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VOLUME 22 , ISSUE 2 ( February, 2021 ) > List of Articles


Dental Neglect in Children: A Comprehensive Review of the Literature

Maria Kiatipi, Sotiria Davidopoulou, Konstantinos Arapostathis, Aristidis Arhakis

Keywords : Child neglect, Dental caries, Dental neglect

Citation Information : Kiatipi M, Davidopoulou S, Arapostathis K, Arhakis A. Dental Neglect in Children: A Comprehensive Review of the Literature. J Contemp Dent Pract 2021; 22 (2):199-204.

DOI: 10.5005/jp-journals-10024-3019

License: CC BY-NC 4.0

Published Online: 17-12-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Aim: The purpose of this review is to present the most recent bibliography regarding the etiology, risk factor indicators, types of dental neglect, and the epidemiological studies, showing the relationship between neglect and dental caries indices. Moreover, the review will focus on the role of oral healthcare professionals in evaluating such conditions. Background: Untreated oral diseases, like dental caries, can lead to a variety of negative impacts on children including pain and infection. However, such complications can be prevented if a child's basic oral health needs are fulfilled. In addition, it is important to be aware that there are significant inequalities in accessing dental care and poverty, and such cases have to be distinguished from neglect. However, when there is adequate access to oral healthcare services and the parent or the guardian persistently fails to ensure appropriate medical care or treatment for his/her child, the possibility of dental neglect has to be seriously considered. Review results: Dental neglect can be apart of a child's general neglect with short-term complications, such as caries, as well as long-term consequences that extend to adulthood, such as poor growth and impaired quality of life. Conclusion: Early diagnosis of dental neglect plays an important role in avoiding adverse impacts on children. Signs and risk factors for dental neglect should alert the dental team in order to intervene in time and prevent suspected cases. Clinical significance: Diagnosis of dental neglect can be difficult. However, identifying dental neglect at an early stage and making a child protection referral may safeguard the child and prevent further harm. For this reason, dentists should be informed about dental neglect and they should know how to deal with these cases. Effective education is necessary to increase knowledge and awareness of all aspects of child neglect.

  1. United Nation General Assembly: Convention on the right of the child; 2012. Available from:
  2. Krug EG, Mercy JA, Dahlberg LL, et al. The world report on violence and health. Lancet 2002;360(9339):1083–1088. DOI: 10.1016/S0140-6736(02)11133-0.
  3. Department of Health. The Children Act 1989. London: Her Majesty's Stationary Office; 1989. Available from:
  4. Iossi Silva MA, Carvalho Ferriani MDG. Domestic violence: from the visible to the invisible. Rev Lat Am Enfermagem 2007;15(2):275–281. DOI: 10.1590/s0104-11692007000200013.
  5. Government HM. Healthy lives, healthy people. London: TSO; 2011. Available from:
  6. Radford L, Corral S, Bradley C, et al. Child abuse and neglect in the UK today. National Society for the Prevention of Cruelty to Children (NSPCC); 2011. Available from:
  7. United States Children's Bureau. Child maltreatment; 2011. Available from:
  8. Fisher-Owens SA, Lukefahr JL, Tate AR, et al. Oral and dental aspects of child abuse and neglect. Pediatrics 2017;140(2):e20171487. DOI: 10.1542/peds.2017-1487.
  9. Sanger G, Bross D. Clinical management of child abuse and neglect: a guide for dental professionals. In: Legal aspects of child abuse. Chicago: Quintessence Pub Co; 1984. p. 109–123.
  10. Schwartz S, Woolridge E, Stege D. Oral manifestations and legal aspects of child abuse. J Am Dent Assoc 1977;95(3):586–591. DOI: 10.14219/jada.archive.1977.0120.
  11. Clarke A. The choice to refuse or withhold medical treatment: the emerging technological and medical-ethical consensus. Creighton Law Rev 1980;13(spring):795.
  12. Loesche WJ. Role of Streptococcus mutans in human dental decay. Microbiol Rev 1986;50(4):353–380.
  13. Douglass JM, Li Y, Tinanoff N. Association of mutans streptococci between caregivers and their children. Pediatr Dent 2008;30(5):375–387.
