Are you confident in spotting a child at risk of neglect?

Do you know what to do if you witness abuse in your practice?

How can you raise concerns safely while protecting both the child and your team?

This episode with Dr. Christine Park provides tangible actions, practical scripts, and clear guidance for managing challenging scenarios—like seeing an adult hit a child in the waiting room or recognizing neglect in the dental chair. These are situations dental school rarely prepares us for.

Every practice needs clear protocols for safeguarding. This episode acts as a North Star, helping you stay compliant while ethically doing the right thing. If you treat children, you must listen to this episode and share it with every colleague who treats children.

https://youtu.be/-kYs23Xa4Ls Watch PDP251 on YouTube

Protrusive Dental Pearl: Find the phone number of your local child safeguarding board / social services. Verify it, then display it where you and your team can quickly access it.

Need to Read it? Check out the Full Episode Transcript below!

Key Takeaways

• Dentists are trained observers of family dynamics.
• Recognizing normal behavior is key in dental care.
• Unconscious observations can guide professionals.
• Feeling uncomfortable about a situation is a valid signal.
• Empowerment comes from trusting your instincts.
• Dental care professionals see many aspects of families.
• It’s important to act on uncomfortable feelings.
• Observation skills are crucial for effective care.
• Children’s interactions reveal much about family health.
• Awareness of discomfort can lead to better outcomes.

Highlights of this episode:

00:00 Teaser

00:59 Intro

02:40 Pearl – Child Protection Hotline

05:23 Dr. Christine Park’s Background and Expertise

08:37 The Role of Dentists in Safeguarding Children

11:19 Practical Scenarios and Guidelines for Safeguarding

15:35 Recognizing Silent Cases of Neglect

17:29 Team Collaboration and Support in Safeguarding

21:58 Guidelines and Policies for Effective Safeguarding

22:03 Midroll

25:24 Guidelines and Policies for Effective Safeguarding

28:32 Handling a Tough Safeguarding Scenario

32:18 Dealing with Poor Oral Hygiene and Neglect

39:12 Managing Parental Reactions and Consent

43:08 The Importance of Safeguarding in Dentistry

45:34 Further Guidance and Resources

46:10 Outro

???? Safeguard your young patients with confidence!

Catch Dr. Christine Park at the Scottish Dental Show in June or via her NES webinars.

Check out the BSPD guidelines on dental neglect —an essential resource for any dentist treating children

✉️ Get in Touch with Dr. Christine:

• General: Christine.park@glasgow.ac.uk
• Patient-info: Christine.park7@nhs.scot

If you loved this episode, don’t miss How to Manage Children in Dental Pain – Paediatric Emergencies – PDP159

#PDPMainEpisodes #Communication #CareerDevelopment

This episode is eligible for 0.75 CE credit via the quiz on Protrusive Guidance. 

This episode meets GDC Outcomes A and D.

AGD Subject Code: 430 PEDIATRIC DENTISTRY (Identification and reporting of child abuse)

Aim: To equip dental professionals with practical knowledge and skills to recognize, respond to, and appropriately escalate safeguarding concerns involving children in dental practice.

Dentists will be able to –

Identify key signs and red flags of child neglect, abuse, or welfare concerns in dental patients. Apply clear communication strategies to discuss concerns with parents/caregivers and involve relevant authorities. Follow practice-based and multi-agency procedures for safeguarding, including documenting observations and escalation. Click below for full episode transcript:

Teaser: We're so well trained in observing, and we're really, really good at knowing what normal is. We know what looks normal to us, and even if we are not consciously aware of what we're seeing, there is always an unconscious part of us. If we see something that doesn't feel right, it will feel uncomfortable.

Teaser:
The worst thing is if a dentist or a nurse gets left to deal with it on their own at half past four on a Friday afternoon, when they can’t get through to anybody, and all the rest of the practice are going, not my problem, I’ll see you later.

What do I want that child to think about in years to come? When they’re grown up and they’re an adult and they can look back, do I want ’em to look back and say, that dentist Christine, she saw me and knew I needed help and did X, Y, Z, or, that dentist saw me and knew I needed help and did nothing.

And never want any of my dental colleagues to be the last health professional to see a child that something then horrific happens to.

Jaz’s Introduction:
If you treat children, it is your duty to listen to this episode in full, because this is one of those times you get to change a child’s life. You get to potentially save a life, or at the very least, change the entire trajectory of a child’s life.

