OSAC 2022-N-0028 Human Abuse Recognition 

and Documentation by Dental Professionals

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OSAC 2022-N-0028

Human Abuse Recognition 

and Documentation by 

Dental Professionals

Forensic Odontology Subcommittee

Medicine Scientific Area Committee

Organization of Scientific Area Committees (OSAC) for Forensic Science
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Draft OSAC Proposed Standard

OSAC 2022-N-0028

Human Abuse Recognition and 

Documentation by Dental Professionals

Prepared by 

Forensic Odontology Subcommittee

Version: 1.0

February 2022

Disclaimer:

This OSAC Proposed Standard was written by the (subcommittee) of the Organization of 

Scientific Area Committees (OSAC) for Forensic Science following a process that includes an 

open comment period. This Proposed Standard will be submitted to a standards developing 

organization and is subject to change. 

There may be references in an OSAC Proposed Standard to other publications under 

development by OSAC. The information in the Proposed Standard, and underlying concepts and 

methodologies, may be used by the forensic-science community before the completion of such 

companion publications.

Any identification of commercial equipment, instruments, or materials in the Proposed Standard 

is not a recommendation or endorsement by the U.S. Government and does not imply that the 

equipment, instruments, or materials are necessarily the best available for the purpose.
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1 1. Human Abuse Recognition and Documentation by Dental Professionals

2 This OSAC Proposed Standard was prepared by the Forensic Odontology Subcommittee, Medicine Scientific Area 

3 Committee, in the Organization of Scientific Area Committees (OSAC) for Forensic Science. 

4 Drafting Committee Chairperson:

5 Lawrence A. Dobrin DMD, DABFO

6

7 Drafting Committee Members:

8 Mary A. Cimrmancic DDS

9 Phyllis Ho DDS, DABFO

10 Robin A. Ainsworth DDS, MS, DABFO, ABGD

11

12 OSAC Forensic Odontology Subcommittee Chairperson:

13 Kenneth W. Aschheim, DDS, DABFO

14

15 OSAC Forensic Odontology Subcommittee 

16 Joe Adserias-Garriga DDS, PhD, MS DABFO

17 Robin Ainsworth DDS, MS, DABFO

18 Paula Brumit DDS, DABFO

19 Clifton Carey, PhD

20 Kent Cattani, JD

21 Mary Cimrmancic DDS

22 Deborah Davis, PhD

23 Lawrence Dobrin, DMD, DABFO

24 Derek Draft, DDS, DABFO

25 Richard Fixott DDS, DABFO

26 Kenneth Hermsen DDS, DABFO

27 Phyllis Ho DDS, DABFO

28 Kathleen Kasper DDS, DABFO

29 Haskell Pitluck, JD

30 Sharon Stanford, BA

31
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32 Human Abuse Recognition and Documentation by Dental Professionals

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34 BACKGROUND

35 Human abuse and neglect have been recorded in literature, art, and science throughout history and in many parts of the 

36 world. Reports of infanticide, mutilation, abandonment and other forms of violence against humans date back to ancient 

37 civilizations. Historical records are filled with stories of unkempt, weak, malnourished, and sexually abused children. The 

38 term "battered child syndrome" was coined to characterize the clinical manifestations of severe physical abuse in young 

39 children. Increasing recognition of elder abuse and intimate partner violence has occurred in recent years. Human abuse 

40 occurs in various forms and may be deeply rooted in cultural, economic, and social practices. The health consequences of

41 human abuse include acute and chronic physical and psychological injuries, and can impact behavioral, sexual and 

42 reproductive health.

43 RATIONALE

44 Health care practitioners should realize the adverse effects of human abuse and neglect. The most tragic consequence 

45 could be a human fatality. In the U.S., there is an average of more than 5 children dying every day from abuse and neglect.

46 The level of reporting of abuses varies by state however, all the states require the reporting of child abuse. The practitioner 

47 should be aware of their state's regulation.

48 State regulations prescribe penalties for failure to report suspected cases. Early stages of domestic violence may be 

49 recognizable in persons who have disabilities, are elderly, or are victims of intimate partner abuse. 

50 1. SCOPE

51 This technical report provides an overview of human abuse and neglect. Its purpose is to guide oral health care 

52 professionals to recognize and document suspected abuse and neglect and report to appropriate authorities for 

53 investigation and definitive diagnosis. 

