You are here » CORE INFO » Reviews » Dental Neglect » What are the parent/carer characteristics of a child with dental neglect, and what oral features are present in these children? » Other useful references

Other useful references

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.



National Standards Relating to Dental Neglect

  • UK Standards 1-3
  • US Standards 4-8


Oral Features of Children admitted into the Child Welfare system for causes of maltreatment other than dental neglect (i.e. physical, sexual, emotional abuse, or general neglect)


  • Features described included extensive childhood caries, poor oral hygiene and gingival inflammation 9-14
  • The introduction of a standardised pre forma for oral examination of all children undergoing a child protection medical improved the recognition of intra-oral features and onward referral of children for dental treatment 14
  • One case control study noted that the study group had almost eight times as many dental caries as five year olds in the general population 13
  • A study of children entering out-of-home care interviewed carers and professionals with regards to oral and dental care.  A number of barriers and facilitators to the provision of appropriate dental care to children in foster care were identified 15


A study of repeat treatment under general anaesthetic in children demonstrated the following:


  • A case control study of children undergoing repeat GA for dental treatment versus those who only required a single GA highlighted a number of key differences: 16
    • Those requiring repeat GA had more behavioural issues undergoing dental treatment
    • They were more likely to be responsible for brushing their own teeth (mean age 2.6 years, range 1.8 – 5.8) than controls (mean age 2.7 years, range 1.4 – 5.7)
    • Parents were more likely to give their child a drink other than water in their bottle at bedtime


Adverse consequences of dental caries in children and risk factors for dental neglect

 Adverse consequences

  • A randomised controlled trial of Bush Creole children demonstrated a significant association between short stature and levels of dental caries. However, the longitudinal study did not show any ‘catch up’ in growth for those children who were randomised to receive dental treatment versus controls 17
  • A study of 12 year old school children in Brazil highlighted that those with dental caries or dental trauma are associated with reduced school performance and those who had worse self-perceived oral health missed more days of school 18
  • School absence related to dental pain or infection was related to poor school performance (p = 0.001) 19

Risk factors

  • Other risk factors include drinking fruit juice before being able to walk; however drinking milk or fruit juices after the child can walk is protective. Fluoridation was also found to be protective 20


 Low Income


  • A number of studies have reported an association between low income and dental disease 20-23
  • Children in low income families have a higher prevalence of cavitated lesions than those in high income families 21
  • Low socio-economic group, consumption of sweet foods and the use of a pacifier in a survey of Italian children had a strong association with dental caries 22


Dental Health Behaviours / Attitudes


  • Higher caries prevalence in caregivers was associated with higher caries prevalence in children 21
  • Parents did not value the primary teeth 22
  • Survey of attitudes to dental health, care and consequences among British children aged 13 – 14 years 24
  • Attitudes of Public Health Nurses in UK to considering dental neglect in children less than five years old 25
  • A study in an area of free dental health care noted that the parents did not feel it was necessary to take their children to the dentist, even in the presence of oral abnormalities 26
  • A survey of parental attitudes to their child’s oral health identified associations between dental caries and general health concerns in addition to a lack of concern about the child’s dental health 26


Quality of Life (QoL)


  • A study of Inuvik children in Canada highlighting the prevalence of pain associated with dental caries in this population 20
  • Maternal anxiety did not appear to correlate with oral health related QoL assessments for pre-school children 23
  • Excellent systematic review of Oral Health Related Quality of Life (ORQoL) tools for children, which highlights that there are validated tools, but also that account needs to be taken of the child’s age, cognitive level and language development 27
  • Valuable systematic review exploring the complex relationship between clinical oral health status and ORQoL 28
  • Poor oral health, in combination with poor general health, has a negative impact on school performance 29
  • A comparison of an Oral Specific QOL (ECOHIS) measure with a generic Paediatric QOL measure (Peds-QLTM 4.0) in preschool children with Severe Early Childhood Caries (S-ECC), demonstrated that children with S-ECC exhibited a significant effect on wellbeing, for the child and family 30
  • A UK QOL survey conducted in addition to a dental examination survey demonstrated that up to a third of children aged 12 years are experiencing a negative impact on their overall wellbeing as a result of dental problems, with pain being the most frequently reported effect 31
  • In a sample of 12 year old Brazilian children, untreated caries and dental overjet were significantly associated with a lower QOL score 32
  • Children aged 30 – 60 months with more dental caries exhibited greater problems with externalising behaviour, sleep disturbances, anxious / depressed and attention deficit / hyperactivity scores than those who were caries free, although neither group had scores outside the normal range for age 33
  • 550 children with a mean age of 7.2 years completed the ‘Child oral health-related quality of life (COHQoL) score’.  Those children with a higher dmft score had a poorer oral health related quality of life 34

