/detail relating to the examination of the child and dental / oral
features
• Intra / extra oral features identified using a referenced recognised index or
using unreferenced but explicitly stated criteria or described in detail
(Quality Standards for Oral Examination)
Exclusion Criteria
• Study relates to adults - 18 and over - either exclusively or where relevant
data cannot be extracted
• Study addresses outcomes of oral neglect measured in adults - 18 or over -
either exclusively or where relevant data cannot be extracted
• Study addresses sexual abuse or physical abuse - either exclusively or
where it is not possible to identify characteristics resulting from oral neglect
• No oral neglect
• Oral neglect suspected or stated, with no supporting detail given
(D Quality Standards for Confirmation of Oral Neglect)
• No data / documentation relating to oral examination of child
• Inadequate data / detail for dental/oral features
• Formal consensus / expert opinion / personal practice / review article /
systematic review
Ranking Quality standards for confirmation of oral neglect

A Oral Neglect
confirmed at Child Protection case conference, multi-disciplinary
assessment including social services, Child in Need Framework
Assessment or Court proceedings,
or admitted by perpetrator,
or described by the child.
B1 Confirmation of Oral Neglect by dental care professional or
professional with dental training.
B2 Failure to attend follow-up appointments.

B3 Failure to follow treatment or preventive regime.

C1 Oral Neglect confirmed by referenced criteria / tool or by non-dental

health professional.
C2 Oral Neglect defined by unreferenced criteria / tool.

D Oral Neglect suspected or stated, with no supporting detail given

Fig. 1 – Inclusion criteria and quality standards for confirmation of oral neglect.

advisory articles.47–51 A third review, conducted by the
Principal Investigator, was undertaken to resolve disagree-
ment between the original two reviewers, where necessary
(Fig. 2).
3. Results
Of 3863 citations and abstracts scanned for relevancy, 83
studies were reviewed; Of these, 9 met the inclusion criteria
(Table 1).52–60 These reflected data relating to 1595 children,
age range 0–15 years; There were two case control studies58,59
with 255 controls and 252 cases. Thus, it was not feasible to
conduct a meta-analysis. Each study had confirmed neglect in
different ways: Five large studies defined specific features (e.g.
oral care, cariogenic diet, untreated trauma or caries, care
seeking behaviour) including three prospective studies,54,56,58
and two retrospective.57,60 The remaining studies confirmed
explicit evidence of psychological maltreatment,59 failure to
thrive as a direct consequence of neglect,55 and with
confirmation by social services,53 including disclosure by
parent or independently witnessed behaviour.52 Those chil-
dren failing to engage in the treatment offered by Butts et al.,
were also referred to Social Services.
232 journal of dentistry 42 (2014) 229–239

Fig. 2 – Study selection and review process.

