2. What you might see in the surgery

Categories of abuse (children)

• Physical — injuries inflicted or covered up. In the head and neck you may see bruises, burns, lacerations, or a torn upper labial frenum in a child who is not yet walking — always think, do not jump to a single cause.
• Emotional — persistent hostility, humiliation, or a child who is unusually withdrawn or watchful. You may see it in how a parent speaks to the child during the appointment.
• Sexual — you will rarely “see the offence”. You might see a child who is overly sexualised in behaviour, who refuses an examination in a way that feels different from ordinary anxiety, or who discloses something. Take any disclosure seriously.
• Neglect — the persistent failure to meet basic needs. In dentistry this includes severe untreated disease, missed reviews with no plausible reason, a child left in pain, or a mouth that does not match the story of “we come every six months”.

Patterns that should make you pause

• Injury or story that does not fit the child’s age or mobility
• Delayed presentation of a painful injury or abscess with a weak explanation
• Repeated DNA (did not attend) when the child is clearly in pain
• A parent who will not let you examine, or who answers every question for an older child
• A child who flinches, who will not make eye contact, or who looks to a parent before answering simple questions
• Poor clothing, hygiene or supervision that is more than a one-off rushed morning

Dental-specific issues

Dental neglect can be a safeguarding issue when it is persistent and the family have been offered reasonable help (appointments, explanation, support) and still do not engage, and the child is suffering. One missed check-up is not neglect. A pattern of untreated pain is different.

Be careful with cultural or socioeconomic assumptions. Poverty is not abuse. Hostility to professionals can have many causes. You are looking at the child’s experience, not scoring the parent.

Other harms to keep in mind

Female genital mutilation, child sexual exploitation, county lines and online harm are part of the modern picture. You do not need to diagnose them in the chair. You do need to know they exist and to pass on a concern if something a child or parent says does not sit right.