  14. van Loveren C, Buijs JF, ten Cate JM. Similarity of bacteriocin activity profiles of mutans streptococci within the family when the children acquire the strains after the age of 5. Caries Res 2000;34(6):481–485. DOI: 10.1159/000016627.
  15. Raphael S. Bottle caries and dental neglect. NSW Public Health Bull 1999;10(4):31–32. DOI: 10.1071/nb99013.
  16. American Academy of Pediatric Dentistry. Policy on early childhood caries (ECC): classifications, consequences, and preventive strategies. The reference manual of pediatric dentistry. Chicago, IL: American Academy of Pediatric Dentistry; 2020. p. 79–81.
  17. Tinanoff N. Dental trauma. In: Kliegman RM, Stanton B, St Geme JW, et al., editors. Nelson's textbook of pediatrics. Philadelphia: Elsevier; 2011. p. 1258–1259.
  18. Josell SD, Abrams RG. Managing common dental problems and emergencies. Pediatr Clin North Am 1991;38(5):1325–1342. DOI: 10.1016/s0031-3955(16)38200-1.
  19. Machado AW, MacGinnis M, Damis L, et al. Spontaneous improvement of gingival recession after correction of tooth positioning. Am J Orthod Dentofacial Orthop 2014;145(6):828–835. DOI: 10.1016/j.ajodo.2013.05.012.
  20. Fushima K, Inui M, Sato S. Dental asymmetry in temporomandibular disorders. J Oral Rehabil 1999;26(9):752–756. DOI: 10.1046/j.1365-2842.1999.00447.x.
  21. Badran SA. The effect of malocclusion and self-perceived aesthetics on the self-esteem of a sample of Jordanian adolescents. Eur J Orthod 2010;32(6):638–644. DOI: 10.1093/ejo/cjq014.
  22. Kiekens RM, Maltha JC, van't Hof MA, et al. Objective measures as indicators for facial esthetics in white adolescents. Angle Orthod 2006;76(4):551–556. DOI: 10.1043/0003-3219(2006)076[0551:OMAIFF]2.0.CO;2.
  23. Bradbury-Jones C, Innes N, Evans D, et al. 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 Apr 19;13:370. DOI: 10.1186/1471-2458-13-370.
  24. Sarri G, Evans P, Stansfeld S, et al. A school-based epidemiological study of dental neglect among adolescents in a deprived area of the UK. Br Dent J 2012;213(10):E17. DOI: 10.1038/sj.bdj.2012.1042.
  25. U.S. Department of Health and Human Services. Oral health in America: a report of the surgeon general. Rockville, MD.: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000. NIH publication 00–4713. Available from:
  26. Dye BA, Tan S, Smith V, et al. Trends in oral health status: United States, 1988–1994 and 1999–2004. Vital Health Stat 11 2007;(248):1–92.
  27. Von Amann GP, Cádima CF. Estudo Nacional de Prevalência das Doenças Orais. Lisboa: Direcção-Geral da Saúde; 2008.
  28. Carmona RH. National call to action to promote oral health. J Am Coll Dent 2005;72(4):8–10.
  29. Lourenço CB, Saintrain MV, Vieira AP. Child, neglect and oral health. BMC Pediatr 2013;13:188. DOI: 10.1186/1471-2431-13-188.
  30. Valencia-Rojas N, Lawrence HP, Goodman D. Prevalence of early childhood caries in a population of children with history of maltreatment. J Public Health Dent 2008;68(2):94–101. DOI: 10.1111/j.1752-7325.2007.00077.x.
  31. Scorca A, Santoro V, De Donno A, et al. Early childhood caries (ECC) and neglect in child care: analysis of an Italian sample. Clin Ter 2013;164(5):e365–e371. DOI: 10.7417/CT.2013.1614.
  32. Gurunathan D, Shanmugaavel AK. Dental neglect among children in Chennai. J Indian Soc Pedod Prev Dent 2016;34(4):364–369. DOI: 10.4103/0970-4388.191420.
  33. Chu CH, Ho PL, Lo EC. Oral health status and behaviours of preschool children in Hong Kong. BMC Public Health 2012;12(1):767. DOI: 10.1186/1471-2458-12-767.