Table 2 lists the included studies according to the key
characteristics of dental neglect noted. The features most
commonly recorded were: failure to, or delay in seeking dental
treatment, failure to follow advice, or complete treatment
plans prescribed; In many cases this co-existed with an
adverse impact of dental neglect on the child e.g. pain and
swelling. The use of an oral health Quality of Life tool in a large
population of school children highlighted the impact of
neglected dental care. It was not possible to define a
‘threshold’ level of dental caries that distinguished dental
neglect from the studies published to date.
4. Discussion
This review has highlighted a paucity of studies addressing the
characteristics of dental neglect in children, suggesting that
the research community has ignored this aspect of maltreat-
ment. In the nine studies that met the inclusion criteria the
key features identified in the children included a failure to
seek appropriate care in a timely way or to follow through with
an appropriate dental treatment plan.52,60
Dentists have an ethical and, in some countries, a
mandatory responsibility to follow child protection proce-
dures, yet there seems to be a reluctance to do so.27–30,32,35–38,61
In the UK, the majority of paediatric dentists treat neglected
children on a regular basis. While they promote the
children’s oral health, only a small proportion regularly
communicate their concerns with other agencies.61 The
reasons why dental professionals do not raise concerns
include lack of training or clear guidance, fear of impact on
their practice, fear of family violence against the dental team
itself, or against the child, fear of litigation, and lack of
certainty of diagnosis.28,62
Table 1 – Details of included studies describing children with features of dental neglect.
Study Blumberg and Loochtan et al. Butts and Elice et al. Thomson Von Kaenal Fakhruddin Montecchi et al. Mansour Ockell
Kunken (1986)53 USA Henderson (1990)55 USA et al. (1996)56 et al. (2001)57 et al. (2008)58 (2009)59 Italy et al. (2010)60
(1981)52 USA (1990)54 USA Australia USA Canada Sweden
Type of study Case study Case study Case series Case study Cross sectional Retrospective Case control Case control Retrospective
Cohort cohort
Primary aim To alert health To define legal, Reporting Literature review To test a dental Study of social To assess the To highlight Studies reasons
of the study professionals clinical aspects implementation and neglect scale factors: poverty, social impact of dental neglect for dental
about of dental neglect of a dental case report of single parent trauma on in a population extractions;
relationship Highlight neglect failure family and quality of life of children with treatment and
between child challenges intervention to thrive ethnic minority exposure to missed
abuse/neglect to for dental programme associated with domestic violence appointments
nursing bottle professionals emergency or experience of prior to
caries attendance abuse extractions
Number of Cases = 2 Case = 1 Cases = 68 Case = 1 Cases = 765 300 dental Cases = 135 Cases = 52, Eating Cases = 206
children records Control = 135 disorders
(ED) = 65, Controls

journal of dentistry 42 (2014) 229–239

=120
Age 15 month 8 years N/A 7 years 10–11 years: 420 Mean age: 9 12–14 years Median age: 10.5 3–8 years
Demographics 2 years Native American African 14–15 years: 345 years years Standard
(Navajo) American Caucasian: 52% Deviation: 3.6
children African Average male age:
American: 45% 9.2 years
Asian/Hispanic: Average female
3.3% age: 4.3 years
Male: 52% Females: 154
Females: 48% Males: 83
Single parent
family: 66%
Clinical Nursing bottle Caries Untreated Nursing bottle Caries Caries/pain Dental Trauma Significantly more 60.5% extraction
findings caries rampant caries/ caries/Failure to Decayed, index, Decayed, levels of plaque due to caries
pain/infection/ Thrive missing, filled missing, filled >2/3 crown
bleeding/ surfaces (DMFS) teeth (DMFT), ( p = 0.0002) in
orofacial trauma Aesthetic maltreated
component of children vs. ED/
Index of controls
Orthodontic No gingival
treatment needs bleeding in
(IOTN) controls,
65% untreated significantly more
dental injuries in maltreated
group:
Spontaneous in
4.26%
Provoked in 14.89
( p = 0.0002)
Maltreated group
had more caries
than ED
( p = 0.05) >
controls ( p = 0.05)
(Decayed surfaces
Study 2.7%

233
Control 0.8%)
 234
Table 1 (Continued )
Study Blumberg and Loochtan et al. Butts and Elice et al. Thomson Von Kaenal Fakhruddin Montecchi et al. Mansour Ockell
Kunken (1986)53 USA Henderson (1990)55 USA et al. (1996)56 et al. (2001)57 et al. (2008)58 (2009)59 Italy et al. (2010)60
(1981)52 USA (1990)54 USA Australia USA Canada Sweden
Primary Failure to seek Failure to seek Failure to seek Failure to seek Failure to seek Failure to seek Failure to seek Failure to seek Failure to seek
characteristic dental treatment dental treatment dental treatment dental treatment dental treatment dental treatment dental treatment appropriate dental dental treatment
of dental neglect Low follow up Low follow up Low follow up Low follow up Low follow up Low follow up treatment Low follow up
Lack of Delay in seeking Delay in seeking
appropriate treatment treatment
dental care Missed
appointments