54 Note to Scope: Although this technical report provides possible signs for recognizing abuse, interpretation based on these 

55 signs alone may be misleading and multiple non-abuse factors should be considered as well.

56 2. NORMATIVE REFERENCES 

57 The document contains no normative references. See Resources and References for additional information.

58

59 3. TERMS AND DEFINITIONS

60 1.1. Abrasion - wound caused by rubbing or scraping the skin or mucous membrane.

61 1.2. Abandon - cease to support or look after an individual.

62 1.3. Abandonment - leaving an elderly individual under the care of a health care provider without arranging for alternative 

63 care. The act of abandoning someone, through either physical, [financial] or emotional means. The act of leaving 

64 someone through physical, financial, or emotional means without arranging for alternative care.

65 1.4. Abuse - cruel or violent treatment of an individual or a group of people on a singular or repeated basis.

66 1.5. Avulsion - tearing away of a structure or part of a body.

67 1.6. Bruise - injury appearing as an area of discolored skin on the body, caused by / from ruptured underlying blood 

68 vessels.

69 1.7. Dental Provider - any licensed oral health care professional who can legally provide the services requested.
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70 Note 1 to entry-whenever forensic odontological services are required, the dental professional should have additional 

71 forensic odontological training and skills to provide a legally recognized competent medical opinion concerning the 

72 evaluation of abuse and neglect 

73 1.8. Dental Neglect - willful or persistent failure of a caretaker to meet the basic oral health needs of someone dependent 

74 upon them.

75 1.9. Incision - type of open wound caused by a sharp-edged object such as a knife, razor, or glass splinter.

76 1.10. Laceration - wound produced by the tearing or splitting of body tissue often from blunt impact.

77 1.11. Mandated reporter – Person / profession required by law to report suspicion of abuse and neglect to designated 

78 authorities.

79 1.12. Neglect - failure to provide a safe and healthy environment by a caregiver, to include nutrition, shelter, access to 

80 health care, protection from others, and maintaining an atmosphere of emotional support.

81 1.13. Physical abuse - any intentional act causing injury or trauma to another person by way of bodily contact.

82 1.14. Psychological abuse - any behavior which is degrading to a person or creates fear, humiliation, or coercion, often 

83 called emotional abuse.

84 1.15. Sexual abuse - abusive sexual behaviors by one person upon another, also referred to as molestation.

85 1.16. Sexual abusive contact - any unwanted sexual touching with an individual who cannot give consent.

86 1.17. Sexual harassment - behaviors characterized by the making of unwelcome and inappropriate sexual remarks or 

87 physical advances in a workplace or other professional or social situation.

88 1.18. Victim - the recipient of intent for harm.

89 1.19. Vulnerable - a person or population group susceptible to physical or emotional harm, including adults and children 

90 who cannot advocate for themselves.

91 4. ABUSE

92 4.1. Introduction

93 Abuse, the improper treatment of an individual, can come in many forms. It can affect individuals physically and 

94 emotionally and harms their quality of life. Because patients are in close proximity to the dental professional for an 

95 extended period, signs of abuse can be observed. These signs can range from subtle to significant, can present clinically 

96 or behaviorally, and provide the dental professional with indicators of potential adverse circumstances.

97

98 4.2. Forms of Abuse

99 4.2.1. Child Abuse

100 Abuse directed toward an individual under the age of 18 that results in harm.

101 4.2.2. Elder Abuse of Elders, Persons with Disabilities

102 Knowing, intentional, or negligent act by a caregiver or other person that causes harm or serious risk of harm to a 

103 vulnerable adult. Elder abuse can take the form of physical, sexual, emotional abuse, financial exploitation, neglect, 

104 abandonment, or self-neglect.

105 4.2.3. Intimate Partner Abuse / Violence (IPV)

106 Intimate partner violence (IPV) is a form of abuse that occurs in a romantic relationship. "Intimate partner" refers to 
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107 both current and former spouses and dating partners. IPV can vary in frequency or severity and range from a single 

108 episode of violence to chronic episodes over multiple years. Regardless of frequency and severity, it could have a 

109 lasting impact on the individual.

