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Forensic Odontology Section: Review Article

Child Abuse Reporting: Role of Dentist in

India – A Review
 Bharti Patil, Sushmini Hegde, Anisha Yaji
Department of Oral Medicine and Radiology, Oxford Dental College and Hospital, Bengaluru, Karnataka, India

Abstract
Healthy, protected, educated and well‑developed child population who will grow up to be productive citizens of the country are pillars of
the nation. However, they are dependent on their parents or care givers, which makes them vulnerable to abuse. The primary responsibility
of protecting children from abuse and neglect lies with the families or the primary caregivers. However, communities and civil society and
all other stakeholders are also responsible for the care and protection of children. The injuries of child abuse may be different for different
children, however, several types of injuries are characteristic to abuse. Many of these injuries are easily observed by the dental professional in
the course of routine dental treatment and are within the scope of dentistry for identification. This literature review shows that there are very
few attempts made to report child abuse from dental offices in India whereas it is mandatory to report child abuse in many other parts of the
world. This difference could be attributed to laws regarding this matter and lack of awareness and knowledge of the procedures to be followed.
The objective of this paper is to review briefly the role of dentist in identifying child abuse and the norms about reporting it in our country.

Keywords: Child abuse, dentist, India, laws, reporting

Introduction child conversing, observing, and providing treatment. This

Child abuse has become a burning issue in the recent years.
This abuse and violence have no geographic and cultural
boundaries. It is prevalent among the rich and the poor,
educated and uneducated, young and middle‑aged, and city
dwellers and rural folks. In the United States, the Center
for Disease Control and Prevention  (CDC) defines child
maltreatment as any act or series of acts of commission or
omission by a parent or other caregiver that results in harm,
potential for harm, or threat of harm to a child. According to
the Journal of Child Abuse and Neglect, child abuse is “any
recent act or failure to act on the part of a parent or caretaker
which results in death, serious physical or emotional harm,
sexual abuse or exploitation, an act or failure to act which
presents an imminent risk of serious harm.”[1]
Dental professionals have a unique role in identifying abused
children than other health professionals as it has been reported
that orofacial trauma is present in approximately 50–75% of all
reported cases of physical child abuse. Routinely, the children
visit a dentist once or twice a year, depending on their need,
and usually the dentist spends at least 45 minutes with that
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provides an opportunity not only for the dentist but also for the
hygienists and assistants to observe and report any suspicions
of child abuse. It has been observed that to avoid suspicion,
an abusive parent or caregiver may take the child to various
physicians or hospitals over a period of time for treatment, but
will visit the same dental office repeatedly.[2]
A study conducted by Human Rights Watch in India reports
that no doctor, whether a general practitioner, gynecologist,
pediatrician or dentist, has been given any training whatsoever
regarding child abuse examination, interviewing, care
taking, the rehabilitation procedures, and the medical and
psychological needs of the child.[3] The objective of this paper
is to briefly review the role of dentists in identifying child abuse
and the norms about reporting it in our country.
Address for correspondence: Dr. Anisha Yaji,
Department of Oral Medicine and Radiology, Oxford Dental College and
Hospital, Bengaluru, Karnataka, India.
E‑mail: anishayaji@gmail.com
This is an open access article distributed under the terms of the Creative Commons
Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak,
and build upon the work non-commercially, as long as the author is credited and the new
creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com

How to cite this article: Patil B, Hegde S, Yaji A. Child abuse reporting:
Role of dentist in India – A review. J Indian Acad Oral Med Radiol
DOI:
10.4103/jiaomr.JIAOMR_30_16
2017;29:74-7.
Received: 21‑03‑2016  Accepted: 21‑06‑2017  Published: 04‑08‑2017

