**Table 2.**

*Types of abuse and behavioral indicators.*

to protect a child from exposure to any danger, cold, starvation or substance abuse [13]. It can also include failure to carry out important aspects of childcare which could impact on a child's emotional, psychological or physical development [13–15]. Poor supervision of a child could also bean indication of neglect [16].

• **Dental neglect** is defined as the "wilful failure of parent or guardian to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection" [15].

As noted, abuse and neglect take on many different forms and this may be obvious or not obvious at all to anyone. However, by becoming more knowledgeable about all these warning signs indicated in **Table 2** above, dental professionals may inadvertently save the childhood or even the life of an abused child who has nobody to turn to for help and lacks the capacity to understand where to seek help in the very first place.

### **3. Guidelines to signs and symptoms of child abuse and neglect**

From the time that a child enters a dental office, there are warning signs that could signal potential malice against their well-being. These warning signs may include the following factors which will likely overlap across the different types of abuse:

#### **3.1 Physical appearance, behavior and demeanor of a child**

The dental clinical environment provides a unique platform with the benefit of close engagement with patients [2, 5, 12]. One of the key aspects to successful dental treatment is the formation of trust between the dental professional and the patient [12, 13]. Dental professionals should be experienced in this regard and need to be well-equipped to identify clues and make deductions from obvious and nonobvious signs of potential abuse [12, 13].

From this vantage point, dental professionals should approach pediatric patients by observing both subtle and gross signs during their consultation and clinical examination, whereby the practitioner should be observing and analyzing the pediatric patient's outward appearance and demeanor, their behaviors and mannerisms and their response to the environment [13, 15].

It should be noted that there are several considerations that make suspicion of abuse challenging. The first is that children often have within their nature the tendency to be shy with strangers, have difficulties with expression, a difference in response to new environments - particularly to a dental environment, which society has portrayed as a place for fear [12, 13]. These are thus usually intrinsic to the behavior of children. Also, children tend to often engage in boisterous play, and are thus prone to more injuries than adults [13, 15]. Another key factor is that there are different forms of abuse, such as neglect, physical and sexual abuse [12–16]. These may have different manifestations and highlight the difficulty with separating suspicion of abuse from the mundane [13, 15].

Below is a description of the observations of outward and non-clinical signs of child maltreatment that dental professionals need to be aware of.

#### *3.1.1 Poor hygiene and attire*

Whilst many children are notorious for challenging parents regarding their choice of clothes and bath routines, and with consideration for the socio-economic restrictions, there is a level of hygiene and tidiness that most parents can achieve with their children [11]. If this level is not attained, it can raise concerns about neglect [11, 16].

Dental professionals should commence any consultation by first evaluating a child's overall hygiene, their physical appearance and their dressing and attire [5, 15]. They should assess whether the child appears unkempt and if the child's clothing

#### *Signs of Child Abuse and Neglect: A Practical Guide for Dental Professionals DOI: http://dx.doi.org/10.5772/intechopen.101564*

is appropriate for the current weather conditions [12]. Clothing that appears to be inappropriate could be used to cover bites, scars and wounds [12]. It is important to also note however, that this factor could be related to poor socio-economic and cultural status and thus as discussed, all individual factors should never be considered in isolation but as part of a far bigger conglomerate of issues [12, 15].