110 4.2.4. Non-Intimate Partner Abuse

111 Non-intimate partner abuse is abuse between the victim and a stranger or by a person with whom the victim has only a 

112 superficial relationship. Typically, there are repetitive meetings between the abuser and the victim. The Americans with 

113 Disabilities Act (ADA), first adopted in 1990, provides specific legal requirements intended to benefit people with 

114 disabilities and defines disability as "a physical or mental impairment that substantially limits one or more of the major 

115 life activities."

116 Individuals with Disabilities abuse is a subcategory of those listed above. Like other abuse, persons with disabilities 

117 can be the victim of abuse by parents, caregivers, intimate and non-intimate partners. In addition, abuse by casual 

118 acquaintances can occur due to bullying, discrimination, or a simple lack of patience in dealing with an individual's 

119 disability. Studies show that people with disabilities are more likely to experience abuse than people without them. 

120 People with disabilities often face specific barriers to accessing the help needed to identify, report, and prevent 

121 4.3. Types of Abuse

122 4.3.1. Physical

123 An intentional act causing bodily injury or trauma to another person.

124 4.3.2. Emotional/Psychological

125 Emotional/Psychological abuse is characterized by an individual being subjected to or exposed to behaviors that may 

126 result in psychological trauma, including anxiety, chronic depression, or post-traumatic stress disorder. It may include 

127 socially isolating an individual and preventing interaction with other friends or family members compromising the quality 

128 of life for the victim. It may also be a behavior pattern by caregiver that interferes with a person’s well-being or 

129 psychological health.

130 4.3.3. Sexual

131 Any unwanted sexual contact or behavior, such as molestation. Any unwanted sexual contact or sexual contact with a 

132 minor, an individual with a cognitive or physical disability, or is impaired by drugs or alcohol. 

133 4.3.4. Financial

134 The illegal, unauthorized, or improper use of a dependent victim’s money, benefits, belongings, property, or assets by 

135 someone other than the victim.

136 4.3.5. Medical

137 The failure to fulfill caregiver medical obligations (i.e., failure to schedule medical visits) for a dependent person

138 4.4. Signs of Abuse

139 Although mandatory reporting requires only a "suspicion of abuse," interpretation based on signs alone may be 

140 misleading since many of these signs have alternative causes which are not abuse. However, it is essential to realize 

141 that the presences of these signs are not pathognomonic for abuse nor is the list all inclusive. Therefore, a thorough 

142 history of the injury is essential to help differentiate accidental injuries from inflicted injuries. Clinical findings are best 

143 evaluated within the context of thorough patient history and potential systemic and accidental etiologies. Although dental 

144 professionals cannot thoroughly investigate suspected abuse or neglect, they are obligated to elucidate a patient's

145 history and consider all possible causes. 

146 4.4.1. Physical/Medical
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147 • bruising, welts, or burns that cannot be sufficiently explained, particularly bruises on the face, lips, and mouth 

148 of infants or several surface planes at the same time

149 • unusual bruising patterns that reflect the shape of the instrument used to cause injury (e.g., belt, wire hanger, 

150 hairbrush, hand, human bitemarks)

151 • clusters of bruises, welts, or burns, indicating repeated contact with a hand or instrument

152 • injuries on the body where children usually do not get hurt (e.g., the torso, back, buttocks, thighs, neck)

153 • burns that are insufficiently explained, e.g., cigarette burns

154 • immersion burns including marks indicating dunking in a hot liquid, including "stocking" and "glove" burns on 

155 feet and hands

156 • rope or restraint burns on the arms, hands, neck, or legs

157 • dry burns caused by forced contact with a hot surface (e.g., a clothes iron, hair curler, heater, or stove)

158 • lacerations and abrasions of the lip, eye, or to any part of a child's face

159 • tears in the tissue of the gums, possibly because of force-feeding

160 • absence of hair or hemorrhaging beneath the scalp due to vigorous hair pulling

161 • withdrawn, fearful, or extreme behavior

162 • Unexplained exaggerated or inappropriate weight loss

163 • Cutaneous manifestations of systemic diseases (e.g., diabetes mellitus, lupus), dermatologic pathology 

164 • Bruising consistent with accidental falls; dermatologic pathology; behaviors (hair pulling, self-harm)

165 • Adult / Elder: Ecchymosis from cutaneous vascular changes, hematologic pathology, secondary to age166 related changes, or medications

167 • cautious of adult contact (children)

168 • exhibits extreme behavior

169 • displays the inappropriate level of maturity (children)

