This week, Israel joined the international organization PANDA (Prevent Abuse and Neglect through Dental Awareness), an organization of dentists that is active in helping children who suffer from abuse.
In the past year, there has been an 84 percent increase in cases of child abuse in Israel, according to a report published by the Israel Association for Child Protection (known by its Hebrew acronym ELI). Experts attribute the rise in part to the difficult security and economic situation. Since 65 percent of injuries to children are in the upper part of the body, from the neck up, it is important for dentists to be awarene of the problem and be able to detect signs of abuse. Dentists are duty-bound to report cases of suspected child abuse to authorities. In Israel, says dentist Haim Galon, an estimated 40,000 children are abused by their parents each year.
Galon, an orthodontist and a specialist in children's dentistry, who was among those behind Israel's joining of PANDA, emphasizes that a dentist can, if given the tools, identify signs of abuse, even when parents try to hide them. Therefore, he has started a special course for dentists and dental clinic staff to increase awareness of the problem in Israel, teach dental professionals to identify children who suffer from abuse and neglect, and encourage reporting suspected abuse to authorities.
A course for diagnosing and identifying children who have been victims of abuse took place this month, in cooperation with the dental health services section of the Health Ministry, the Hebrew University faculty of dentistry, and the Dental Association. During the course, Galon announced that Israel was joining PANDA, which has members from 44 states within the United States and from six countries in Europe. The organization will continue to conduct seminars and in-service courses, creating a nucleus that will work to advance PANDA's goals.
In Israel, dentists have not yet reported abuse. In the United States, the percentage of dental professionals reporting suspected abuse has risen by 60 percent since the courses began, and the subject is part of the course of study in several dozen universities. In states where PANDA is active, the increase in the number of reports to the authorities is even more impressive.
Non-reporting by Israeli dentists of suspicions of abuse may indicate not only a lack of awareness, but fear of losing the patient or of revenge by the abusive parent. The law is unequivocal on this issue, imposing a prison sentence on professionals who fail to do everything in their power to prevent a crime against a minor, when there is a reasonable basis for suspecting that such a crime has taken place.
Galon points out that there are telltale signs easily identified in a dental clinic. Injuries in which one can discern an indentation in the shape of an object or the hand of an adult, or harm to both sides of the face; signs of bites that the dentist can identify by comparing the finding to the teeth of the attacker (43 percent of bites are in the area of the head and neck); fractures in the jaws, various degrees of breakage in the crown or root of the tooth, and even the loss of an entire tooth. Sometimes injuries around the mouth are a result of an attempt to silence a crying child by force. Force-feeding of babies with a hot bottle may cause burns and even lacerations in the front of the mouth.
A study carried out by the U.S. Academy of General Dentistry revealed the following breakdown of cases of abuse: injury to teeth (32 percent), lacerations of the lips or mouth (24 percent), fractures of the jaw (11 percent). In another study of 1,248 cases of child abuse in the United States, it was found that half of them were in children from birth to the age of four, and that 75 percent of the injuries were in the area of the mouth, the face, the neck and the head.
Physical abuse can also cause displacement of teeth. A discoloration of the teeth may also hint at abuse of children, or earlier injuries. The dentist must therefore develop enough skill to understand the origin of the abuse, since 35 percent of cases of abuse end in disability - if not always physical, then certainly emotional.
Therefore, Galon distributed a questionnaire to the 220 children's dentists registered in the association, which will make it possible to get up-to-date statistics regarding dentists' reporting on this matter.
Course sessions on the subject in dentistry schools emphasize that in half of the cases of child abuse, the behavior is repeated, and even becomes worse, if it is not discovered and stopped. In the PANDA program, which originated in the state of Missouri, dentists, dental assistants, social workers and community activists work together. The number of reports there of cases of abuse to the proper authorities has been steadily increasing.
The PANDA steering committee in Israel includes, in addition to Galon, the head of dental services in the Health Ministry, Dr. Shlomo Zussman, and three senior dentists from the Hadassah University Hospital in Ein Karem.
