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      Dentist attitudes and responsibilities concerning child sexual abuse. A review and a case report

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          Abstract

          According to the World Health Organization, child abuse and neglect is “every kind of physical, sexual, emotional abuse, neglect or negligent treatment, commercial or other exploitation resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power”. The aim of the present report is to inform about the most relevant aspects of child abuse and the characteristics of injuries to the head, neck, and orofacial regions, in addition to the suggested role of, and management by, the dentist for the evaluation of this condition, and also for reporting a case of a physically and sexually abused girl aged 5 years 8 months. Throughout the appointments, some type of abuse in this patient was suspected by the treating dentists at the clinic, mainly due to the initial behavior exhibited by the patient in the dental chair. Based on the clinical diagnostic an intensive preventive plan and restorative treatment was realized. The timely detection of the signs and symptoms of sexual abuse, often present in the orofacial region, place the pediatric dentist in a strategic situation, with the capacity to recognize, register, and later report those cases considered as suspect, including the dental treatment delivered and the intensive behavioral-psychological management, in order to achieve acceptation by the otherwise very anxious patient of the indicated restorative and preventive dental procedures.

          Key words:Child abuse, dentistry, behavior management.

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          Most cited references35

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          Analysis of missed cases of abusive head trauma.

          Abusive head trauma (AHT) is a dangerous form of child abuse that can be difficult to diagnose in young children. To determine how frequently AHT was previously missed by physicians in a group of abused children with head injuries and to determine factors associated with the unrecognized diagnosis. Retrospective chart review of cases of head trauma presenting between January 1, 1990, and December 31, 1995. Academic children's hospital. One hundred seventy-three children younger than 3 years with head injuries caused by abuse. Characteristics of head-injured children in whom diagnosis of AHT was unrecognized and the consequences of the missed diagnoses. Fifty-four (31.2%) of 173 abused children with head injuries had been seen by physicians after AHT and the diagnosis was not recognized. The mean time to correct diagnosis among these children was 7 days (range, 0-189 days). Abusive head trauma was more likely to be unrecognized in very young white children from intact families and in children without respiratory compromise or seizures. In 7 of the children with unrecognized AHT, misinterpretation of radiological studies contributed to the delay in diagnosis. Fifteen children (27.8%) were reinjured after the missed diagnosis. Twenty-two (40.7%) experienced medical complications related to the missed diagnosis. Four of 5 deaths in the group with unrecognized AHT might have been prevented by earlier recognition of abuse. Although diagnosing head trauma can be difficult in the absence of a history, it is important to consider inflicted head trauma in infants and young children presenting with nonspecific clinical signs.
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            Characteristics of child dental neglect: a systematic review.

            Neglect of a child's oral health can lead to pain, poor growth and impaired quality of life. In populations where there is a high prevalence of dental caries, the determination of which children are experiencing dental neglect is challenging. This systematic review aims to identify the features of oral neglect in children.
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              Improving child protection: a systematic review of training and procedural interventions.

              To synthesise published evidence regarding the effectiveness of training and procedural interventions aimed at improving the identification and management of child abuse and neglect by health professionals. Systematic review for the period 1994 to 2005 of studies that evaluated child protection training and procedural interventions. Main outcome measures were learning achievement, attitudinal change, and clinical behaviour. Seven papers that examined the effectiveness of procedural interventions and 15 papers that evaluated training programmes met the inclusion criteria. Critical appraisal showed that evaluation of interventions was on the whole poor. It was found that certain procedural interventions (such as the use of checklists and structured forms) can result in improved recording of important clinical information and may also alert clinical staff to the possibility of abuse. While a variety of innovative training programmes were identified, there was an absence of rigorous evaluation of their impact. However a small number of one-group pre- and post-studies suggest improvements in a range of attitudes necessary for successful engagement in the child protection process. Current evidence supports the use of procedural changes that improve the documentation of suspected child maltreatment and that enhance professional awareness. The lack of an evidence based approach to the implementation of child protection training may restrict the ability of all health professionals to fulfil their role in the child protection process. Formal evaluation of a variety of models for the delivery of this training is urgently needed with subsequent dissemination of results that highlight those found to be most effective.
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                Author and article information

                Journal
                J Clin Exp Dent
                J Clin Exp Dent
                Medicina Oral S.L.
                Journal of Clinical and Experimental Dentistry
                Medicina Oral S.L.
                1989-5488
                1 July 2015
                July 2015
                : 7
                : 3
                : e428-e434
                Affiliations
                [1 ]DDS, MS, PhD, Associate Professor, Pediatric Dentistry Postgraduated Program, Faculty of Dentistry, San Luis Potosi University, San Luis Potosí, SLP México
                [2 ]DDS, MS, Associate Professor, Pediatric Dentistry Postgraduated Program, Faculty of Dentistry, San Luis Potosi University, San Luis Potosí, SLP México
                [3 ]Undergraduate Student, Faculty of Dentistry, San Luis Potosi University, San Luis Potosí, SLP México
                Author notes
                Faculty of Dentistry San Luis Potosi University SLP, Mexico Av. Dr. Manuel Nava #2 Zona Universitaria C.P.78290 San Luis Potosí, SLP. Mexico , E-mail: apozos@ 123456uaslp.mx
                Article
                52301
                10.4317/jced.52301
                4554246
                a7caa5c7-bab0-4e70-b439-f04c43d5b14e
                Copyright: © 2015 Medicina Oral S.L.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 March 2015
                : 10 January 2015
                Categories
                Review
                Community and Preventive Dentistry

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