170 • anxious/uneasy when other children cry

171 • indiscriminate seeking of affection

172 • wears concealing clothing

173 4.4.2. Sexual

174 • While most signs are not observable in the dental practice setting, the following may be noted:

175 • difficulty walking or sitting

176 • Reported history of sexually transmitted infections, frequent urinary or yeast infections

177 • pregnancy

178 • frequent complaints of stomachaches or headaches 

179 • withdrawal or chronic depression

180 • feeling threatened by physical contact, closeness 
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181 • the child is "parentified" or overly concerned for siblings

182 • Signs observable outside of the dental setting:

183 • pain or itching in the genital area

184 • torn, stained, or bloody underclothing

185 • laceration or abrasion to the external genitalia

186 • bruises or bleeding in the external genitalia

187 4.4.3. Behavioral

188 While most signs are not observable in the dental practice setting, the following may be noted:

189 • running away from home

190 • low self-esteem, lack of confidence

191 • peer problems, lack of involvement with friends

192 • extreme weight change

193 • suicide attempts or threats; especially with adolescents

194 • hysteria, lack of emotional control

195 • sudden school difficulties

196 • unprovoked cruelty to animals

197 • observed aggressive behavior of caregiver towards patient

198 • observed inappropriate intimate behavior of caregiver towards patient

199 • observed depression can use genetic depression scale to help determine diagnosed depression

200 • withdrawal from social interaction

201 • apathy

202 • fear of caregiver

203 • exhibits extreme behavior

204 • developmentally delayed

205 4.4.4. Financial

206 While most signs are not observable in the dental practice setting, the following may be noted:

207 • failure to make financial decisions (if responsible)

208 • failure to fulfill caregiver obligations (financial)

209 • inability to pay bills due to failure to utilize resource appropriately (if responsible)

210 • inability to renew prescriptive drugs or to pay for them

211 5. NEGLECT

212 5.1. Introduction

213 Unlike physical abuse, conditions of human neglect may not be as easy to observe. Health issues, money 
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214 mismanagement, alcohol and drug usage, inadequate clothing and food, lack of medical care, lack of adequate shelter, 

215 and insufficient employment are all frequent family unit situations.

216

217 5.2. Forms of Neglect

218 5.2.1. Child Neglect 

219 This term refers to the mistreatment of children by their caregivers. Specific criteria have been established by a 

220 community's laws that provide for the child, at minimum, medical treatment, education, food, shelter, adequate 

221 hygiene, supervision, protection from alcohol, drugs, and environmental dangers. Caregivers should be aware of the 

222 necessity to provide the child with resources to meet those needs. Once educated and exposed to those resources, 

223 the caregiver's continual failure to provide the child with adequate care would constitute neglect.

224 5.2.2. Intimate Partner Neglect

225 Intimate partner neglect occurs when there is a physical, psychological, or financial dependency on the intimate 

226 partner. The dominant partner often leverages this dependency to their advantage and may deprive the dependent 

227 individual of the resources necessary to maintain an adequate quality of life.

228 5.2.3. Elder Neglect

229 Elder neglect is the failure to provide support services an elderly individual who is incapable of caring for themselves. 

230 This type of neglect leads to a diminution of sustainable health and detrimental changes to the individual's well-being. It 

231 is sometimes referred to as elder abandonment.

232 5.2.4. Individuals with Disabilities (cognitive, physical, developmental) Neglect

233 This is similar to intimate partner neglect but often involves failure to provide support services to individuals incapable 

234 of caring for themselves.

235 5.3. Types of Neglect

236 5.3.1. Physical/Medical

237 Medical neglect occurs when a caregiver fails to recognize or respond to the medical needs of an individual. This type 

238 of negligence can include not only a failure to recognize signs of serious illness but also the failure to follow instructions 

239 once medical advice is given

240 5.3.2. Dental

241 Dental neglect will lead to a diminished oral health level and the individual's inability to have proper dental function and 

242 freedom from pain and infection. Unfortunately, this type of neglect may be due to inadequacy of funds; however, 

243 dental neglect can often be avoided by seeking open government social services. An additional contributing factor may 

244 be a dental phobia, which usually requires other therapeutic measures.

245 5.3.3. Psychological

246 Psychological neglect sometimes refers to emotional neglect and occurs when a caregiver fails to provide the required 

247 emotional care, attention, and affection to an individual.