74 © 2017 Journal of Indian Academy of Oral Medicine & Radiology | Published by Wolters Kluwer - Medknow
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Patil, et al.: Child abuse reporting
Prevalence
Child abuse in India is often a hidden phenomenon,
especially if it happens at home or by family members. The
union ministry of women and child development (MWCD)
released a study report in 2007 which assessed the incidence
of child abuse nationwide.[4] Recently released data by the
NCRB highlights the fact that there is a 70% rise in rape and
abduction of minors whereas it has increased to 40% in case
of dissertation.[5]
Risk Factors
Child abuse is rarely due to one cause, it is rather a result of
interaction between multiple risk factors. Some of the risk
factors are:[1]
• Children with learning disabilities, conduct, or
developmental disorders; chronic illnesses; mental
retardation; or other handicaps
• Teenage, unwanted, or twin pregnancy; lack of knowledge
of parenting, child health, and development
• Depressed parent or intimate partner violence within a
family
• Dangerous neighbourhoods or poor recreational facilities
• Poverty and associated burdens.
However, physicians need to be open minded about the fact
that not only low income but children from all socioeconomic
strata can be maltreated.
Indicators of Child Abuse
Conducting and documenting interviews with the child and
parents forms the first and key step in recognizing and reporting
child abuse. A dentist should begin with an overall assessment
of the child as soon as he or she walks into the treatment room.
For example, when a dentist observes a particular injury he
should ask about its history and check if it is uncommon for
that age.[2]
• Interview should be done in the presence of a witness,
and if possible the child and parent should be interviewed
separately. Questions should be open‑ended and
nonthreatening that require a descriptive answer. While
dealing with the parent, they should be informed regarding
the reason for the interview. The dentist needs to be
objective, discuss concerns regarding the child’s injury
or lesion, reassure the parent of support, and should not
attempt to prove abuse or neglect
• The dentist should determine if the parent’s story conflicts
with the child’s story or their explanation makes any
sense before making the decision to report the case to the
appropriate authorities
• In cases of severe abuse where the dentist suspects the
parents may abscond with the child, it is recommended
to notify the appropriate authorities prior to informing
the parents of suspicions of abuse. However, the ideal
situation is that the oral healthcare professional should
make an effort to gain as much information as possible
Journal of Indian Academy of Oral Medicine & Radiology  ¦  Volume 29 ¦ Issue 1 ¦ January‑March 2017
as well as the confidence of the parent before making any
report.
The following behaviors when observed should raise a concern
of child abuse:[2]
• Child wary of adult contact or he or she displays passive
behavior to avoid conflict or seems frightened of their
parents and afraid to go home
• Child seems overly aggressive, violent, demanding, or
displaying abusive behavior; may also exhibit dramatic
mood changes
• Parents seem extremely overprotective of their child
• Child’s behavior may not be consistent with that of other
children at the same maturity level
• It seems that the child is lying about any abuse so the
parent will not retaliate or while talking patient makes
indirect hints about abuse.
When suspicion of child abuse is present, a thorough
examination is needed. The dentist should begin with
examination of the child’s lips and proceed in a systemic order
to other parts of the oral cavity and the body.[1]
• Lips: lacerations or scars from trauma, burns from heated
implements, or rope marks on the corners of the mouth
from a gag being placed over the mouth
• Palate: any unexplained petechiea or bruises that may be
indicative of forced oral sex (fellatio) particularly at the
junction of the hard and soft palate
• Floor of the mouth: Contusions
• Teeth: fractured or nonvital teeth that appear to be from
nonaccidental trauma and any teeth missing or displaced
for which there is no obvious explanation
• Edentulous patients: bruises on edentulous ridges or severe
lacerations
• Labial frenum: lacerated from forced feeding or from blunt
trauma from an instrument or hand
• Tongue: scars or abnormal mobility from repeated trauma
or damage from forcibly biting down
• Oral mucosa: burns in the mouth from caustic substances
or scalding liquids. This will appear as a white slough from
necrotic epithelium. In addition, the child may salivate
excessively, drool, and may have difficulty in swallowing.
• Radiographs: exhibit healed or recent fractures
• Venereal warts, HIV‑associated lesions, or any STDs
• Injuries, bruises, and hand cuff marks on the overlying
soft tissues that are not directly supported by bone, such
as the cheeks (below the zygoma), lips, neck, inner
thighs, and inner aspect of the upper arm should be
viewed with suspicion, as they are more likely to result
from abuse.
Why to Report?
The purpose of reporting child abuse is to identify children
suspected to be victims of abuse as well as to prevent them
from facing further abuse. Without detection, reporting, and
intervention, these children may remain victims for the rest
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Patil, et al.: Child abuse reporting
of their lives both emotionally and/or physically, and also,
in some cases, they may repeat the pattern of abuse with
their own children.[6] The reporting is required not only for
ethical reasons but also Section 21(1) of the Protection of
Children from Sexual Offences (POCSO) Act, 2012 has made
it mandatory to report cases of child sexual abuse to the law
