**Abstract**

Children are the future of society. Society should, in turn protect their dignity and wellbeing by ensuring that they are treated with respect and care. Dental practitioners are often the first health professionals to come into contact with victims of child abuse and neglect, not only to render treatment to abuse victims but also to serve as their first line of defense. As part of a larger human community, dental practitioners are responsible for identifying evidence of intentional harm befalling children and reporting it to law enforcers. Physically abused children predominantly present with injuries to the maxillofacial and oral regions. It is therefore important for dental practitioners to be aware of the intra-oral and extra-oral signs that may be indicative of child abuse and neglect in order to champion the fight against child abuse.

**Keywords:** physical abuse, sexual abuse, emotional abuse, dental trauma, dental neglect

## **1. Introduction**

Evidence from the United States of America (US) indicates that there was an estimated number of 656,000 (rounded) victims of child abuse and neglect in recent years [1]. These statistics indicate that the victim rate for child abuse and neglect is 8.9 victims per 1000 children in the US population [1]. Information from the World Health Organization (WHO) (2020) shows that globally, nearly 3 in 4 children - or 300 million children - aged 2–4 years regularly suffer physical punishment and/or psychological violence at the hands of parents and caregivers [2, 3]. It is therefore important to be aware that victims of child abuse and dental neglect could present in the dental office. 65% of physical abuse to children involves injuries to the head, face, neck, or mouth and dental professionals could be the first health professionals to render treatment to abuse victims as well as being their first line of defense [4]. Hence, there should be an awareness of pediatric patients who are withdrawn or present with a hostile demeanor accompanied by tell-tale bruises, bite-marks, scars, swollen lips and severely decayed teeth [4–6]. These could be red flags that could alert the dental professional that the pediatric patient has experienced child neglect and gross physical, verbal or sexual abuse [5].

Dental professionals – including general dentists, dental specialists, dental hygienists, dental therapists and dental assistants – are all afforded a unique lens into the lives of children who pass through their dental offices [4, 5]. It is thus both an obligation and mandatory for dental professionals to ensure that they are knowledgeable on both outward extra-oral and oral clinical clues, which may preclude dental injuries and trauma as a result of child abuse and neglect [7, 8].

This guide thus offers a practical outlook on signs of neglect and trauma that intends to signal cases of abuse and neglect to assist dental professionals identify and recognize those signs.

It is advised that all dental patient examinations should follow a holistic assessment and analysis [9–11]. The dental professional's jurisdiction for such signs may go beyond dental and oral signs, particularly when seeking to identify victims of abuse. This would imply the need for increased vigilance related to visible physical injuries with suspicious appearance, location and origin, inconsistent verbal testimonies as well as the outward behavior and demeanor of the potentially neglected or abused child [9–11]. It is also important to consider the details that would be required to form a comprehensive report in order to support or warrant alerting the relevant authorities for further investigations [9–11].