248 5.3.4. Financial

249 Financial neglect is the improper, unauthorized, or illegal use of a dependent's assets, benefits, or property to benefit 

250 another individual.

251 5.4. Signs of Neglect: 
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252 Although mandatory reporting requires only a “suspicion of neglect,” interpretation based on signs alone may be misleading 

253 since many of these signs have alternative causes which are not neglect. However, it is essential to realize that the 

254 presences of these signs are not pathognomonic for abuse nor is the list all inclusive. A thorough history of the injury is 

255 essential to help differentiate accidental injuries from inflicted injuries. Clinical findings are best evaluated within the context 

256 of thorough patient history and potential systemic and accidental etiologies. Although dental professionals cannot thoroughly 

257 investigate suspected neglect, they are obligated to elucidate a patient’s history and consider all possible causes.

258 5.4.1. Physical/Medical

259 • uncleanly overall appearance, which can include soiled or reused clothing, untrimmed hair, body odor, unshaven 

260 appearance (men), or elongated fingernails

261 • issues with temperature regulation

262 • poor oral hygiene

263 • malnutrition and dehydration

264 • untaken prescribed medications or unrenewed medications

265 • lack of routine visits to a physician or other healthcare providers

266 • decay teeth

267 • recurrent angular cheilitis

268 • herpetic lesions or mouth sores

269 • oral thrush

270 • compounding medical problems that go untreated

271 • evidence of confusion in comprehension or reasoning, unawareness of surroundings

272 5.4.2. Emotional/Psychological

273 • untreated delusional behavior or dementia

274 • depression, anxiety, or apathy 

275 • failure to thrive 

276 • hyperactivity or aggression 

277 • developmental delays 

278 • low self-esteem 

279 5.5. Financial

280 • unpaid bills

281 • failure to pay dependent's bills

282 6. HEAD AND NECK INJURIES

283 6.1. Introduction

284 Although physical abuse can occur anywhere on the human body, a large percentage of physical abuse injuries occur in 

285 the head and neck region., Since the dentist is most familiar with the area, they are in a unique position to observe and 

286 document these types of injuries.
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287 6.2. Bruises

288 6.2.1. Characterization of Bruises

289 Injuries can be bruises from blunt force trauma that result in a superficial discoloration secondary to bleeding into the 

290 tissue from ruptured blood vessels beneath the skin without the skin itself being broken. Bruises can also include 

291 swelling, tenderness, and discoloration of the tissue,

292 6.2.2. Aging of a Bruises

293 The aging of these bruises by the discoloration can help with an estimation of when the injury was inflicted and if the 

294 history reported by the caregiver is valid. Although, it is accepted that discoloration is not a reliable indicator of the 

295 exact temporal value of when a bruise occurs. However, a spectrum of colors on various injuries may suggest a 

296 continuum of ongoing abuse situation with recent, not so recent, and older.

297 6.3. Possible Patterned Injuries of Dental Origin

298 6.3.1. Introduction

299 Patterned dental origin injuries, commonly referred to as "bitemarks," are often associated with intentional infliction of 

300 potentially painful injuries utilizing the teeth. Individuals of any age group may present clinically with these injuries 

301 which may be self-inflicted or caused by other children or adults. Animal activity is also a possibility. When these 

302 injuries occur on the face, ears, or neck, they may be observable upon routine dental examination. However, clothing 

303 may conceal these types of injuries on extremities or other parts of the body. 

304 6.3.2. Characteristics

305 Patterned dental origin injuries represent a spectrum of blunt force injuries: bruises, abrasions, lacerations, and 

306 avulsions. These injuries may reflect characteristics of the inflicting dentition. The injury typically reflects an ovoid or 

307 elliptical pattern representing primary or permanent dental arches' shape and dimensions. The damage may also 

308 reflect the shape, dimensions, arch position, and surface features of individual teeth. In addition, a central area of 

309 bruising may be present because of the compression of tissues between the two dental arches, which rupture capillary 

310 blood vessels. 

311 6.3.3. Opinions

312 Conclusions drawn from these types of injuries can carry significant implications when associated with a pattern of 

313 abuse. Since the most common bite injuries originate from dogs, it is essential to differentiate these injuries from those 

314 of human origin and determine whether the injuries are consistent with the history reported by the victim and caregiver.

