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Journal of the Louisiana Dental Association

Journal of the Louisiana Dental Association

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and infection”. 9 However, paying careful attention to detailsabout emotional and socioeconomic barriers and <strong>the</strong>ir effectson <strong>the</strong> lives <strong>of</strong> children and caretakers need to be considered.Signs and Symptoms <strong>of</strong> Abuse 6,7,8,9Physical abuseProminent areas <strong>of</strong> s<strong>of</strong>t tissue:Cheeks <strong>of</strong> <strong>the</strong> headFaceNeckBilateral injuriesLacerationsBruising to scalpBite marksCigarette burnsLacerations and bruises <strong>of</strong>:CheeksNose lipsNecksEarsTorn labial frenumOral mucosal burns with sloughing<strong>of</strong> tissueOral – hard tissue prominenceFractures <strong>of</strong> maxilla and mandibleMissing teethSexual Abuse*Palatal petechiae for forced fellatioSexually transmitted infections*Definitive diagnosis <strong>of</strong> <strong>the</strong>se conditions requireappropriate laboratory tests for confirmationEmotional AbuseLags in physical developmentLags in development <strong>of</strong> speechRocking motionsFacial ticsOdd reactions to persons in authorityWhile physical abuse tends to beepisodic, neglect tends to be chronic.– LA Children’s Trust FundCall to ActionToday, four children will die as a result <strong>of</strong> child abusein <strong>the</strong> United States as reported by Safe Horizon, a nationalcoalition <strong>of</strong> child advocates. This organization urges everyoneto help protect children and save lives. 10Traditionally, dental health pr<strong>of</strong>essionals have shown a lowreporting rate <strong>of</strong> child abuse and neglect. It is imperative thatdentists become more aware <strong>of</strong> <strong>the</strong>ir moral, legal and ethicalresponsibilities in recognizing and reporting cases <strong>of</strong> childabuse and neglect. 11Several initiatives have helped dentistry deal with childabuse and neglect. The most notable is <strong>the</strong> Prevent Abuseand Neglect through <strong>Dental</strong> Awareness Coalition (PANDA).PANDA was established to assist dental pr<strong>of</strong>essionals withmaking critical judgment calls on abuse and neglect cases. Thiscoalition also makes an effort to ease <strong>the</strong> uncertainty <strong>of</strong> making<strong>the</strong>se judgment calls that appear so subjective and complicatedby <strong>the</strong> doctor- patient relationship and family dynamics. 12Along with using resources like PANDA, dentists canbest help protect children from maltreatment through anunderstanding <strong>of</strong> <strong>the</strong> child protective services process.Contact <strong>the</strong> Office <strong>of</strong> Community Services to determine yourarea-reporting site. Arrange continuing education courses inyour district to improve your knowledge and understanding<strong>of</strong> <strong>the</strong> reporting process. Specifically in <strong>Louisiana</strong>, PreventChild Abuse <strong>Louisiana</strong> (www.pcal.org) has been one <strong>of</strong> <strong>the</strong>leading advocacy groups that provides crisis intervention,parent training, community information and advocacy, aswell as training to mandated reporters. Identify <strong>the</strong> childadvocates in your community. It may also be helpful towork with <strong>the</strong> child’s pediatrician when cases are suspected.Be proactive in observing children in your practice and helping toreduce <strong>the</strong> incidence <strong>of</strong> child abuse and neglect in <strong>Louisiana</strong>.AcknowledgementSpecial thanks to Rishu Garg, MPH for data collection andresearch assistance.References1. <strong>Louisiana</strong> Court Appointed Special Advocates, www.louisianacasa.org2. Child Welfare Information Gateway. Fact Sheet: Child abuse and neglectfatalities: Statistics and Interventions. June 2006.3. Keeping Children and Families Safe Act <strong>of</strong> 2003 (P.L. 108-36)4. LA Children’s code,[Art. 603(13)].5. LA Children’s code, revised statutes 14: Title VI: 601-713.6. Brannon, RB, Stro<strong>the</strong>r, EA. Child Abuse and Neglect: The Responsibility <strong>of</strong><strong>the</strong> <strong>Dental</strong> Community. LDA <strong>Journal</strong> Fall 2005, 64: 6-15.7. Mouden, LD. The Hygienist’s Role in Recognizing and Reporting Child Abuseand Neglect. Practical Hygiene 1996;5(2):25-28.8. Kellog, N and Committee on Child Abuse and Neglect. The Evaluation <strong>of</strong>Sexual Abuse in Children. Pediatrics 2005;116: 506-512.9. Kellog, N and Committee on Child Abuse and Neglect. Oral and <strong>Dental</strong>Aspects <strong>of</strong> Child Abuse and Neglect. Pediatrics 2005; 116:1565-2315.10. Safe Horizon. www.safehorizon.org11. Mouden, LD, Bross, DC. Legal Issues Affecting Dentistry’s Role inPreventing Child Abuse and Neglect. J Am Dent Assoc 1995;126:173-179.12. Mouden LD. How Dentistry Succeeds in Preventing Family Violence.<strong>Journal</strong> <strong>of</strong> <strong>the</strong> Michigan <strong>Dental</strong> <strong>Association</strong> September 1996:44-48.32 LDA <strong>Journal</strong>

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