journal of dentistry 42 (2014) 229–239

Secondary Pain Pain/infection Caries were Failure to Attended Untreated Attended
characteristic suspected to provide basic emergency clinic children had emergency
of dental neglect contribute to oral care due to dental more chewing clinic due to
failure to thrive pain difficulties, dental pain
avoided smiling Significantly
and experienced more children
affected social with caries related
interactions extractions
had a history
of missed
appointments
in the preceding
year ( p = 0.004)
Relevant Nursing bottle Barriers to 67% of the Severe dental Dental neglect Children from Untreated Abused children One in 25 children
conclusion caries should attendance families decay can be a was greater in single parent children are more had extractions
alert us to (financial) misled counselled about contributing males, younger families, low suffered neglected by their during one year,
possible child team as to true the problem, and factor to failure children, whose socio-economic significantly caregivers from mainly due
abuse/neglect extent of child given direct to thrive mothers were group, African- more social point of view of to caries
protection access to dental less educated, American impact dental hygiene
concerns, which care, chose to and who had not children were than non and access to
only came to follow received dental over- injured dental treatment
light following recommended care in last two represented peers They had higher
dental referral treatment years ( p < 0.05) levels of dental
The intervention Dental neglect plaque, gingival
process was scale may be inflammation and
effective in 2/3rd useful in untreated decayed
cases understanding teeth, and were
variations in less cooperative
dental health during dental
and targeting visits
health
promotion
strategies
 journal of dentistry 42 (2014) 229–239 235

Table 2 – Characteristics of neglect identified in the included studies.

Author(s)/year Primary characteristics of oral neglect Additional characteristics

Blumberg and Kunken (1981)52
Loochtan (1986)53
Butts and Henderson (1990)54
Elice et al. (1990)55
Thomson and Gaughwin (1996)56
Von Kaenel et al. (2001)57
Fakhruddin et al. (2008)58
Montecchi (2009)59
60
Mansour Ockell et al. (2010)
Failure to seek Failure to seek dental Failure to provide Impact of dental neglect
dental treatment treatment, and failure to basic oral care e.g. e.g. pain, swelling, failure
or delay in seeking follow dental advice, tooth brushing to thrive, social issues
treatment administer medication,
attend appointments or
complete treatment
U U U
U
U U U
U U U
U U
U U
U U
U U
U U