315 Multiple patterned injuries in various stages of healing can indicate repeated abuse over time. However, it is not 

316 uncommon for children to sustain injuries from other children, particularly siblings. The presence of multiple aged 

317 injuries from child-to-child biting suggests a responsible adult's failure to recognize and end the maltreatment. 

318 Patterned dental origin injuries can be a painful form of physical abuse and may escalate to more serious, even fatal 

319 outcomes. In many jurisdictions, it is considered a significant crime. 

320 As mandated reporters, dental professionals are trained to recognize and report indicators of suspected abuse. 

321 Formulating a determination of a patterned injury of dental origin may require that evidence documentation and 

322 analysis be carried out by experienced forensic odontologists. 

323 7. EXAMINATION

324 The dental professional should perform an initial patient examination. Given the sensitive nature of an examination for 

325 possible abuse, the dental professional may not feel comfortable with completing a comprehensive exam with a potential 

326 diagnosis of human abuse or neglect. However, the diagnosis of suspicion of abuse is based on initial observations, which 
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327 only a physical examination can support. Although the dental professional is only obligated to report potential abuse and

328 neglect, the more detailed an investigation, the more likely an accurate confirmation or refutation to such abuse or neglect is 

329 validated. 

330 7.1. Interview: 

331 The dental office interview should not be considered a sociological or psychological investigation. A detailed interview 

332 should be carried out by the appropriate child protective professionals as indicated. The sole purpose of this interview is 

333 to help the dental professional determine if child protective services should be further investigated suspicion of abuse 

334 and neglect.

335 The examination should always begin with an interview of the patient. If any of the physical or psychological signs are 

336 present, the interviewer should explain using the patient's words. It is typically wise to start with empathy or concern for 

337 patients to make them feel at ease at the beginning of the process. It is essential to review the medical and dental history 

338 of the patient for a possible explanation of the patient’s narrative of subjective findings. 

339 7.2. Interview of patient

340 Patients can often provide crucial historical context for clinical findings, such as timelines for injuries, whether the injuries 

341 are painful or tender or linked to repeated intentional or unintentional trauma. Following the patient's initial discussion, a 

342 preliminary determination should be made regarding whether a more detailed interview and examination are necessary. 

343 It is always better to err on the side of caution if there are any concerns about the patient narrative's accuracy. 

344 Whenever possible, and if age-appropriate, additional biographic data should be collected. Although this should be as 

345 comprehensive as possible, consideration should be made about the psychological impact it may have on the individual.

346 The biographical data includes information on an individual's sex and current and historical former information on health 

347 issues, nutritional status, medications (prescription and OTC) substances, dietary intake, exercise routine. Information

348 concerning the home environment should be obtained if possible. This includes information on whom the individual lives 

349 with and the house's location (basement, attic, presence of stairs, privacy). Additional helpful information concerns 

350 information on caregivers and daily protocols dealing with bathing, toileting, daily, and special needs could also prove 

351 beneficial.

352

353 7.3. Interview of caretaker

354 The caregiver can often provide critical supporting information to help to

355 determine the origin of trauma. Especially in cases where the patient is non-communicative, an effort should be made to 

356 obtain needed information. It is vital that the interview be performed in a non-judgmental manner and only as a method to 

357 determine the required information.

358 The caregiver can represent a key resource for the dental team, particularly when the patient has limited ability to 

359 communicate. By providing insights into the health status, and support of daily activities of the dependent patient, the 

360 caregiver can partner with both the patient and dental provider in oral health care delivery, and maintenance.

361 When the dependent individual presents with apparent traumatic injuries, the caregiver can often provide critical 

362 supporting information as to the history, and potential etiology. When the injuries appear to be inconsistent with history, 

363 the dental provider needs to assess whether further interview with the caregiver may pose additional risk to the patient. If 

364 the dental provider is comfortable with discussion with the caretaker, a non-judgmental approach is key. Moreover, the 

365 interview should be conducted only to the extent needed to assess the need to report. The dental professional should 

366 contact the appropriate authorities for further investigation. 

367 7.4. Physical Examination by Dental Professional

368 A physical examination, including photographs and radiographs, should be conducted by the dental provider when 

369 possible.
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370 7.4.1. Extraoral and Intraoral

371 Evaluate the head and neck for any abnormalities or injuries that are not considered within normal limits. A systematic

372 examination includes observations as well as palpation of regions to detect underlying abnormalities. 