enforcement authorities, which applies to everyone including
parents, doctors, and school personnel. Failure to report a
suspicion of child abuse is an offence under the act. Further,
it makes it clear that the obligation to report exists regardless
of whether the information was acquired through the discharge
of professional duties or within a confidential relationship of
information.[6]
What to Report?
A report of child abuse should contain the following
information, if it is known:[6]
i. The names and home address of the child and the child’s
parents or other persons believed to be responsible for the
child’s care
ii. The child’s present whereabouts
iii. The child’s age
iv. Be specific about the nature and extent of the child’s
injuries, including any evidence of previous injuries.
Description of lesion should start with the size, shape,
color, location, and radiographic description (if applicable)
of the injury. Along with that mention the number of
injuries present at each site, and if necessary, sketch the
injury and the body part where it is located. If it appears
suspicious, detail the child’s behavior alone as well as
when they interact with their parent
v. The name, age, and condition of other children in the same
household
vi. Any other information that you believe may be helpful in
establishing the cause of the abuse to the child
vii. The identity of the person or persons responsible for the
abuse or neglect to the child, if known
viii. Document all aspects of your interviews with the child
and parent. Record verbatim the comments made by the
child and parent explaining the injury
ix. Sign and date the report, and obtain the signature of a
witness to the injuries and interviews.
According to the POSCO Act, it is not mandatory for a reporter
to inform the child and/or his/her parents or guardian about the
dentist’s duty to report child abuse to authorities. However, it
is advised to let them know as this will help establish an open
relationship and minimize the child’s feelings of betrayal if a
report needs to be made.[6]
Measures Taken by the Government for
Protecting the Child
After the MCWD study on child abuse conducted in 2006,
various measures have been taken to shield children from
violence and abuse and the Integrated Child Protection Scheme
76 Journal of Indian Academy of Oral Medicine & Radiology  ¦  Volume 29  ¦  Issue 1  ¦  January‑March 2017
is one among them. The MWCD launched a CHILDLINE
service in 1998–1999. The 24‑hour toll‑free emergency
service provides assistance to children in need of care and
protection. As of March 2013, a total of 27 million calls have
been serviced. It operates in 291 cities/districts in 30 states
and Union Territories across India.[7]
In May 2012, India’s parliament took a major step by
passing the POCSO Act. Under the law, all forms of child
sexual abuse are now specific criminal offenses for the first
time ever in India. The law states that, when a doctor has
reason to suspect that a child has been or is being sexually
abused, he/she is required to report this to the appropriate
authorities (i.e., the police or the relevant person within
his/her organization who will then have to report it to
the police). Failure to do so would result in imprisonment
of up to 6 months, with or without fine.[6] In 2014, a bill was
passed to amend Juvenile Justice Act which included corporal
punishments also as criminal offence.[8]
Apart from its domestic laws, India is a part of a number of
international human rights treaties, including the International
Covenant on Civil and Political Rights and the Convention
on the Rights of Child, which provide specific protections
for the rights of children. These regulatory bodies call for
measures to prevent and punish abuses by government
officials and place a burden on governments at the central and
state levels to adopt measures to prevent and punish abuses
by private citizens.[7]
Nongovernmental Organizations in Child
Protection
Apart from government, there many nongovernmental
organizations (NGOs) in India which are also striving toward
betterment of children by rehabilitating abused children or
providing underprivileged children education and mid‑day
meals or implementing the laws to protect children. In case
a dentist wishes to approach an NGO for rehabilitating his
abused patient, the list of NGO’s in the nearest locality is
available online at http://www.ngosindia.com/(NGO resources,
database and information project).[9]
Despite having these support systems, child abuse is often under
reported, especially by the dental health professionals. This
could be due to lack of training and experience in identifying
and intervening effectively in such situations, fear of litigation,
and concern about offending patients or embarrassment about
bringing up the topic. These shortcomings can be overcome
by legislatively making it mandatory for all healthcare
professionals to undergo:
1. Training regarding examining and careful handling of
abused patients
2. Training about reporting norms and rehabilitation
programs once they encounter an abuse case
3. CMEs/CDEs to learn about India’s juvenile justice and
child protection systems
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Patil, et al.: Child abuse reporting

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5. Kacker L, Varadan S, Kumar P. Study on child abuse: India 2007.
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articleshow/37920725.cms [Last accessed on 2015 Oct 10].
Conflicts of interest 7. Model Guidelines under Section 39 of the Protection of Children from
Sexual Offences Act, 2012. Ministry of Women And Child Development;
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POCSO‑ModelGuidelines.pdf [Last accessed on 2015 Oct 14].
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