New report shows shocking tooth decay in children known to social services

Katherine Johnston (31 October, 2018) Health

'Children presenting late with acute dentofacial infection are suffering dental neglect that may be an indicator of wider neglect'

23053King's College Hospital emergency department

Forty per cent of children seen by King’s College Hospital over two years for tooth decay so serious they needed surgery were known to social services, a new report reveals.

Figures published last Thursday, October 26, in the British Dental Journal, show that from January 2015 to January 2017, 40 per cent of the children needing a type of surgery called maxillofacial surgery at the hospital were already known to the authorities.

The surgery, given under anaesthetic, treated potentially life-threatening infections in the face and neck caused by severely decaying teeth.

In total, twenty-seven children aged between two and fifteen years needed the specialist treatment, which could have been avoided with correct oral hygiene and regular visits to the dentist – appointments which are free on the NHS for children.

Forty-one per cent of the children had first been seen by their dentist before being referred to hospital, but just over a third had gone straight to A&E.

Over half were shockingly young – between five and eight years old. All the children treated had to have teeth removed and cuts made in the swelling to drain the infection.

The report’s findings spurred King’s to introduce new procedures for children admitted with these types of severe infections. All children in A&E with similar problems will now be risk assessed for neglect and referred to the safeguarding team accordingly.

King’s College Hospital-based authors Kathy Fan, a consultant oral and maxillofacial surgeon, and consultant paediatric dentist Marielle Kabban, both say dentists can play a role in spotting child neglect.

“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,” Dr 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.”

Ms 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.

“Awareness and confidence to escalate concerns, as well as educate non-dental healthcare workers, is essential to recognise dental neglect early and arrange treatment.”

Its authors, who are members of the British Association of Oral and Maxillofacial Surgeons, are now calling on the NHS to implement this approach across the country, and believe children who are under a child protection plan with their local authority should automatically have a dental assessment carried out.

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