Relevant training issues have been addressed in the UK
over recent years. The Department of Health funded provision
of a booklet to all dental practices (‘Child protection and the
dental team’) with equivalent open-access, web-based guid-
ance63; Local authorities and Trusts have child protection
policies in place. Similarly, other countries have child
protection procedures and encourage dental professionals
to undertake regular training.64
Barriers to seeking dental care include fear of the dental
environment as perceived by the child or the parent, ‘transport
difficulty’, difficulty in locating publicly funded dental health
providers and the direct and indirect costs incurred, and lack
of perception of a need for dental care. Disadvantaged
caregivers report multiple barriers to accessing dental care
for their children; In fact there is an expectation of poor oral
health.65
The World Health Organisation has stated that neglect
has to be distinguished from circumstances of poverty,
implying that neglect can only occur in cases where
reasonable resources are available to the family or caregiv-
er.40 In the UK, where NHS dental treatment for children is
free at the point of delivery, one would not expect the cost to
be a barrier to utilisation of dental care. Other countries,
such as France,66 have reported similar issues with uptake
of dental treatment even when the total cost for treating
children is reimbursed.
While there were no large scale comparative studies to
define explicit differences in oral features between those
children whose parents did or did not neglect their dental care,
three included studies set out to describe the oral features of
children who had suffered a variety of forms of physical abuse
or general neglect. They noted primarily the presence of
untreated dental caries and associated pain and/or infection,
and lack of continuity of dental care amongst these chil-
dren.52,53,55 Montecchi reported high levels of caries, plaque
and gingival bleeding in the children who suffered maltreat-
ment compared with controls.59 Thomson and Gaughwin
reported that dental neglect was positively associated with the
child not having received dental treatment over the last two
years and in families with low socioeconomic status; the latter
characteristic was also reported in two other studies.53,57 Butts
and Henderson used indicators to aid in identification of
dental neglect in children including untreated caries, pain
infection, bleeding or orofacial trauma, and a history of lack of
continuity of care; they selected 68 children for a dental
neglect intervention programme.54 Fakhruddin et al. studied
the social impact of untreated dental problems in children and
reported that children suffering from untreated dental trauma
experienced more difficulties in chewing, avoided smiling and
experienced an effect on social interaction; and restoration of
injured teeth improved aesthetics and social interactions.58
Identifying dental neglect at an early stage, and making a
child protection referral, may safeguard the child and prevent
further harm. The National Institute of Health and Care
Excellence (NICE) has indicated that clinicians should suspect
neglect in general when there are repeated observations of
poor standards of hygiene which affect the child’s health and
in circumstances where parents or carers have access to, but
persistently fail to obtain NHS treatment for dental caries.26
This review supports the view that it would be a ‘vast over
simplification to assume that there is a threshold number of
carious teeth, beyond which a diagnosis of dental neglect can
be made’.25 Multiple factors have to be considered before
diagnosing dental neglect. The impact of the caries on the
child should be assessed, dental records studied and parental
awareness and knowledge, access to dental care and the
child’s willingness to undergo treatment considered when
suspecting dental neglect.25 Other risk factors should be
considered as adolescents with special educational needs,
refugees and children ‘looked after’ by local authorities have
been recently reported to experience a higher proportion of
dental neglect.67 This review highlights some of the oral
findings which have been reported to be present in children
with dental neglect. These characteristics along with a
psychosocial evaluation of the family can be helpful in
alerting the dental team to ‘at risk’ children, and aid in
prompt identification and management of cases of dental
neglect. While there were no large scale comparative studies
to define explicit differences in oral features between those
children who did or did not suffer from dental neglect; six
excluded studies addressed the oral features of children with
other forms of maltreatment noting a high prevalence of
dental caries with associated pain/infection, plaque and
gingival bleeding (Table 3).
 236
Table 3 – Oral findings in children who suffered abuse or neglect.
Study Badger (1986)68 USA Symons et al. (1987)69 Da Fonseca Greene et al. (1994)70 Greene and Chisick Valencia-Rojas et al.
Australia (1992)32 USA USA (1995)71 USA (2008)72 Canada
Number of children 42 1 1248 Cases = 30 Cases = 42 Cases = 66
Control = 873 Control = 822 Control = general
population
Age in Years 2–19 8 Up to 17 5–13 3–11 Average 4.1 (SD = 1.2)
Aim of study To determine if any To review child abuse To determine the To determine whether To determine whether To investigate the
relationship existed and report on dental frequency of oral health status and oral health status and prevalence of early
between child abuse/ aspects of three cases injuries to head, dental treatment needs dental treatment needs childhood caries in a
neglect and the decayed (one suspected child neck, face and differ between abused/ differ between abused/ population of
extracted filled (def)/ abuse, one confirmed mouth due to child neglected and non- neglected and non- maltreated children in
decayed, missing, filled child abuse and one case maltreatment in abused/non-neglected abused/non-neglected Toronto, Canada
(DMF) rate of severe neglect) patients seeking children in their children in their primary
care at a major permanent teeth teeth
county hospital

