Dentists learn to identify child abuse by recognizing tell-tale signs on the head, face and neck of their young patients.
By Judy Siegel-Itzkovich
In 1989, a law was passed requiring professionals in the medical and social services to report any suspicions of physical abuse of a child they have encountered. The punishment for lack of reporting is six months in prison. Yet in the 12 years since, few such cases have actually been reported - and none of them by dentists. Not a single professional has been prosecuted for failing to report, despite some 32,000 known cases of child abuse every year, and a suspected 10 times that number of unreported cases.
Hanita Zimrin, the chairperson of Eli (Israel Association for the Prevention of Violence Against Children), claimed recently that cases of physical abuse of children have increased by 84 percent since the wave of violence began some 16 months ago. She explained that the serious economic recession and its resulting unemployment, as well as tension over the security situation, have increased violence against children. It is imperative that medical professionals look out for signs of abuse.
A new joint initiative by dentists and the Ministry of Health will hopefully soon change this poor record. The initiative, called PANDA (Prevent Abuse and Neglect through Dental Awareness), was developed by an American dentist seven years ago. The movement is
already active in 46 US states, as well as Canada, Romania, Peru and Guam.
The founder of the original PANDA organization is Dr. Lynn Douglas Mouden, who spent 16 years in private practice and eight as an associate professor of the University of Missouri dental school. Since 1994, Mouden, who now serves as director of the Arkansas office of oral health and is the American Dental Association's national spokesman on child abuse prevention, has delivered over 250 lectures worldwide on the identification of physical abuse by looking in children's mouths and at their heads.
One of those lectures was attended by orthodontist Dr. Haim Galon, former secretary of the Israel Dental Association. "I first learned about the possibility of dentists recognizing signs of abuse among young patients when I attended a lecture on forensic dentistry at a conference in Prague 16 years ago. I became really interested in the subject. We were told that around the world, about 65 percent of all physical abuse of children shows up on the head and neck." Then, in 1994, Galon attended an American Dental Association conference in New Orleans where he heard Mouden's lecture. They spoke after the lecture, and kept in touch. Recently, Mouden addressed a conference on the Hebrew University's Givat Ram campus, attended by 120 dentists, oral surgeons, dental hygienists, government officials and social workers.
Dr. Shlomo Zusman, who heads the dental health branch of the Ministry of Health, is coordinating membership and providing information about PANDA-Israel. Zusman explains that he and his colleagues are working not only to increase awareness of the matter, but also to introduce the subject in the curricula of the two dental schools (in Jerusalem and Tel Aviv). "I've worked as a dentist for many years, but I admit I never picked up a case of child abuse. I'm sure there were cases, but I had not been trained to identify them," he says. Nirit Pessah, Head of Social Services and General Health at the Ministry, adds that PANDA-Israel will advise dentists on whom to consult before filing a complaint. Dentists may not only be unaware of the clinical signs of abuse, she explains, but also feel uncomfortable
alerting the authorities to suspected abuse by the parents of their private patients.
PANDA has produced a 30-minute video that presents examples of signs of physical abuse against children. The most commonly inflicted injuries are by an instrument, food utensils, hands, fingers, scalding liquids or caustic substances. The abuse may result in contusions or lacerations of the tongue, inside cheek, palate or other parts of the mouth; fractured, displaced, discolored or missing teeth; facial bone and jaw fractures; burns; and other injuries. In addition, there may be signs of gonorrhea or syphilis in the mouth that point to sexual abuse.
Even neglect of teeth can be a sign of physical abuse, adds Galon. "If a child has a mouthful of cavities, infected gums and pain, this could be a sign of neglect. Dental care is not included in the basket of health services, but even if parents cannot afford dental treatment for their children, there are a number of free dental clinics and special programs for the needy. It is possible to prevent children who have been abused in the past from suffering more serious
injuries in the future, before it is too late. Sometimes it is a matter of life and death."