Neglect

Neglect is often misunderstood and misdiagnosed. Cavities, periodontal disease, and other oral conditions are commonly associated with inadequate attention to nutrition and dental hygiene and can be signs of neglect. These conditions are not benign; they can lead to pain, infection, loss of function and other health conditions, which can negatively affect normal growth and development of a child.⁷

Dentists must distinguish, however, between caregivers who cannot provide adequate care for their children and caregivers who will not. Dental neglect is defined by the American Academy of Pediatric Dentistry as the “willful failure of parent or guardian, despite adequate access to care, to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infections.”²¹ Before making a report of maltreatment to child protection, a dentist should determine whether the caregiver understands the explanation and implications of the dental issue and, despite having the resources to address the condition, fails to do so. When the failure to provide adequate dental care is based on financial or transportation barriers, a different type of intervention should be considered. If parents fail to obtain therapy after barriers to care have been addressed, the case should be reported to the appropriate child protective services agency as concerning for dental neglect.

1. Indicators of dental neglect^9,22 include:

   • Multiple, untreated caries easily detectable by a lay person

   • Untreated pain, infection, bleeding, or trauma affecting the orofacial region

   • History of lack of continuity of care in the presence of identified dental pathology

   • Failure on the part of the caregiver to provide information concerning the child’s history or demonstrated disinterest in the child’s presenting issues and the dentist’s treatment recommendations

2. Indicators of general neglect^23,24 include:

   • Constant food seeking behavior by the child indicating extreme hunger

   • Unexplained fatigue or listlessness

   • Unattended medical needs

   • Poor personal hygiene, extremely dirty or unbathed, severe diaper rash

   • Inappropriate or inadequate clothing for the weather conditions

   • Poor school attendance or school performance

Figure 8.

Figure 8.

Severe case of diaper rash from caregiver neglect of the child.