(Royal College of Surgeons, 2018)
The staggering numbers above may well be as a result of the modern-day lifestyle, for example, high levels of sugar in our diets etc, however, we should be aware that it could also be an indication that a child is being mistreated or neglected in other ways.
Dental neglect is defined by the British Society of Paediatric Dentistry as:
‘The persistent failure to meet a child’s basic oral health needs, likely to result in serious impairment of a child’s oral, or general health, or development’.
I can remember, just over 10 years ago, dentists and dental staff attending my child protection training did not recognise severe tooth decay as a safeguarding concern. This could be due to the fact that dentists and dental staff have only been subject to mandatory safeguarding standards and CQC registration requirements since April 2011. This was introduced as a result of the Social Care Act 2008 and therefore, they have only been routinely making safeguarding referrals since the General Dental Council (2013) issued standards for regulating dental teams. This means that raising safeguarding concerns for dental neglect in children is still a relatively new concept for the dental profession.
What Is The Responsibility of the Parent?
Children have a right to good oral health, as well as overall general health and wellbeing, and are reliant on their parents and / or carers to meet these basic needs on their behalf.
At one end of the spectrum good dental hygiene should start in the early years of childhood (whether at home, nursery, or preschool), and, at the other end of the spectrum, dentist appointments can be built into child protection plans.
It is a part of parental responsibility for children to have regular dental check-ups (every six months)*, so that any early signs of decay can be treated before developing into something more harmful.
Parents who do not present or encourage children to attend regular dentist appointments will not access early treatment for minor problems but may find their children develop more painful issues which require more invasive treatments, such as extractions.
Having teeth extracted can be a harrowing and distressing experience for a child, however, it is an experience that we should be able to protect them from, as under most circumstances, with regular check-ups, it is completely avoidable.
Serious dental neglect in children is a safeguarding issue, and for parents of children under 16 years of age, such harm could ultimately result in criminal charges for persistent and wilful neglect.
* It is important to note that there are currently ongoing national debates that certain areas of the country do not have enough NHS dentists available for parents to register their children.
What Is The Responsibility Of The Professional?
It is the responsibility of a professional to advise, challenge and refer as and when there are early signs and concerns.
Child dental neglect could be stand alone – It could arise from a parent and / or carers lack of knowledge around oral hygiene, or difficulty in offering healthy diets due to income, or other family conditions. Or, it could be part of a more serious set of circumstances of wilful or severe child neglect, where a parent and / or carer fails to respond to a known significant dental or oral hygiene problem. Whichever, it is crucial for childhood, and for long-term adulthood, that the child receives timely support and intervention, along with their family and / or carers.
It is therefore the responsibility of the professional to understand the various signs and symptoms that could point to wilful neglect, and the correct procedure to follow should this be a concern. To do so, it is important to keep up to date with safeguarding training, to ensure you are aware of any changes to legislation and guidance and guarantee that safeguarding is always at the forefront of your mind. It is also critical that your safeguarding policy and procedures (for both children and adults at risk) are reviewed yearly to reflect any such changes.
Points to consider if you are a professional worried about a child with dental neglect are:
- Predisposing factors
- Individual susceptibility
- Previous dental history
- Regional and social inequalities
- Access to dental services and treatment
- Impact on the individual
- Consult other professionals
After consideration of all these factors then a safeguarding referral should be made if professionals believe that a child is suffering, or likely to suffer, significant harm.
The Future of Safeguarding
Despite the contribution dental paediatric practitioners make towards prevention and crisis intervention, the topic of neglect is often still not discussed. As dental care becomes more and more prominent within the safeguarding agenda, we must push to have difficult conversations and continue to include it in safeguarding basic awareness training. Going forward, there needs to be a much stronger focus on prevention and early intervention, as well as multi-agency working.
On World Oral Health Day, 2019, I wanted to bring this to the forefront, to raise awareness of a safeguarding issue that sadly still gets overlooked. A child’s smile, displaying healthy teeth and gums, can be just the start of a positive child development.
If you are looking for safeguarding training to be delivered by experts in their field that place care and creativity at the heart of training, contact us for more information.