Dental Practitioners Response to Child Abuse and Neglect

  • A UK study surveying general dental practitioners identified that although 37% of respondents had suspected abuse and neglect, only 11% had made a child protection referral.  73% of dentists were interested in identifying dental neglect 35


Click here to open


  1. General Dental Council. Statement on child protection and vulnerable adults. London: General Dental Council, 2008. [PDF guidance brochure]
  2. Crawford, PJ. UK National Clinical Guidelines in Paediatric Dentistry. Continuing oral care: review and recall. International Journal of Paediatric Dentistry. 1998;8(3):227-228. [Pubmed citation only]
  3. Harris J, Sidebotham P, Welbury R, Townsend R Green M, Goodwin J, Franklin C. Child protection and the dental team: an introduction to safeguarding children in dental practice. Sheffield: Committee of Postgraduate Dental Deans and Directors (COPDEND), 2009. [PDF guidance brochure]

  4. American Academy of Pediatrics Committee on Child Abuse and Neglect & the American Academy of Pediatric Dentistry Council on Clinical Affairs. Guideline on oral and dental aspects of child abuse and neglect. Clinical Guidelines: Reference Manual. 2010;33(6):147-150. [Clinical guidelines provided by American Academy of Pediatric Dentistry]
  5. American Academy of Pediatric Dentistry Child Abuse Committee & Council on Clinical Affairs. Definition of dental neglect. Definitions. 2010;13. [Definition provided by American Academy of Pediatric Dentistry]
  6. American Academy of Pediatric Dentistry. Policy on early childhood caries (ECC): Classifications, consequences, and preventive strategies. Oral Health Policies: Reference Manual. 2011; 33(6):47-49. [Policy provided by American Academy of Pediatric Dentistry]
  7. American Academy of Pediatrics Committe on School Health. Policy statement: Soft drinks in schools. Pediatrics. 2004;113(1):152-154. [Pubmed]
  8. Gutmann ME, Solomon ES. Family violence content in dental hygiene curricula: a national survey. Journal of Dental Education. 2002;66(9):999-1005. [Pubmed]
  9. Badger GR. Caries incidence in child abuse and neglect. Pediatric Dentistry. 1986;8(1 Spec No):101-102. [Pubmed citation only]
  10. Symons A, Rowe P, Romaniuk K. Dental aspects of child abuse: review and case reports. Australian Dental Journal. 1987;32(1):42-47 [Pubmed citation only]
  11. Da Fonseca MAF. Dental aspects of 1248 cases of child maltreatment on file at a major county hospital. Pediatric Dentistry. 1992;14(3):152-157. [Pubmed]
  12. Greene PE, Chisick MC, Aaron GR. A comparison of oral health status and need for dental care between abused/neglected children and nonabused/non-neglected children. Pediatric Dentistry. 1994;16(1):41-45. [Pubmed]
  13. Valencia-Rojas N, Lawrence HP, Goodman D. Prevalence of early childhood caries in a population of children with history of maltreatment. Journal of Public Health Dentistry. 2008;68(2):94-101. [Pubmed]
  14. Paradowski IM, Seifert D, Püschel K, Anders S. Dental neglect: pediatric dental examinations in clinical forensic outpatients [German]. Rechtsmedizin. 2013;23(3):186-190 [Abstract available from Springer Link]

  15. Melbye M, Huebner CE, Chi DL, Hinderberger H, Milgrom P. A first look: determinants of dental care for children in foster care. Special Care in Dentistry. 2013;33(1):13-19 [Pubmed]

