Dental neglect as a marker of broader neglect: A qualitative investigation of public health nurses' assessments of oral health in preschool children

Background: Child neglect is a pernicious child protection issue with adverse consequences that extend to adulthood. Simultaneously, though it remains prevalent, childhood dental caries is a preventable disease (in the presence of appropriate care). Public health nurses play a pivotal role in assessing oral health in children but little is known about how they assess dental neglect. Understanding these factors is important if improvements are to be made in care pathways.

Methods: A qualitative study was conducted in Scotland during 2011/12. Sixteen public health nurses were recruited purposively from one health region. Individual, semi-structured interviews were undertaken and data analyzed inductively using a framework approach. Results: Public health nurses assess oral health through proxy measures, opportunistic observation and discussion with parents. Dental neglect is rarely an isolated issue that leads on its own to child protection referral. It is part of a mosaic of issues associated with child neglect. It is other presenting issues that initiate a response. Barriers to intervention are that dental neglect may be ‘unseen' and ‘unspoken'. The study revealed a communications gap in the care-pathway for children where significant dental problems are identified.

Conclusions: Clear guidance for public health nurses as to what to look for - and how - is required. Improved two way communication between child dental care providers and public health nurses is necessary to close the gap in the care pathway. Public health nurses take their child protection role seriously, but rarely make a prospective link between dental caries and child neglect.