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Tuesday, September 07, 1999Report child abuse, even at risk of losing business, dentists told
Tooth decay called a sign
Canadian dentists are being urged to join teachers and physicians as sentries in the battle against child abuse -- even if it means offending clients and losing business.
While most dentists limit intrusions in their patients' personal lives to chair-side small talk, an article published in this month's edition of the Journal of the Canadian Dental Association urges them to start scanning young patients for injuries to the head and mouth and to report any suspect wounds to government authorities.
"Screening for maltreatment should be an integral part of any clinical examination performed on a child," the report says. "By providing continuing care, dentists are in a unique position to observe the parent-child relationship as well as changes in the child's behaviour.
"A parent may bring a child to the dentist to have loose or broken teeth treated, but may not seek treatment from a physician for other types of injuries."
The article, Detecting Child Abuse and Neglect -- Are Dentists Doing Enough?, was prepared by David Sweet, a forensic dentist at the Vancouver-based Bureau of Legal Dentistry, and Andrew Tsang, a resident at the University of British Columbia's faculty of dentistry.
Dr. Sweet, who has compiled dental evidence in numerous criminal cases, says he initiated the study after noting how many abuse cases are characterized by injuries about the head.
"Dentists tend to focus only on questions or problems in which they have professional expertise," he said in an interview.
"The point we're trying to make is, like it or not, dentists are in a position to see these things and have a responsibility to act."
Many injuries dentists see are not caused by abuse, the authors acknowledge. But "dentists should always be suspicious of traumatic injuries" and watch out for other, more subtle signs, they say; even untreated tooth decay and gum disease could be regarded as a sign of potential neglect.
Dentists are not the first profession enlisted to help identify children at risk. In British Columbia, teachers have been provided with manuals encouraging them to look for signs of abuse, even in their students' school work. Doctors have for years been one of the key sources of child-abuse tips to child-welfare authorities.
But Drs. Sweet and Tsang argue that all dental staff can play a role in the lookout. Reception-area workers, for example, should keep an eye out for children with poor hygiene or failing health. "Is the child's clothing appropriate for the present weather?" they ask. "Are there any wounds or bruises on the child's face or body?"
The report is accompanied by photographs of injuries that are unmistakably intentional, such as pattern wounds, bruising to the inner lips and gums and cigarette burns to the face and hands.
Dentists, however, may be reluctant to abandon their professional distance, especially if intervening puts their business at risk, Dr. Sweet said.
"That's one of the reasons we have heard from dentists who decided not to get involved [in suspected abuse cases]," he said. "I don't believe that holds water. Maybe one family will not seek business in your office any more. But I think the vast majority of people out there would want you to respond, and your reputation would certainly improve in the eyes of your other patients."
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