Child Protection and the Dental team

When a child presents with a neglected dentition, you should not seek to blame the parents or carers but to support them. Some LSCB/ACPC procedures make provision for initial management of minor concerns about the welfare of a child, where the criteria for immediate referral to social services are not met.³⁰ Three stages of intervention are described:

Preventative single agency response - raise concerns with parents, offer support, set targets, keep records, monitor progress
Preventative multi-agency response - liaise with other professionals, check Child Protection Register (where this facility is available), agree a joint plan of action, review at agreed intervals
Referral to social services - if the situation is too complex or deteriorating

Note that these principles:

relate only to neglect or emotional abuse
are appropriate only when there is isolated dental neglect, unaccompanied by signs of general neglect

The example of a 4-year-old child with caries who only attends when in pain shows how the dental team might put this into practice where resources permit

The case study of a family of four children illustrates good practice in:

multi-agency working
early intervention to safeguard children
management of dental neglect

Download sample letter to health visitors regarding children under-5 who fail to attend, to assist you in multi-agency working

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Much of this will be familiar to those who already employ a preventive approach to treatment planning for children. If you have any doubts about the appropriateness of such action, you should discuss with an experienced colleague and proceed to make a referral to social services.

Example of a preventative single agency response to dental neglect: a team approach (applied to a 4-year-old child with caries who only attends when in pain)

Guide for action	Action required	Suggested team member/s responsible
Raise concerns with parents	Explain clinical findings, the possible impact on the child, and why you are concerned	Dentist
Explain what changes are required	Explain treatment needed and expectation of attendance	Dentist
	Give advice on changes needed in diet, fluoride use and oral hygiene	Therapist, hygienist or dental nurse as appropriate
Offer support	Consider giving free fluoride toothpaste and brush	Dental nurse
	Offer the parent or carer a choice of appointment time	Dental receptionist
	Listen for indications of a breakdown in communication, or parental worries about the planned treatment, and offer to discuss again or to arrange a second opinion if this is the case	All team members
Keep accurate records	Keep accurate clinical records	Dentist and/or other team members
	Keep accurate administrative records of appointments and attendance	Dental receptionist
Continue to liaise with parents/carers	Keep up open communication with the parents and repeat advice, so that they know what is expected of them	All team members
Monitor progress	Arrange a recall appointment	Dentist
If concern that child is suffering harm, involve other agencies or proceed to make a child protection referral	Consult other professionals who have contact with the child (e.g. health visitor, nursery nurse) and see if your concerns are shared	Dentist
	Take further action without delay if indicated	Dentist

Case study

Illustrating good practice in:

multi-agency working
early intervention to safeguard children
management of dental neglect

A family of four children aged 7, 4, 3 and 1 attended for a dental examination. The eldest had been a patient at the practice two years previously but then failed to complete a course of treatment. On this occasion all four children had dental caries and poor oral hygiene, the younger children presenting with more extensive caries at an earlier age than their older siblings.

At subsequent appointments it became apparent that all the children were consuming frequent sugar-containing snacks and drinks. The two youngest children were drinking juice from a bottle throughout the day and night. Advice was given on caries prevention. Their mother reported increasing difficulty coping with the children’s eating and sleeping habits and behaviour. She readily agreed to the dentist’s offer to contact their health visitor to see if any support and advice might be available.

The health visitor visited the family at home on several occasions over the next six months to give advice on various aspects of health and parenting. She put them in touch with local Sure Start services. The situation soon improved and there were no further concerns.

In the months that followed, the two younger children required dental extractions under general anaesthesia. A note was made that they remained at high risk of caries and would require regular preventive care. When they missed a subsequent recall appointment and no response was received to a letter offering a further appointment, the health visitor was informed by letter (download sample letter) in accordance with practice policy. This prompted the family to phone for a further appointment and they now attend for regular dental care.

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