Children found to have severe dental decay should be referred to local safeguarding teams as it may be an indicator of wider neglect, dentistry experts have said.
Researchers at London’s King’s College Hospital said two out of five (40%) children who needed oral and maxillofacial surgery due to dental decay over a two-year period were already known to social services.
Their findings have led to the introduction of a new care pathway for children admitted to the hospital’s A&E unit with dental/oral and maxillofacial infections, which will see them risk assessed for neglect and referred to the safeguarding team accordingly.
The study authors said they also want to see their review, which is published in the British Dental Journal, rolled out across the NHS.
Dental neglect is defined as the persistent failure to meet a child’s basic oral health needs, which is likely to result in the serious impairment of the child’s oral, general health or development.
Sadly, by the time we treated the children they would already have suffered a sustained period of oral neglect, and probably been in pain
Dentofacial/cervicofacial infection (infection affecting the face and neck) in children is avoidable, and if left untreated it can significantly disadvantage them for the rest of their lives, they warned.
Researchers said GPs are trained to identify general neglect and should be made aware that acute dental infection can also be an indicator of wider neglect.
They looked at the patient data of children who attended King’s with a dental/oral maxillofacial infection that required surgery under general anaesthetic between January 2015 and January 2017, and found there were 27 children aged between two and 15.
The youngest child was two years and three months, while the oldest was 15 years and nine months.
They found 11 (40.7%) children were already known to social services prior to hospital admission.
The average number of extracted teeth was 3.2, with up to 11 taken out. The average length of hospital stay was 2.5 days.
Study co-author, Kathy Fan – consultant oral and maxillofacial surgeon at King’s, said: “Dental decay in children is a preventable disease and access to NHS dental services is entirely free for children, therefore these children presenting late with acute dentofacial infection are suffering dental neglect that may be an indicator of wider neglect.
“Over half of the children we cared for were aged between five and eight, and indicates this age group is at greatest risk of harm.
“Sadly, by the time we treated the children they would already have suffered a sustained period of oral neglect, and probably been in pain.”
Consultant paediatric dentist and co-author Marielle Kabban said: “Where patients or carers repeatedly fail to access dental treatment for a child’s tooth decay or leave dental pain untreated, alarm bells should ring for clinicians to consider neglect.
“Awareness and confidence to escalate concerns as well as educate non-dental healthcare workers is essential to recognise dental neglect early and arrange treatment.”
The pair also suggest that all children who are made subject to a child protection plan should have a dental assessment carried out.
The number of hospital admissions for tooth decay among five to nine-year-olds rose to 26,000 last year, according to data from NHS Digital.
Tooth decay was the main reason for hospital admissions among five to nine-year-olds in England – with more than twice as many compared to tonsillitis.