  34. Benzian H, Monse B, Heinrich-Weltzien R, et al. Untreated severe dental decay: a neglected determinant of low Body Mass Index in 12-year-old Filipino children. BMC Public Health 2011;11(1):558. DOI: 10.1186/1471-2458-11-558.
  35. Arora A, Scott JA, Bhole S, et al. Early childhood feeding practices and dental caries in preschool children: a multi-centre birth cohort study. BMC Public Health 2011;11(1):28. DOI: 10.1186/1471-2458-11-28.
  36. Begzati A, Berisha M, Meqa K. Early childhood caries in preschool children of Kosovo - a serious public health problem. BMC Public Health 2010;10(1):788. DOI: 10.1186/1471-2458-10-788.
  37. Kvist T, Zedrén-Sunemo J, Graca E, et al. Is treatment under general anaesthesia associated with dental neglect and dental disability among caries active preschool children? Eur Arch Paediatr Dent 2014;15(5):327–332. DOI: 10.1007/s40368-014-0118-z.
  38. Thomson WM, Spencer AJ, Gaughwin A. Testing a child dental neglect scale in South Australia. Community Dent Oral Epidemiol 1996;24(5):351–356. DOI: 10.1111/j.1600-0528.1996.tb00875.x.
  39. Acharya S, Pentapati KC, Bhat PV. Dental neglect and adverse birth outcomes: a validation and observational study. Int J Dent Hyg 2013;11(2):91–98. DOI: 10.1111/idh.12001.
  40. Jamieson LM, Thomson WM. The Dental Neglect and Dental Indifference scales compared. Community Dent Oral Epidemiol 2002;30(3):168–175. DOI: 10.1034/j.1600-0528.2002.300302.x.
  41. Thomson WM, Locker D. Dental neglect and dental health among 26-year-olds in the Dunedin Multidisciplinary Health and Development Study. Community Dent Oral Epidemiol 2000;28(6):414–418. DOI: 10.1034/j.1600-0528.2000.028006414.x.
  42. Coolidge T, Heima M, Johnson EK, et al. The Dental Neglect Scale in adolescents. BMC Oral Health 2009;9:2. DOI: 10.1186/1472-6831-9-2.
  43. Jamieson LM, Thomson M. Dental health, dental neglect, and use of services in an adult Dunedin population sample. N Z Dent J 2002;98(431):4–8.
  44. Skaret E, Astrøm AN, Haugejorden O, et al. Assessment of the reliability and validity of the Dental Neglect Scale in Norwegian adults. Community Dent Health 2007;24(4):247–252.
  45. McGrath C, Sham AS, Ho DK, et al. The impact of dental neglect on oral health: a population based study in Hong Kong. Int Dent J 2007;57(1):3–8. DOI: 10.1111/j.1875-595x.2007.tb00111.x.
  46. Katz RV, Smith BJ, Berkey DB, et al. Defining oral neglect in institutionalized elderly: a consensus definition for the protection of vulnerable elderly people. J Am Dent Assoc 2010;141(4):433–440. DOI: 10.14219/jada.archive.2010.0196.
  47. Jenny C. Child abuse and neglect: diagnosis, treatment, and evidence. St. Louis: Saunders/Elsevier; 2011. p. 589–590.
  48. Amin MS, Harrison RL. Understanding parents’ oral health behaviors for their young children. Qual Health Res 2009;19(1):116–127. DOI: 10.1177/1049732308327243.
  49. Freeman R. The role of the primary care dentist in safeguarding children. In: Taylor J, ThemesslHuber M, editors. Safeguarding children in primary health care. London: Jessica Kingsley; 2005. p. 60–76.
  50. Goh EZ, Beech N, Johnson NR. Dental anxiety in adult patients treated by dental students: a systematic review. J Dent Educ 2020;84(7):805–811. DOI: 10.1002/jdd.12173.
  51. Pretty IA, Sweet D. Anatomical location of bitemarks and associated findings in 101 cases from the United States. J Forensic Sci 2000;45(4):812–814.
  52. Peres MA, Macpherson LMD, Weyant RJ, et al. Oral diseases: a global public health challenge. Lancet 2019;394(10194):249–260. DOI: 10.1016/S0140-6736(19)31146-8.