Safeguarding of children is one of the recommended topics from our regulator, and there’s a really good reason for that. We, as dentists, are in a phenomenal position to be able to look out for nuances and really safeguard the children. They only see their medical doctor when there’s a problem, but they see us more regularly.

And if you treat children, it should be part of your personal development plan to safeguard them. And this episode will give you CPD for that. But forget the CPD, because more importantly, when you see an adult hitting a child in the waiting room, or you see a neglected child in your dental chair and you need to raise concerns, this episode will give you tangible actions, scripts to follow, and good, safe guidance on how to manage these really tricky scenarios, which dental school just does not prepare us for.

This episode with Dr. Christine Park will give you the tools you need to manage these tough scenarios. Now, it’s not a very common thing, thankfully. It’s a bit like mouth cancer. We do screening for mouth cancer every single patient, and we hope not to find it, but when we do find it or are concerned, we refer, we get some expert advice, and we should be doing the same when it comes to safeguarding children.

Every practice needs to have clear protocols in place, and this episode is a great North Star to follow, to help us stay compliant, but also ethically do the right thing. So if you treat children, you must, must, must listen to this episode and share it with every colleague that treats children.

Dental Pearl
Hello, Protruserati. I’m Jaz Gulati, and welcome back to your favorite dental podcast. Every PDP episode I give you a Protrusive Dental Pearl. It’s a very important actionable step I’m giving you for this episode’s pearl. Now, most of us under our computer or near our workstation, we have the phone number to call if the service stops working.

Or if we need IT support, and this is almost like universal for all dental practices I’ve worked in. Now, what all practices don’t have is a phone number for when you are concerned about the wellbeing of a child, when you need to do some safeguarding for children, the phone number of social services near you, or a safeguarding authority for children near you.

Do you have that phone number easy to find somewhere? And I think it’s our duty to have that number easy to reference. It’s a bit like when a dental trauma comes in, we refer to the guidelines, we follow the steps. Well, sometimes with these high-octane, adrenaline-pumping, tough conversations that we have with parents, we need a quick reference of a phone number to call for help, as well as discussing it with the lead nurse, practice manager, the other dentist.

Because when safeguarding and children is concerned, it is an entire practice issue, and it is a community-wide issue. So my top tip is have the phone number. Have a phone number of your local safeguarding authority, and you have to do a bit of work. I would say ask ChatGPT, then verify that what ChatGPT is telling you is correct. You need a local contact to get advice. And I think it’s our ethical duty to do so.

Anyway, let’s check out the main episode with Dr. Christine Park, who really breaks it down. Well, we have scripts. We have tangible actions for you to better look after children. I really hope you never have to use these scripts, but when you do, you’ll be way more prepared and you’ll be able to really help children and change their entire life. Enjoy the learning. I’ll catch you in outro.

Main Episode:
Dr. Christine Park, welcome to the Protrusive Dental Podcast. So nice to have you smiling. You’ve got the a nice little, what, what’s that poster you got behind you?

[Christine]
So this is a little poster that we had at the Glasgow Science Festival back in June, July. I’d taken some of my students there to talk about the science behind prevention. So we had done lots of sort of public engagement there, so for families as well as children, but all the families doing a bit of public engagement about why we use fluoride and why we brush teeth and all that kind of thing. So I like the, so I keep it.

[Jaz]
Well, tell us about yourself in terms of which hospital you work in, which trust you work for, and what is your day in, day out role? Obviously Scottish, we’ve had some great Scottish guests in in the past. Scotland is like, I was always taught as a dental student, my lecturer is actually a Scottish lecturer who was teaching me, and he said, in his lovely Scottish accent, he said that Scotland is like the sick man of Europe. But then as a sick man of Europe, it produces the best guidelines. And any guidelines, you bypass England, you go straight to, let me check out the Scottish guidelines. Okay. So isn’t that just fascinating?

[Christine]
It’s absolutely.

[Jaz]
Tell me about yourself.

[Christine]
So yeah, so I work at Glasgow Dental Hospital and School. So I’ve been a senior clinical lecturer and an honorary consultant here for the last sort of nine years. And my day in, day out, I do sort of half university and half NHS.

