A recent article in our journal (JAAOMS) carried the hypothesis that there is an association between severe dental caries and child abuse and neglect. In our practice, we rarely see children with severe caries. That fact is more of a socioeconomic reality than anything else. When we do see these, I have to agree that it goes through my mind; how did these parents let this happen? We are often given exactly that information at the time of consultation – such as special circumstances, exposures, habits, etc. which lead to the problem.

For the most part, in my career, the primary cause of this is not neglect, abuse, or lack of love; rather it is just a lack of knowledge/education of the parents. Undereducated parents often have just never been told about the risks. Or there may be social factors such as substance abuse by the parents which is certainly a form of neglect – but it presents a complicated web of “accountability” as far as who might be “to blame” for the child’s oral health problems. (J Oral Maxillofac Surg 75:2304-2306, 2017).

Having spent quite a bit of time providing care in second and third world countries I have seen consistently extensive dental caries and dental disease in young patients. I know that these people truly love their children and provide the best care that they can for their children. For them it is a lack of resources, no access to care, lack of home hygiene facilities such as clean water, lack of fluoride, and possibly lack of education about care, etc. which lead to the child’s teeth being in poor condition (rampant decay, etc.). Here in the USA we have an expectation for good care and frankly we do have the resources available for oral care support, but you still have to be educated about it and have the knowledge/motivation to seek it out. When we see extensive dental problems in children, educate the parents and children. Encourage them toward healthy habits and diet.

As far as the hypothesis of the article: that dental problems in children may be a sign of other forms of abuse – I would say this is generally untrue. To target parents of children with bad dental disease would be a mistake. We should of course all be on the alert for subtle signs of child abuse such as abnormal bruising or old healed fractures and report these as is appropriate.