Child Abuse Lecture 5

 Abuse can involve children, women, men and the elderly.  The dental team can assist in early detection of someone being abused when conducting an exam within the oral cavity.

 Children whose parents abuse substances are almost three times more likely to be abused and four times more likely to be neglected than other children  It is estimated that each day five children die as a result of child abuse or neglect.

 Parents with substance abuse problems are less educated and less likely to be employed full time;  Many parents with substance abuse problems have histories of child abuse or neglect that might affect their violent behavior.

 There is accumulating research evidence that physical, sexual, and emotional abuse and neglect during childhood increase a person's risk of developing substance abuse problems.  A recent study confirms that children of alcoholics have an altered brain chemistry that may make them more likely to become alcoholics themselves (whether or not they have been abused)

In reported cases:  the most persistent form of child abuse is neglect (60 percent),  followed by physical abuse (25 percent),  sexual abuse (13 percent), and  emotional maltreatment (5 percent).  More than 50 percent of the victims were 7 years old or younger; slightly  More than half of victims were girls

 It is estimated that 42 of every 1,000 children (under age 18) in the United States have been either abused or neglected.  The number of sexually abused girls is three times the number of boys.  Boys are more likely than girls to be seriously injured by abuse.  Boys are also more likely to be emotionally neglected.

 Child abuse is any act that harms the child's physical or emotional development.  Neglect occurs in 78.3% of child abuse cases.  Dental neglect is one type of abuse because it is the deliberate act to seek and obtain treatment for dental problems by a parent or guardian.  Failure to obtain treatment causes the child pain, infection, or interfere with adequate function of mastication.

Signs that the dentist search for when he suspects a case of abuse :  Fractured incisors – may be due to repeated trauma.  Burns on lips – due to forced feeding of hot food.  Bruises on lips - in children may be due to forced pacifier use.

 Frenum bruising or tear – due to forced feeding of a child or an elderly or due to a slap across the face.  Oral or perioral syphilis or gonorrhea or palatal petechiae or erythema – probable sexual abuse.  Bite marks – 65% of bite marks are visible on areas that are not covered by the child's clothes.

 Bite marks on abused children tend to come from individuals who have uncontrollable anger toward the child.  Infants that are bitten by the perpetrator are more disciplinary in nature as the bites are basically driven by a specific behavior by the infant.

 Dental professionals are called upon to participate in crimes related to children, especially if a bite mark is associated with the victim.

 The elder population of 65 and older is increasing each year, so are the cases for elder abuse.  Each year, millions of elders suffer from abuse.  The United States Department of Justice indicates that violent crimes against people ages 65 and older are approximately 4 in 1,000.

Elder abuse can be put into 5 categories:  physical abuse  sexual abuse,  psychological abuse  financial abuse  violation of rights.

Clues for physical abuse :  Injuries with incompatible histories.  Repeated injuries to head and neck regions.  Approximately 30% of known elder abuse cases were related to neck and facial regions.

 traumatic hair loss  rope or strap marks indicating physical restraint  multicolored bruises indicating injuries at various healing stages.  lacerations  puncture wounds  oral soft tissues injuries  jaw fractures  fractured or avulsed teeth

The NCPEA reported some indicators of elder abuse :  Injuries that are unexplained or are unlikely.  Family members providing different explanations of how injuries were sustained.

 Repeated injuries with frequent hospitalizations in different medical facilities to prevent medical practitioners from observing abuse pattern.  Delay between onset of injury and seeking medical care.

 It is crucial to document the signs of the repeated deliberate orofacial trauma in the dental patient record when it is recognized by the dental professional.

 The documentation of findings includes: - a description of the area, shape, size, color - a picture either using the intraoral camera or digital camera to help with the documentation.  This documentation assists the dental professional to report the abuse patterns.  It helps with the investigation of abuse cases.

 Prevention of elder abuse focuses on educational programs, which are critical elements in any broad approach to domestic violence.

These educational programs focus on :  knowledge as to how to protect themselves  their rights  how to seek help  educating professionals, caregivers, and the general public regarding the nature of elder abuse and its prevention.

 Progress should be made to increase professional awareness and involvement through training sessions on abuse, with the specific aim of fears concerning treatment of the elderly among staff.

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