Many Dentists May Violate Child Abuse Reporting Laws

Laird Harrison

October 11, 2012

October 11, 2012 — Although all 50 states require dentists to report signs of child abuse in their patients, some research suggests that few dentists are reporting these cases, according to a report published in the October issue of the Journal of the American Dental Association (JADA).

In addition to violating the ethical standards upheld by the American Dental Association (ADA) and other professional groups, dentists who fail to report suspected abuse face civil and criminal penalties and, in some states, the loss of their licenses.

Dentists can play an especially important role in detecting abuse because many abuse injuries are to the head and neck, the researchers note. Chipped or fractured teeth and strangle marks are among the most common signs of abuse. "When kids get abused, it's common for them to go to the dentist because of injury to the mouth," first author David R. Katner, JD, told Medscape Medical News.

Previous research suggests that many dentists are not fulfilling their obligation to report these injuries, said Katner, a professor of clinical law at Tulane University in New Orleans, Louisiana. He cited a 1995 JADA study in which researchers showed that dentists made less than 1% of all reports in states that track cases by the reporter's profession.

Katner said he spoke to leaders at several dental schools and found a lack of awareness of the issue.

Dentists may be underreporting abuse because they are not aware of the law, because they do not want to alienate their paying patients, or because they fear retaliatory lawsuits from parents, Katner said. However, after surveying the laws in all 50 states, he found that most grant immunity from lawsuits based on reporting suspected abuse. In addition, some states protect the identity of the reporter.

Although all the states required dentists to report abuse, Katner and coauthor Christopher E. Brown, DDS, a clinical associate professor in the Department of Prosthodontics, School of Dentistry, Louisiana Health Sciences Center, New Orleans, did find some variation. For example, some states extend the obligation to report to hygienists, whereas others apply it only to dentists. Some states, including New Hampshire and Virginia, allow the boards of dentistry to censure or revoke the license of professionals who conduct their practice in ways that are "contrary to the standards of ethics of dentistry or dental hygiene."

Despite the variation, juries are likely to hold dentists to the ADA's Principles of Ethics and Code of Professional Conduct, which state, "Dentists shall be obliged to become familiar with the signs of abuse and neglect and to report suspected cases to the proper authorities, consistent with state laws."

Even dentists who do not belong to the ADA may find that the code applies to them if attorneys present it to a jury as the best ethical practice in dentistry.

Courts in some states have ruled that the laws requiring professionals to report signs of child abuse can be used to support civil lawsuits against the professionals, and 7 states (Arkansas, Colorado, Iowa, Michigan, Montana, New York, and Rhode Island) have included civil liability in their mandatory reporting laws, the researchers said, citing a previous study.

The new JADA article might serve to call attention to the problem of underreporting, forensic dentist John McDowell, DDS, told Medscape Medical News.

"All of us need constant reminders of what a serious issue child abuse is in this country and, indeed, the world," Dr. McDowell, director of oral medicine and forensic science at the University of Colorado School of Dental Medicine in Denver, said. "But honestly, I don't think [the article] adds much to what we know."

Dentists are not unique among health professionals in neglecting their duty to abused children, he said. "I don't think dentists can be separated out in not reporting child abuse."

In addition, Dr. McDowell noted, dental schools in general do offer instruction in how to detect abuse. "I think most dental schools are doing a good job," he said. These signs and symptoms include injuries at variance with the history given, injuries at different stages of healing (which might suggest a pattern of abuse), a patient's reluctance to talk about the injuries, and a patient's general fear of adults. However, Dr. McDowell added, "I would like to see more time allocated in dental schools to train dentists to be able to identify the signs and symptoms of neglect."

Dr. McDowell did point out that most abused children will tell dentists how they were injured if asked directly.

The bottom line?

"If you have a reasonable suspicion, you need to report that things are not just fine."

The authors and Dr. McDowell have disclosed no relevant financial relationships.

JADA. 2012;143:1087-1092. Abstract