  16. Sheller B, Williams BJ, Hays K, Mancl L. Reasons for repeat dental treatment under general anesthesia for the healthy child. Pediatric Dentistry. 2003;25(6):546-552.[Pubmed]
  17. van Gemert-Schriks MC, van Amerongen EW, Aartman IH, Wennink JM, Ten Cate JM, de Soet JJ. The influence of dental caries on body growth in prepubertal children. Clinical Oral Investigations. 2011;15(2):141-149.[Pubmed]
  18. Piovesan C, Antunes JL, Mendes FM, Guedes RS, Ardenghi TM. Influence of children's oral health-related quality of life on school performance and school absenteeism. Journal of Public Health Dentistry. 2012;72(2):156-63 [Pubmed]

  19. Jackson SL, Vann WF Jr, Kotch JB, Pahel BT, Lee JY. Impact of Poor Oral Health on Children's School Attendance and Performance. American Journal of Public Health. 2011;101(10):1900-1906.[Pubmed]
  20. Leake J, Jozzy S, Uswak G. Severe dental caries, impacts and determinants among children 2-6 years of age in Inuvik Region, Northwest Territories, Canada. Journal of the Canadian Dental Association. 2008;74(6):519.[Pubmed]
  21. Reisine S, Tellez M, Willem J, Sohn W, Ismail A. Relationship between caregiver's and child's caries prevalence among disadvantaged African Americans. Community Dentistry and Oral Epidemiology. 2008;36(3):191-200.[Pubmed]
  22. Campus G, Lumbau A, Sanna AM, Solinas G, Luglie P, Castiglia P. Oral health condition in an Italian preschool population. European Journal of Paediatric Dentistry. 2004;5(2):86-91.[Pubmed]
  23. Goettems ML, Ardenghi TM, Romano AR, Demarco FF, Torriani DD. Influence of maternal dental anxiety on oral health-related quality of life of preschool children. Quality of Life Research. 2011;20(6):951-959.[Pubmed]
  24. Stokes E, Ashcroft A, Platt MJ. Determining Liverpool adolescents' beliefs and attitudes in relation to oral health. Health Education Research. 2006;21(2):192-205.[Pubmed]
  25. Bradbury-Jones C, Innes N, Evans D, Ballantyne F, Taylor J. Dental neglect as a marker of broader neglect: a qualitative investigation of public health nurses' assessments of oral health in preschool children. BMC Public Health. 2013. 13;370. [Abstract available from Springer Link]

  26. Lourenço CB, Saintrain MV, Vieira AP. Child, neglect and oral health. BMC Pediatrics. 2013;13:188 [Pubmed]

  27. Barbosa TS, Gaviao MB. Oral health-related quality of life in children: part I. How well do children know themselves? A systematic review. International Journal of Dental Hygiene. 2008;6(2):93-99.[Pubmed]
  28. Barbosa TS, Gaviao MB. Oral health-related quality of life in children: part II. Effects of clinical oral health status. A systematic review. International Journal of Dental Hygiene. 2008;6(2):100-107.[Pubmed]
  29. Blumenshine SL, Vann WF Jr, Gizlice Z, Lee JY. Children’s school performance: Impact of general and oral health. Journal of Public Health Dentistry. 2008;68(2):82-87.[Pubmed]
  30. Lee GH, McGrath C, Yiu CK, King NM. A comparison of a generic and oral health-specific measure in assessing the impact of early childhood caries on quality of life. Community Dentistry & Oral Epidemiology. 2010;38(4):333-339.[Pubmed]
  31. Nuttall NM, Steele JG, Evans D, Chadwick B, Morris AJ, Hill K. The reported impact of oral condition on children in the United Kingdom, 2003. British Dental Journal. 2006;200(10):551-555.[Pubmed]
  32. Piovesan C, Antunes JL, Guedes RS, Ardenghi TM. Impact of socioeconomic and clinical factors on child oral health-related quality of life (COHRQoL). Quality of Life Research. 2010;19(9):1359-1366.[Pubmed]
  33. Williamson R, Oueis H, Casamassimo PS, Thikkurissy S. Association between early childhood caries and behavior as measured by the Child Behavior Checklist. Pediatric Dentistry. 2008;30(6):505-509.[Pubmed]
  34. Arrow P. Child oral health-related quality of life (COHQoL), enamel defects of the first permanent molars and caries experience among children in Western Australia. Community Dental Health. 2013;30(3):183-188 [Pubmed]

  35. Harris CM, Welbury R, Cairns AM. The Scottish dental practitioner's role in managing child abuse and neglect. British Dental Journal. 2013;214(9):E24 [Pubmed]






^ back to top