Dental neglect is defined as:
|...‘wilful failure of parent or guardian to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection.’
|American Academy of Pediatric Dentistry25
No corresponding definition has been produced in the UK where there has been limited debate of this issue to date.
Many adults visit the dentist only when in pain for emergency treatment and choose not to return for treatment to restore complete oral health. They may choose to use dental services in a similar manner for their children. Dental professionals have traditionally respected this choice and not challenged this behaviour. However, children may suffer dental pain or other adverse consequences as a result and, when young, are reliant on their carers to seek treatment for them. Anecdotally, it is reported that other health professionals who work regularly with children are shocked that the dental team often fails to rigorously follow up such children.
Dental Neglect - wilful neglect?
Severe dental disease may result from a parent or carer’s lack of knowledge of its causation or from difficulty implementing the dietary habits and oral hygiene measures they would wish to; for example, because of family stress or poverty. This cannot be equated with wilful neglect of a child. However, when the dental problems have been pointed out and appropriate and acceptable treatment offered, the following may be indicators that give concern:
- irregular attendance and repeatedly failed appointments
- failure to complete planned treatment
- returning in pain at repeated intervals
- requiring repeated general anaesthesia for dental extractions.
This 4-year old boy has caries in his primary incisors. Your clinical records show that the decay is not getting worse. He has never complained of toothache. He is due to start school soon. His parents are unconcerned by the appearance of his teeth. He cooperates well with dental treatment but sometimes misses appointments.
He obviously has untreated carious teeth – but is it dental neglect?
You need to consider:
What is the impact of dental disease on the child (you may want to refer to Dental neglect - wilful neglect, or Dental neglect - general neglect)?
What other information do you need to make a decision?
What records would you make of your observations and decisions?