Abstract title: To what extent are the oral health needs of children affected by maltreatment still ‘neglected’?  Findings from an international scoping review

Abstract

Dental neglect and poor oral health can be precursors to, or signs of, child maltreatment. Because dentists perform detailed oral examinations, they are well-placed to identify and prevent early signs of child neglect and abuse [1]. Furthermore, because the mouth and head are common sites of physical injury, dentists can also play an important role recognising and supporting children experiencing physical and sexual abuse [2].  Over the past two decades, the dental profession has increasingly embraced its role identifying and addressing oral health dimensions of child maltreatment [3]. Nevertheless, there are concerns that dental education and ongoing professional training are not equipping dentists with the requisite skills to consistently identify and respond to the oral health and welfare needs of mistreated children [4].

With this in mind, we considered it valuable and timely to map the contemporary nature of the research landscape. We did this by carrying out a scoping review, as characterised by Arksey and O’Malley [5]. Included papers were peer-reviewed empirical publications that explored the oral health needs of children affected by, or likely to be affected by, abuse or neglect. We included papers that explored professional attitudes, values and knowledge about responding to the oral health needs of children affected mistreated. We did not set a timeframe for publication inclusion. Searches were carried out using four electronic databases and 1890 titles and abstracts were initially screened. Through a systematic process, we identified 69 papers that met the inclusion criteria. Data was abstracted and the study team analysed and synthesised the papers following Ritchie and Spencer’s (1994) Framework Analysis approach [6]. The review findings were critically discussed with an inter-disciplinary panel of researchers and practitioners.

 

Analysis of the papers identified three thematic areas: 1) There is a relationship between poor oral health and child maltreatment that is well-evidenced but conceptually under-developed 2) There are discrepancies between the knowledge of members of the dental team about child maltreatment and their confidence and aptitude to identify and report child protection concerns 3) There are areas of local-level policy and practice development that seek to improve working relationships between dentists and health and social care practitioners; however, there is widespread evidence that this group of vulnerable children continue to ‘slip through’ the gaps of different professional communication systems and policy areas.  Based on the review findings, we present a conceptual tool: the Patterns, Advances, Gaps, Evidence Recommendations (PAGER) framework to guide future work. The framework is likely to be of interest and relevance to researchers, practitioners and policy makers working across dentistry, health, social care and specialist child protection fields.

 

Workshop plan

  • Introductions: invite participate to comment on their interest/ awareness of this topic
  • Presentation of review findings followed by Q and A session
  • Using the PAGER framework, group (or small groups depending on numbers) discusses its potential use in their research/ practice context. Discussion captured in a mapping exercise and action points identified where possible
  • Reflections and close

 

References

[1] Harris, J. , Sidebotham, P. , Welbury, R.  and Čuković-Bagić, I. , 2010.  Child protection and the dental team: an introduction to safeguarding children in dental practice

[2] Kellogg, N. , 2005.  Oral and dental aspects of child abuse and neglect.  Pediatrics, 116(6), pp. 1565-1568

[3] Jameson, R. , 2016.  Working together to share the dental neglect.  British dental journal, 221(12), p. 755.

[4] Harris, J. C. , 2018.  The mouth and maltreatment: safeguarding issues in child dental health.  Archives of disease in childhood, pp. archdischild-2017

[5] Arksey, H.  and O’Malley, L. , 2005.  Scoping studies: towards a methodological framework.  International journal of social research methodology, 8(1), pp. 19-32

[6] Ritchie, J. , Lewis, J. , Nicholls, C. M.  and Ormston, R.  eds. , 2013.  Qualitative research practice: A guide for social science students and researchers, Sage

 

Author: Louise Isham