So depending on what day of the week it is, I might have my dental students in the main pediatric clinic at the dental hospital, or I might have them in outreach in some of the more deprived areas of Glasgow, or I might be doing general anesthetic lists myself or intravenous sedation for anxious adolescents, as well as new patient clinics and what have you as well. So I’m also an educational supervisor for one of our STs, and we’ve got some lovely CTs in the department as well. So very varied week, but it’s great. I love it.

[Jaz]
Very lovely diverse week that you have. That’s awesome. And you are like, your background, is it pediatric, or is it community dental, or a bit of both?

[Christine]
So my background is pediatric dentistry. So I qualified from Glasgow and then went over to Edinburgh to do my sort of VT stuff and then came back to Glasgow to do specialist in pediatric dentistry training, and then went down to London to Guy’s and St. Thomas’s to do some of my consultant training down there, and then decided to go down the academic route. So managed to get a job back in Glasgow, where the sort of family roots are, round about the same time that they were thinking of starting a family. So it was well timed.

[Jaz]
Excellent. And the topic today that we want to address is safeguarding. So one thing for sure is the area of expertise and area of experience and what you teach, is that more towards safeguarding in children? Is the conversation very much gonna be more safeguarding in children, because we have a duty of care in safeguarding in children and adults. How much do you, I mean, how much adult interaction do you get and is this something that you’re involved with, the safeguarding adults as well, or is it mostly children?

[Christine]
So it’s mostly children that I’m involved with safeguarding with. So I’ve done a master’s, initially looking at the dental team’s role in protecting children and the oral health of vulnerable children in Glasgow. And then I have more recently done a PhD developing a serious game to try and help dental teams get over their fears that are involved with referral when they’ve got a concern about wellbeing or welfare, particularly in pediatric patients. I do have colleagues who are much more expert in adult safeguarding, but that’s not particularly my area of expertise. It’s much more the pediatric safeguarding part.

[Jaz]
Well, it’s nice to go home into a niche and talk about a topic deeply. So I’m quite excited to talk about, okay, safeguarding children because it’s such a huge responsibility that we have, anyone who treats children, and it’s one of the sort of required or recommended learnings from the GDC for good reason, that we should be learning about safeguarding in children.

Why do you think as dentists we are in primary care, we are in a good position to be, why is it like an important topic that the GDC have said, hey, you need to learn more about this? What makes us in a position to be able to look after children in this position?

[Christine]
So especially dentists in general practice, they’re so privileged that they have really good relationships with families and will often see families over a long period of time, much more so than, you know, myself in hospital or even my colleagues in the public dental service. And because of that, they really develop a bond of trust with patients and their families.

Dental checkups, dental reviews are one of the only sort of regular healthcare points that children still have, especially once they’re at school, once they’re past the sort of health visitor stage. Their dental checkups are that kind of touch base point that other general medical practitioners won’t have, because generally in the other specialties, they’re only seeing them if they’ve got an issue.

Whereas in dentistry, you’re seeing them much more commonly. So we’re well placed to pick up any things that are developing. We’re well placed to see changes in families. If it’s a family you’ve known for a long time and suddenly think, this is not the same as it was before, perhaps there’s a struggle. Or even on the flip side of that, if you’re seeing children for a long time and you’re giving the advice, but it’s not being enacted, or they keep coming back in pain to you and nothing’s changing, you can really be that first link in the chain to offer a family in crisis a bit of help.

So dentists and therapists, in fact, all dental care professionals, we’re so good at observing. We’re so well trained in observing, and we’re really, really good at knowing what normal is. We see so many different aspects of families. We know how children interact with their family members. We know what looks normal to us, and even if we are not consciously aware of what we’re seeing, there is always an unconscious part of us.

If we see something that doesn’t feel right, it will feel uncomfortable. And I think part of what I want to do is just really help people to know that if you feel uncomfortable like that, then there is something wrong. So don’t just sit on that feeling. If you’ve got that uncomfortable feeling that something’s not right, you will be correct. So you should feel really empowered from that point of view.

[Jaz]
Can you give us a tangible made up scenario where a general dentist may see a family and then see a, have a child in their chair and their radar’s going off like, okay, something is not adding up today, something’s wrong? Can you give us in like a case report, case study, you can make it up obviously to protect children and stories and whatnot, but like just some scenarios, because as dentists we really, with the scenarios, we can actually identify really well with.