journal of dentistry 42 (2014) 229–239

Examined by Dentist Dentist Non dental medical Dentists Dentists Dentist
staff
Clinical findings At age 6–11 years Carious tooth Oral hard tissue Decayed missing filled Decayed filled surfaces Early Childhood caries
Average DMF score 1.4 Gingival inflammation injuries (tooth surfaces (DMFS) score (dfs) score of primary (ECC) 1
(1.9) Plaque deposits fractures, jaw noted teeth noted Cases = 57.6 Control
At age 12–17 years Severely worn primary fractures) (general population of 5
Average DMF score 6.1 teeth Soft tissue injuries year olds) = 30%
(4.7.) (lacerations and Severe Early Childhood
mucosal injuries) Caries (SECC)  4
Poor oral hygiene 31.8%
Extensive caries Dental injury
37.5% had injuries (discolouration) = 6%
to head and neck, Proportion of children
face and mouth. with untreated caries:
The percentage Physical/sexual
doubled (75.5%) in abuse = 61.5%
physically abused Neglected = 56.6%
children
Additional Points The study group were Treatment carried out Study aimed to The study group came All children came from Proportion of children
children of military under general identify the dental from military families military families with untreated caries
personnel anaesthetic aspects of abuse Logistic regression Logistic regression and SECC was higher
DMF values not Failed follow up Poor oral hygiene analysis controlling for analysis carried out to among the physically/
significantly different ’’Treating only dental Extensive caries the influence of variables determine influence of sexually abused than
from national mean, in problems and ignoring reflected a delay in including socioeconomic abuse status and other the neglected children
spite of free access to social problems is a gross seeking dental characteristics, to socioeconomic No difference found in
dental care failure to understand treatment evaluate the influence of characteristics on ECC prevalence
needs of the patient and abuse on oral health outcome measures between different types
family’’ status Abuse status does not of maltreatment
contribute to differences 4–6 years old within
in oral health status, but study group had 9 times
does to presence of more decayed teeth
untreated decayed than the 5 year olds in
primary teeth general population.
 journal of dentistry 42 (2014) 229–239 237

Abused and neglected

(almost double) levels

ECC was 30% in same

5. Conclusion

population in the city

children, by contrast
ECC was 58% among

age group of general

children had higher

of tooth decay than

general population

abused/neglected
While it is indisputable that members of the dental team are
well positioned to observe the signs of general and/or dental
neglect, lack of clinical confidence in identifying and referring
neglect prevails. This review reiterates certain features of
dental neglect as being clearly identifiable: namely a failure or
delay in seeking treatment for significant dental caries or
link between child abuse/

trauma, failure to complete a recommended course of

The study establishes a
children were 5.2 times

neglect and poor oral

treatment, or allowing the child’s oral health to deteriorate

more likely to have

primary teeth than

untreated decayed
Abused/neglected

avoidably. Such cases should be reported promptly to the

appropriate agencies. There is a clear deficiency of case–
control studies to precisely define the distinguishing oral
controls

health

characteristics of this group of children. Given the known

consequences of dental neglect, it is to be hoped that dental
practitioners will be more pro-active in working with their
local safeguarding team to ensure the safe and appropriate
care of these children.
times more likely to have

permanent teeth than

Abused children are 8

non-abused children
untreated decayed

Financial interests

None of the authors have any financial interests to disclose.

Conflict of interests
face and mouth, the

(75.5%) in physically
percentage doubled
37.5% had injuries
to head and neck,

Involving dental
abused children

professionals is

None of the authors have any conflict of interests.

important

Sources of financial assistance

Funded by the National Society for the Prevention of Cruelty to

Oral features of one case

Children (NSPCC).
of neglect: presence of

gingival inflammation
caries, plaque and

Acknowledgements

Grateful thanks to Laura Wain for editorial assistance. Along

with some of the authors of this article, the reviewers
conducting these reviews for Cardiff Child Protection System-
significant differences in

atic Reviews were: Rachel Brooks, Katherine Gale, Evender

def/DMF rates from the
Abused and neglected

Harran, Nicola Harvey, Nia John, David Johnson, Richard Jones,

children display no

national averages

Sianed King, Katina Kontos, Maria Morgan, Meeta Morthey,

Heather Payne, Ingrid Prosser, Alicia Rawlinson, Jane Rodgers,
Elspeth Webb and Bethan Williams.
Thanks to the National Society for the Prevention of Cruelty
to Children (NSPCC) for funding this work.

Appendix A. Supplementary data

Supplementary data associated with this article can be

Conclusion

found, in the online version, at http://dx.doi.org/10.1016/

j.jdent.2013.10.010.
238 journal of dentistry 42 (2014) 229–239
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