  53. Reisine ST. Dental health and public policy: the social impact of dental disease. Am J Public Health 1985;75(1):27–30. DOI: 10.2105/ajph.75.1.27.
  54. Low W, Tan S, Schwartz S. The effect of severe caries on the quality of life in young children. Pediatr Dent 1999;21(6):325–326.
  55. Inglehart MR, Filstrup SL, Wandera A. Oral health and quality of life in children. In: Inglehart MR, Bagramian RA, editors. Oral health-related quality of life. Chicago: Quintessence Publishing Company; 2002. p. 79–88.
  56. Filstrup SL, Briskie D, da Fonseca M, et al. Early childhood caries and quality of life: child and parent perspectives. Pediatr Dent 2003;25(5):431–440.
  57. Sheiham A. Dental caries affects body weight, growth and quality of life in pre-school children. Br Dent J 2006;201(10):625–626. DOI: 10.1038/sj.bdj.4814259.
  58. Malden PE, Thomson WM, Jokovic A, et al. Changes in parent-assessed oral health-related quality of life among young children following dental treatment under general anaesthetic. Community Dent Oral Epidemiol 2008;36(2):108–117. DOI: 10.1111/j.1600-0528.2007.00374.x.
  59. Glick M, Williams DM, Kleinman DV, et al. A new definition for oral health developed by the FDI World Dental Federation opens the door to a universal definition of oral health. J Public Health Dent 2017;77(1):3–5. DOI: 10.1111/jphd.12213.
  60. Casamassimo PS, Thikkurissy S, Edelstein BL, et al. Beyond the dmft: the human and economic cost of early childhood caries. J Am Dent Assoc 2009;140(6):650–657. DOI: 10.14219/jada.archive.2009.0250.
  61. Broadbent JM, Thomson WM, Williams SM. Does caries in primary teeth predict enamel defects in permanent teeth? A longitudinal study. J Dent Res 2005;84(3):260–264. DOI: 10.1177/154405910508400310.
  62. Harris JC, Elcock C, Sidebotham PD, et al. Safeguarding children in dentistry: 2. Do paediatric dentists neglect child dental neglect? Br Dent J 2009;206(9):465–470. DOI: 10.1038/sj.bdj.2009.356.
  63. Kiran K. Child abuse and neglect. J Indian Soc Pedod Prev Dent 2011;29(6 Suppl. 2):S79–S82. DOI: 10.4103/0970-4388.90749.
  64. Manea S, Favero GA, Stellini E, et al. Dentists’ perceptions, attitudes, knowledge, and experience about child abuse and neglect in northeast Italy. J Clin Pediatr Dent 2007;32(1):19–25. DOI: 10.17796/jcpd.32.1.f920721252jx3614.
  65. Jordan A, Welbury RR, Tiljak MK, et al. Croatian dental students’ educational experiences and knowledge in regard to child abuse and neglect. J Dent Educ 2012;76(11):1512–1519.
  66. Ivanoff CS, Hottel TL. Comprehensive training in suspected child abuse and neglect for dental students: a hybrid curriculum. J Dent Educ 2013;77(6):695–705.
  67. Rayman S, Dincer E, Almas K. Child abuse: concerns for oral health practitioners. N Y State Dent J 2013;79(4):30–34.
  68. Laud A, Gizani S, Maragkou S, et al. Child protection training, experience, and personal views of dentists in the prefecture of Attica, Greece. Int J Paediatr Dent 2013;23(1):64–71. DOI: 10.1111/j.1365-263X.2012.01225.x.
  69. Souster G, Innes N. Some clarification of trigger signs for dental neglect. Evid Based Dent 2014;15(1):2–3. DOI: 10.1038/sj.ebd.6400996.
  70. Harris JC, Balmer RC, Sidebotham PD. British Society of Paediatric Dentistry: a policy document on dental neglect in children. Int J Paediatr Dent 2018;28(5):e14–e21. DOI: 10.1111/j.1365-263x.2009.00996.x.
  71. Stevens CL. Is dental caries neglect? Br Dent J 2014;217(9):499–500. DOI: 10.1038/sj.bdj.2014.950.
  72. Cairns AM, Welbury RR. The role of the dental team in child protection—a review. Scott Med J 2009;54(2):37–40. DOI: 10.1258/rsmsmj.54.2.37.
