Introduction
According to the American Academy of Pediatric Dentistry, “Dental neglect is willful failure of a parent or guardian to seek or follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection.” Dental neglect can be further divided into three different types:
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Active neglect—intentional failure of parents or guardians to fulfill their care-giving responsibilities.
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Passive neglect—unintentional failure of parents or guardians to fulfill their care-giving responsibilities because of lack of knowledge, illness, infirmity, finances, or lack of awareness of available community support/resources.
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Self neglect—a person’s inability to provide for his or her own needs because of a physical, mental, or developmental disability or any combination of these.
Neglect can also be defined as any action or inaction by any person that causes harm to a vulnerable person.
Recognition
Rampant dental decay or other manifestations of dental disease in a very young child should arouse suspicion of dental neglect. In the United States, health care professionals are mandated to report cases of suspected abuse and neglect of children. Each state has its own definitions of child abuse and neglect based on general standards set by Federal law. In 2006, the U.S. Department of Health and Human Services (US DHHS) reported that approximately 905,000 children were victims of maltreatment. Child protective services (CPS) agencies respond to the needs of children who are alleged to have been maltreated. According to the US DHHS, 64.1% of confirmed cases of child maltreatment were neglect cases. (See Chapter 5, “Epidemiology of Child Neglect.” )
Possible Causes and Risk Factors
Many factors can contribute to an increased risk of dental neglect, including family isolation, lack of finances, parental ignorance, or lack of perceived value of oral health. Another contributing problem is the inability of parents to establish a dental home for their children, defined by the American Academy of Pediatric Dentistry as, “The ongoing relationship between the dentist and the patient, inclusive of all aspect of oral health care delivered in a comprehensive, continuously accessible, coordinated and family-centered way.”
Description
Dental neglect is often a component of overall neglect. When health care professionals recognize signs of general neglect in patients, they should look for the possibility of dental neglect. Signs of neglect include poor oral hygiene, lack of care after an injury, or poor nutrition, including inappropriate choices of food and drink for the child. The parents might also be abusing drugs and/or alcohol. Neglectful parents or caregivers commonly ignore the treatment recommendations of health care providers. This can be especially problematic in the treatment of dental disease, which is preventable in most cases.
Early childhood caries (ECC) was in the past called “nursing or baby bottle decay.” It remains a common occurrence in young children who are neglected. The American Academy of Pediatric Dentistry defines ECC as, “The presence of one or more decayed, missing (due to caries), or filled surfaces in any primary tooth in a child 71 months of age or younger.” ECC is observed in infants and toddlers who are breastfed on demand or who are given nighttime bottles filled with highly cariogenic liquids including milk, soft drinks, juices, or sports drinks. The failure of parents to provide oral hygiene (brushing and flossing) for their children contributes to this destructive disease. The accumulation of plaque on the anterior teeth is evidence of the lack of oral hygiene care by parents or guardian ( Figure 56-1 ).
White spot lesions ( Figure 56-2 ) are an early indication of ECC. These are frequently initially evident on the maxillary incisors. The mandibular incisors are protected from the cariogenic liquid because of the tongue’s position when sucking. Cariogenic liquids pool around the maxillary incisors when a child is put to bed with a bottle filled with a substance other than water, or when a child is breastfed on demand throughout the night. If this liquid is not removed by brushing or wiping the teeth by the caregiver, tooth decay can result.
