How is Human Trafficking Recognized?

Head and Neck Indicators Associated with Possible Trafficking Victims in a Dental Practice^18,28.

• Any bruising, head trauma or areas that are visible or in the process of healing. Bruising will go through different color variations depending upon whether the bruise is new or old. A variation could mean an ongoing process of frequent beating and trauma.

• Trauma to the oropharynx or soft palate indicating forced oral sex. This could also result in long-term neck issues due to force. These may be in the form of ecchymosis, petechia or purpura. The victim may also be exposed to the Human Papilloma Virus, HPV 6 & 11. And develop oral squamous papillomas. Condyloma Acuminatum results from oral-oral or oral-genital contact. When condyloma acuminatum is detected in a child, it is considered child abuse until proven otherwise.

• Broken teeth, oral lesions and evident trauma to the mouth.¹⁵

• Signs of anemia or poor nutrition. The lack of sun exposure and vitamin C deficiency may indicate confinement suggesting there has been a lack of sun exposure, etc. This may affect the skin and also the hair of the victim.

• Children may have growth and developmental abnormalities. Lack of nutrition and poor environment may decrease a child’s growth. Some children are in trafficking even before age 12 and have not had proper nutrition or care.

  ^10,20,30,36

• Gingival inflammation resulting from poor oral care as well as fungal infections in the oral tissues and lip areas. There may be indications of gonorrhea, syphilis, and infections from human papilloma virus (HPV).

• Abnormal neck findings such as trauma and bruising from strangulation. A common finding may be bruising, scars from ropes or branding on the back of the neck.

• Tattoos (indicating property of an individual) in neck area or hairline, including any tattoos that are visible in any areas of the body. These could be evaluated in an oral exam while examining the occipital nodes and auricular nodes.

• Respiratory issues or complaints that indicate inhalation of chemicals, toxic fumes, or poor working conditions in damp, cold or hot locations. These may indicate domestic trafficking or use of the individual in a labor capacity such as a factory, closed containment facility or even mines.

• Cigarette or scald burns in visible areas. These could have resulted from the perpetrator controlling the victim during seasoning activities (preparing the victim for work by psychological and physical control).

   

  Seasoning

   

  is usually a prime time when severe injury of the child or adult may result.

  ^18,29

• Ligature marks or visible scars around the ankles or wrists. This is an indication of confinement and/or torture.

• Marks around the commissures may indicate the person has been gagged extensively. Also, candida and any sores around the commissures may indicate poor oral health with repeated neglect. This may also indicate infection related to HPV and oral sex of the captive person.

• Angular cheilitis in children usually indicates an iron deficiency. Nutritional deficiency in children can be observed quickly when living conditions are poor.

• Torn or crushed frenums may indicate extreme pressure applied possibly because of adult hand over the mouth of the child victim.

• Observable bruises to the pinna (ear area) due to possible blunt force trauma. This is another feature that is considered child abuse until proven otherwise. Children do not fall on the ear-they will fall backwards or forward. The ear has very little blood supply and blunt force must be applied to develop severe bruising.

• Agricultural workers spend extensive time in the sun without proper SPF protection leaving them vulnerable to sun damage. Squamous cell carcinoma, basal cell carcinoma and evident skin changes should be noted and discussed.

Additionally, depending upon the type of work the victim is involved in, there could be extensive cuts, bruises and calluses on the hands and feet, perhaps suggesting farm work, fishing boat work or generally very hard labor. In current studies, there appears to be a lack of focus and training on clinical indicators that are evident when healthcare providers are examining such patients.^11,18,20,36 Dental providers have full view of the head and neck with the use of high-quality lighting. This makes the visibility extremely valuable in detection of oral/extraoral findings.