Children with severe dental decay should be referred to local safeguarding teams
23 October 2018 (Last updated: 26 Oct 2018 09:25)
KCH maxillofacial surgeons and paediatric dental consultants say children with severe dental decay should be referred to local safeguarding teams
Severe dental decay in children that requires surgery by oral and maxillofacial surgeons (OMFS) is dental neglect and may be an indicator of wider neglect, according to OMFS and paediatric dentistry consultants at London’s King’s College Hospital (KCH). They say that the children must be discussed with local safeguarding teams and referral to social services considered.
New data from a report published today into paediatric dentofacial/cervicofacial* infection shows that 40% of the children in the two-year case review who needed oral and maxillofacial surgery for potentially life-threatening infection as a result of dental decay were already known to social services. *(infection affecting the face and neck)
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. Dentofacial/cervicofacial infection in children is avoidable, but if left untreated it can significantly disadvantage children for the rest of their lives.
King’s College Hospital-based co-authors Kathy Fan, consultant oral and maxillofacial surgeon, and consultant paediatric dentist Marielle Kabban, say that GPs are trained to identify general neglect and should be made aware that acute dental infection can also be an indicator of wider neglect: “All dentists also have a key role to play in spotting a child at risk of neglect,” they said.
Marielle Kabban stressed the importance of better communication between all professionals “so that the pieces of the jigsaw can be brought together to form an accurate picture of a child’s risk”.
The analysis of patient data for children aged below 16, who attended King’s with a dental/oral and maxillofacial infection that required surgery under general anaesthetic, found 27 children aged between two and 15 years-of-age. The team also reviewed how many were already known to social services departments.
Half of the children (41%) had first gone to their local dentist before referral to the hospital, while just over a third had gone straight to King’s A&E. More than 50% of the children were aged between five and eight years old. All children with decay had incision and drainage* under general anaesthetic as well as dental extractions. *(a cut made in the swelling either inside the mouth or in the neck to allow the infection to drain and prevent infection spreading even deeper into the neck and around the airway)
“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,” Kathy Fan said. “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.”
Marielle Kabban added: “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.”
As a result of the report’s findings KCH has introduced a new care pathway for children admitted to the hospital with dental/oral and maxillofacial infections. This means that all children admitted to A&E will be risk assessed for neglect and referred to the safeguarding team accordingly.
“Awareness and confidence to escalate concerns as well as educate non-dental healthcare workers is essential to recognise dental neglect early and arrange treatment,” Marielle Kabban said.
The lead authors want to see the learning from this review, published in full in the British Dental Journal, rolled out across the NHS and the KCH care pathway used as a template. Furthermore, they suggest that children who are made subject to a child protection plan should have a dental assessment carried out.
Kathy Fan and Marielle Kabban want a further study that will demonstrate the indicators for possible neglect better: “A comparative study to analyse the difference between elective extractions under general anaesthetic with children admitted as emergencies should allow us to define more precisely the likelihood of possible neglect.”
Ends
For further information and interviews contact: Siân Evans on 020 8674 8921 / 07752 414433 or BAOMS
Notes to editors
- The British Association of Oral and Maxillofacial Surgeons (BAOMS) promotes the advancement of education, research and the development of oral and maxillofacial Surgery in Great Britain, and encourages and assists postgraduate education, study and research. Further information is available on this website.
- For a copy of the report please contact Siân Evans or ring 07752414433.
- Paediatric dental infections – a potential tool for identifying children at risk of neglect? A paper by consultant paediatric dentist Marielle Kabban, and British Association of Oral and Maxillofacial (BAOMS) members Kathy Fan, Jurgen Schlabe and David Chapireau published in full in the British Dental Journal October 26 2018.
- The observational study was carried out at King’s College Hospital between January 2015 to January 2017. Patient records were reviewed for all children below the age of 16 years admitted as an emergency under oral and maxillofacial surgery to understand if they had experienced dental neglect.
- The tests and treatment that a child is likely to undergo depending on the severity of the dentofacial/cervicofacial infection include:
- antibiotics through a vein (intravenously)
- steroids through a vein (intravenously)
- blood tests
- scans in addition to routine x-ray
- intubation if there is an airway swelling secondary to the infection until the swelling has resolved
- surgery under a general anaesthetic to remove pus and extract teeth causing the infection
- drains in the wound after surgery to drain away any pus.
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