  73. Berger S, California Society of Pediatric Dentistry. Dental neglect - when to report. California Pediatrician 1989(Fall);1:31–32.
  74. Nuttall NM. Initial development of a scale to measure dental indifference. Commun Dent Oral Epidemiol 1996;24(2):112–116. DOI: 10.1111/j.1600-0528.1996.tb00825.x.
  75. Taylor J, Lauder W, Moy M, et al. Practitioner assessments of ‘good enough’ parenting: factorial survey. J Clin Nurs 2009;18(8):1180–1189. DOI: 10.1111/j.1365-2702.2008.02661.x.
  76. Balmer R, Gibson E, Harris J. Understanding child neglect. Current perspectives in dentistry. Prim Dent Care 2010;17(3):105–109. DOI: 10.1308/135576110791654883.
  77. National Collaborating Centre for Women's and Children's Health (2009). When to suspect child maltreatment. London: RCOG Press.
  78. Powell J, Appleton J. Children and young people's missed health care appointments: reconceptualising ‘did not attend’ to ‘was not brought’. A review for the evidence for practice. J Res Nurs 2012;17(2):181–192. DOI: 10.1177/1744987112438158.
  79. Cukovic-Bagic I, Dumancic J, Kujundzic Tiljak M, et al. Croatian dentists’ knowledge, experience, and attitudes in regard to child abuse and neglect. Int J Paediatr Dent 2015;25(6):444–450. DOI: 10.1111/ipd.12151.
  80. Bhatia SK, Maguire SA, Chadwick BL, et al. Characteristics of child dental neglect: a systematic review. J Dent 2014;42(3):229–239. DOI: 10.1016/j.jdent.2013.10.010.
  81. Harris CM, Welbury R, Cairns AM. The Scottish dental practitioner's role in managing child abuse and neglect. Br Dent J 2013;214(9):E24. DOI: 10.1038/sj.bdj.2013.435.
  82. Saini N. Child abuse and neglect in India: time to act. Japan Med Assoc J 2013;56(5):303–309.
  83. Seth R. Protection of children from abuse and neglect in India. Japan Med Assoc J 2013;56(5):292–297.
  84. Ramazani N. Child dental neglect: a short review. Int J High Risk Behav Addict 2014;3(4):e21861. DOI: 10.5812/ijhrba.21861.
  85. General Dental Council. Preparing for practice 2012. Available from:
  86. Burgette JM, Safdari-Sadaloo SM, Van Nostrand E. Child dental neglect laws: Specifications and repercussions for dentists in 51 jurisdictions. J Am Dent Assoc 2020;151(2):98–107.e5. DOI: 10.1016/j.adaj.2019.09.010.
  87. Sharma A. Dental neglect leading to foreign body in tooth. J Orofacial Res 2013;3(4):263–265. DOI: 10.5005/jp-journals-10026-1108.
  88. Kirankumar SV, Noorani H, Shivprakash PK, et al. Medical professional perception, attitude, knowledge, and experience about child abuse and neglect in Bagalkot district of north Karnataka: a survey report. J Indian Soc Pedod Prev Dent 2011;29(3):193–197. DOI: 10.4103/0970-4388.85807.
  89. Yu SM, Bellamy HA, Kogan MD, et al. Factors that influence receipt of recommended preventive pediatric health and dental care. Pediatrics 2002;110(6):e73. DOI: 10.1542/peds.110.6.e73.
  90. American Academy of Pediatric Dentistry, Council on Clinical Affairs. Policy on Early Childhood Caries (ECC): classifications, consequences, and preventive strategies. Pediatr Dent 2018;40(6):60–62.
  91. Heads D, Ahn J, Petrosyan V, et al. Dental caries in children: a sign of maltreatment or abuse? Nurs Child Young People 2013;25(6):22–24. DOI: 10.7748/ncyp2013.
  92. Mouden LD. Child abuse and neglect: the dental assistant's role in prevention. Dent Assist 2000;69(1):30–37.
  93. Sperber ND. Bite marks, oral and facial injuries--harbingers of severe child abuse? Pediatrician 1989;16(3–4):207–211.
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