A ground-breaking University of Otago study of dental therapists in New Zealand has highlighted the crucial role they play in child protection, but also the barriers they face when seeking to report suspected cases.
Registered dental therapists, most of whom work for District Health Boards, are in the front line against tooth decay for New Zealand school-age children, and are often the most consistent health-care practitioner they will see up to the age of 14 years.
But until this study, the role of these practitioners (previously known as dental nurses) in detecting child abuse and contributing to child protection has remained largely unexplored.
In their study, University of Otago School of Dentistry researchers Dr Jonathan Broadbent, Colleen Murray and final-year dentistry student Dhara Tilvawala, looked at dental therapists' knowledge and beliefs about child maltreatment.
About half (320) the total number of registered dental therapists in New Zealand completed questionnaires in which they were asked how frequently they suspect and report child maltreatment, their participation in and demand for relevant training courses, and also their views of the main barriers to reporting suspected cases.
The researchers found that, over the past year, 55 of the 320 dental therapists surveyed had each suspected up to 10 cases of physical abuse; 87 had suspected up to 10 cases of child neglect, and 101 had suspected up to 10 cases of dental neglect.
Not all suspected cases were reported, but international studies have shown that our therapists' level of reporting is comparable to, and in some cases better than, those of dentists and specialists in other countries.
Final-year Bachelor of Dentistry Student Dhara Tilvawala, whose work was funded by the Child Injury Prevention Foundation and carried out as a summer studentship, has just returned from a Colgate-funded trip to present the paper at the International Association of Dental Research conference in Bangkok.
She says the dental therapists reported seeing bruises and physical signs of abuse to the head and neck area, including cigarette burns, and children who seemed overly fearful and flinching when the dental therapist tried to look in their mouths. In physical abuse cases, 50 to 75% of injuries are to the head and neck area – the very area that therapists look at and treat.
"Dental therapists are the most common type of health professional to see children in New Zealand – more than their GP." she says.
The study concluded that the biggest barriers to reporting child abuse were that therapists were unsure how to refer cases, and they feared mistakenly reporting someone as this could have negative repercussions.
Other barriers to reporting included unfamiliarity with the signs of child abuse, lack of historical knowledge, and that they feared violence to themselves from caregivers in their clinic or they did not want to confront people. A very small number feared losing patients.
Co-author, Senior Lecturer at the School of Dentistry, Colleen Murray says one of the biggest problems dental therapists faced was knowing where to report suspected cases of child maltreatment.
"Some will discuss it with a colleague, or a dentist who is their mentor; about 40% will report directly to the Child Youth and Family Service, while others may report what they suspect to a teacher or school principal. The study showed that very few will report the matter to the Police," she says.
"But there is demand by dental therapists for this topic to be out there and talked about. One of the positives of the study showed that almost two in every three therapists have attended ongoing professional development courses on this topic. They are keen to upskill and contribute. Dental therapists find it distressing when they come across children who they believe are being maltreated, and they want to do something about it."
Almost all (94.6%) of the dental therapists felt they had a responsibility to report cases where they suspected child abuse, with 75.8% of those believing reporting should be mandatory.
In 2003, the United Nations International Emergency Funds (UNICEF) reported that deaths among children due to abuse and neglect were six times greater in New Zealand than similar developed countries. Data from the Ministry of Social Development shows that in 80% of recent reports of suspected abuse, the children were aged 14 and under – the same age-group treated by dental therapists.