BY Dr. S Preveen | October 05, 2022
District Child Protection Unit (DCPU) is a government organisation directly under the control of collector and Superintendent of Police of the district. DCPU plays an important role in protecting the children against crime and raising them in a socially acceptable path without any psychological and emotional issues. This makes the understanding of child abuse cardinal and most of the physical injuries during the child mistreat happens in face and head regions which are frequently accessed by dentist than any other medical personnel. This puts a forensic odontologist in a deliberate position to acknowledge and record the children who are abused. Thusly a forensic odontologist finds his place in the District Child Protection Unit with concern of providing educational awareness, prevention and identification of physical abuse, sexual abuse and dental neglect, documentation, intervention, reporting the suspicious and sometimes as a translater in child abuse cases. Wherefore it has to be clearly emphasised to the human fraternity to give the children welfare and not a farewell.
District Child Protection Unit (DCPU) is the government organisation directly under the control of district collector and Superintendent of Police. DCPU plays an important role in protecting the children against the crime and raising them in a socially acceptable path without any psychological and emotional issues. The head of DCPU is a District Child Protection Officer (DCPO) who has certain discrete powers to appoint an expert based on their need for consultation. They mainly take up cases on child abuse which is a pre-planned harming and frightening to harm a child mostly by an adult and sometimes by older child. Therefore, here comes role of forensic odontologist in the DCPU playing a vital role in the arena of child abuse. The child abuse now exist in this civilised world creating a non- accidental injury which is insulated beyond territory, ancestry and enlightened people of this sphere. This makes the understanding of child abuse cardinal since most of the physical injuries during the child mistreat happens in face and head regions which are frequently accessed by dentist than any other medical personnel. This puts a forensic odontologist in a deliberate position to acknowledge and record the children who are abused. The child abuse thus gives a red alert to the world citizens which otherwise overlooked creates a larger impact on the future society and furthermore child abuse is a scar which cannot be reversed once it has happened. Thusly a forensic odontologist finds his place in the District Child Protection Unit with concern of providing educational awareness, prevention and identification of physical abuse, sexual abuse and dental neglect, documentation, intervention, reporting the suspicious and sometimes as a translater in child abuse cases.
Figure 1 - Poster view – Role of Forensic Odontologist in DCPU
Educational awareness is done by organising programmes for the community, primary health care workers, medical colleges, paramedical colleges and dental colleges. It can also be customised by conducting campaigns on child abuse like establishing a week or a day for child abuse prevention. The government can also dedicate a ribbon (Fig. 2) with a particular colour to represent child abuse. The government can also be urged to pass required acts on child abuse like creating a council for prevention of child abuse and also requesting the government to include other related organisations in the educational awareness program (Kenney, Mcdowell and spencer 366).
Figure 2 - Stop Child Abuse Ribbon
5. Single parent
6. Unwanted pregnancy.
1 . Difficult child
2. Premature child
3. Mentally retarded child
4. Physically disabled child
The above parents and children factors should be identified for child abuse prevention.
In addition a forensic dentist should also sense the alarming signs of child abuse like injury not relevant with history, age of the child and development of the child, trauma to non exposed and non prominent parts of the body, numerous injuries of various stages, history of earlier bone fractures as well as patterned injuries (Hinchliffe 425, 426). Besides the forensic odontologist should also keep in mind for a consultation with relevant authorities, respected agencies and medical experts before arriving a diagnosis on child abuse.
Physical abuse is a non- accidental injury or trauma to a child like pinching, hitting, shaking, drowning that cause physical injuries to a child. Most of the physical injuries occur in head and facial regions during child abuse. So this drive a forensic odontologist to play his role in child abuse and look for intra oral and extra oral injuries (Rai and Kaur, 179)
Extra oral signs:
A forensic odontologist should examine the following,
a. Examine head and neck for asymmetry, swelling, bruising, inspect scalp for hair pulling, check ears and nose for scars, tears and abnormalities.
b. Bruises and abrasions of varying colour which can indicate various stages of healing.
c. Check for patterned marks. (Fig. 3)
d. Check for bruises around eyes, sclera of eyes, ptosis of eyelids and deviated gaze.
Figure 3 – Patterned Marks- Bite Marks
Intra Oral Signs:
A forensic odontologist should examine the following intra-oral signs,
a. Bruising/ laceration of lips and mucosa (Fig. 4)
b. Tooth traumas like fracture, intrusion or avulsion
c. Missing tooth not explained by decay or periodontal status
d. Tongue injuries
e. Frenal laceration
f. Facial bone fracture
g. Oral signs of STD- vesicular, erythematous or ulcerative lesion
Figure 4 - Intra Oral Signs a) Lip Laceration; b) Intrusion; c) Avulsion; d) Tongue Injury; e) Frenal Laceration
Sexual abuse is an inappropriate physical behaviour with child by forcing them in sexual activities. The worst case is sometimes the child is unaware of what is happening. Bite mark injury is a notable sign of sexual abuse. Bite marks in places other than self inflicted areas are never accidental. So a forensic odontologist can document and photograph the bite mark injury. Then it should be swabbed for DNA. If possible dental impression of the suspect is taken. If the evidence has sufficient forensic value, a pattern association can be carried out between bite mark injury and suspect’s dentition to include the biter and exclude the innocent (Hinchliffe, 427). All these procedures are carried out after getting proper permission from the respected government agencies.
American Association of Paediatric Dentistry defined dental neglect as wilful failure of a parent or guardian to undertake the necessary dental treatment affecting the overall oral health of the child and preventing it from its normal function. A forensic odontologist should look for untreated rampant caries, untreated pain and infection, bleeding/ trauma, break in continuity of the treatment and missing the appointments. The forensic odontologist should also keep in mind the differential diagnosis of these conditions which may happen due to the insufficient knowledge of the parents or the guardians.
The forensic odontologist can document and intervene by asking open ended questions, recording incident in child’s own words, observing the behaviour of the attender and child, recording history and explanation of the injuries, detailed description of the injuries like site, proceeding with photographs and radiographs and continuing with documenting bruise type, size, shape and colour. Forensic odontologist should consult with physicians, local authorities or social worker on any doubts (Rai and Kaur, 181)
Forensic odontologist can report the suspicions to the head of DCPU or higher authorities without informing the parents or caretaker because direct disclosure with them may risk the forensic odontologist, office personnel or the child itself (Rai and Kaur, 182).
Sometimes child abuse can also occur cross borders between states or countries. In such a situation if the forensic odotologist knows the language of the child beyond no doubts he can also act as a translater of the particular language. This can make the child feel comfortable and explain things in a better way.
Child abuse thus is a faded flower which cannot be reversed once it has happened. Wherefore it should be clearly emphasised to give the child a welfare not farewell. Thus I like to conclude that the forensic odontologist congruously has the place in District Child Protection Unit whose role cannot be replaced.
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Note - The figures and images used in this blog are only for educational purposes.