373 7.4.2. Radiology

374 Radiographs are an essential adjunct to the visual clinical examination and can accurately detect underlying 

375 abnormalities in oral-maxillofacial structures. Additionally, radiographs can serve as a historical record for previously 

376 healed injuries and prior surgical interventions. 

377 8. DOCUMENTATION

378 Documentation of injuries potentially caused by physical abuse should be completed as soon as possible after the 

379 examination so that important details are not omitted

380 8.1. Photography

381 Photographs ensure the accuracy of evidence collection. Once consent has been obtained, it is essential to capture 

382 the crucial components of the injury. This includes orientation photographs to demonstrate the correct anatomical 

383 location of the damage and close-up photographs to highlight injury details. It is critical to photograph the wound with a 

384 ruler/scale (ex. ABFO Ruler #2) in place; preferably, both the ruler and injury are perpendicular to the camera lens to 

385 record injury metrics accurately. If a ruler/scale is not readily available, a periodontal probe, or a coin can be used.

386 8.2. Findings

387 • Record statements in the patient's own words, e.g., "Patient reports..."

388 • Record pertinent physical findings

389 • Create a body diagram highlighting injuries and photos (if available and with consent)

390 • Document an opinion as to the history given and the appearance of the injury

391 9. REPORTING

392 Dental Professionals are mandated to report suspected child abuse in all 50 states, the District of Columbia, and the five 

393 U.S. territories. These mandates provide varying immunity levels from prosecution for individuals who report in good faith 

394 suspected instances of child abuse or neglect. "Good faith" is defined as when the reporter, to the best of their knowledge, 

395 believes that the child in question is at risk or was subjected to abuse or neglect. These immunity statutes also protect 

396 reporters from civil or criminal liability. Mandatory reporters are required to report the facts and circumstances that led them 

397 to suspect that a child may have been abused or neglected and but are not required to provide proof. Note 1 to entry: The 

398 dental professional should have the phone numbers of their local Child Protective Services (CPS) and Police Department 

399 readily available in the event a patient presents with suspected abuse.

400 10. CONCLUSIONS

401 Violence is a global problem that does not discriminate on the basis of age, gender, or socioeconomic status. Signs of 

402 physical abuse can occur in the head and neck region. Dental providers need to be aware of this fact. With adequate 

403 education, training, and experience, dental professionals can recognize the signs and symptoms of abuse and neglect and 

404 be prepared with an established plan of action in place should such a case present.

405 11. RESOURCES

406 Childhelp® National Child Abuse Hotline:

407 Childhelp® is a national organization that provides crisis assistance and other counseling and referral services. It is staffed 

408 24 hours a day, 7 days a week, with professional crisis counselors who have access to a database of 55,000 emergency, 
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409 social service, and support resources. All calls are anonymous. Contact them at 1.800.4ACHILD (1.800.422.4453).

410 For a State-by-State summary of mandatory reporting laws, see Child Welfare Information Gateway's Mandatory Reporters 

411 of Child Abuse and Neglect at https://www.childwelfare.gov/topics/systemwide/laws-policies/statutes/manda/

412 Domestic Violence Resource Network: https://www.acf.hhs.gov/fysb/programs/family-violence-prevention413 services/programs/centers

414 Academy on Violence and Abuse, https://www.avahealth.org/resources/resource_index/resource_material_index.html

415 The AMA guidelines: https://www.nlm.nih.gov/exhibition/confrontingviolence/materials/OB11102.pdf

416 The National Institute of Justice https://www.nij.gov/publications/pages/publication-detail.aspx?ncjnumber=188564

417 The CDC https://www.cdc.gov/ViolencePrevention/intimatepartnerviolence/datasources.html

418 The U.S. Preventive Services Task Force, https://www.ahrq.gov/professionals/clinicians-providers/guidelines419 recommendations/guide/section2c.html#ipv

420 The Agency for Healthcare Research and Quality, https://www.ahrq.gov/professionals/prevention-chronic-care/healthier421 pregnancy/preventive/partnerviolence.html

422 12. BIBLIOGRAPHY

423 https://www.childwelfare.gov/pubpdfs/fatality.pdf

424 https://www.cdc.gov/violenceprevention/childabuseandneglect/fastfact.html 

425 https://www.cdc.gov/violenceprevention/intimatepartnerviolence/fastfact.html

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OSAC 2022-N-0028 Human Abuse Recognition 

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