[Christine]
Yep. So I’ll give you a couple of options. So sort of scenarios that I’ve been involved with. One was a family who has three children, so it was about an 8-year-old, a 6-year-old, and a newborn baby. And I was asked to see them as part of a comprehensive medical assessment. So I was doing the dental bit of that, but it could be any dentally qualified person who’s doing that, can be a general dental practitioner.

And I was examining the children, and both older children were really compliant. They were fine for examination. I could look in their mouths, and what I found was that the older child’s oral hygiene at the front of their mouth was generally okay, but the more posterior teeth was very poor oral hygiene, and they had active caries.

The six-year-old’s oral hygiene was appalling, and they had active caries. Now, in comparison, the six-month-old child had beautiful oral hygiene, just the lower incisors, but not a speck of plaque on them. Now, in addition to this, both of the older children smelled quite strongly of stale body odour.

They were visibly dirty, their skin, their hair was visibly dirty. I could see ingrained dirt in their skin. And then in comparison, the six-month-old baby was beautifully clean, freshly laundered clothes. So this was really an example of where it’s a family who obviously aren’t living in hygiene poverty because they can launder the baby’s clothes.

They obviously do have toothbrushes at home, ’cause the baby’s teeth were clean. But for some reason there was neglect happening with the older children. So that might be something that comes up in general practice. And when I spoke to the general practitioner who was involved in that, she said, yeah, the kids are actually really good.

They come, they have their dental treatment done, but they never complete a course of treatment, which is one of the warning signs for dental neglect from the British Society of Pediatric Dentistry’s policy documents. So they come, but they don’t get brought to complete their course of treatment, but they’re great when we’re here. It’s not a behavior management issue.

So that’s one of the things that you might see in practice. And the other one that comes to mind is a 3-year-old child that the dentist was concerned about because they had gross caries in almost every tooth, and they had then referred them to me, but they didn’t come to see me.

And then I couldn’t get hold of them. So what we did with the dentist is we got back in touch and said, have they been to see you? And they said, no, actually, they’ve not. And we got the health visitor’s details from the dentist, who knew the doctor, and we were able to work together to get that child to come in.

And what turned out was the dentist was concerned about them, and that’s why they referred them to me, but they weren’t attending nursery because of their teeth. They weren’t eating or drinking properly because of their teeth, and they ended up needing a clearance. But it was just the dentist just bringing that to the attention of the health visitor was just so impactful, because the reason mum wasn’t sending the child to nursery was because of their teeth.

So although it was awful that we had to take out the teeth, it’s really been so impactful in that child’s life because now they’re out of pain. Now they’re able to eat and drink better, so their body weight is coming back onto the normal curves we would hope to see. And they’re engaging with education now.

Yes, it’s awful that they don’t have teeth, but their mouth isn’t sore anymore. They’ve made a real, that dentist has made a real impact for that child, which as, it’s not one of these things where it makes you a lot of money, but it really is so impactful, that child is…

[Jaz]
So rewarding.

[Christine]
So rewarding, and their life is going to be so much better because the dentist took the time to say, something’s not right here, we need to get you some help, and it did take that multi-professional working with the health visitor to go into the house and try and get them to come to the appointments, explain that it was so important, that nobody’s going to be nasty to you, we just want to try and get this child’s health better and then support you in the future so that she can have the best health she can.

[Jaz]
Well in epidemiology and public health, we know that that’s the tip of the iceberg. That’s what we’re seeing, right? And then there’s so many other cases, which are perhaps not as advanced, or it’s happened but then they’ve slipped the net because the general dentist was not confident. They were scared.

They were scared of backlash from the parent. A busy practice, they’ve got like 15 referral letters to write for other things or medicine stuff. And then there’s one thing which requires a lot of energy and effort and finding and health visitor stuff. So what I’d love to do is talk about this similar scenario whereby the patient is, the child is getting rampant caries and maybe they’ve already had a GA before.

And one of the things I always remember is like a repeat GA is like a huge, the biggest like red flag you can have, in the sense that this is like a major neglect. So how can we definitely, obviously prevent the first general anesthetic, but to repeat should be a never event.

So, again, that’s like the tip of the iceberg. There’s so many that are suffering in silent. And so if we can give dentists some guidelines, some ideas about how to make the right choice the easy choice, how to give them tools that they can use and discuss in their team meetings.

But okay, if we spot this, this is our clear protocol, because you know what, Christine? We’ve got protocols. Every practice has got a safeguarding policy that everyone writes their squiggle against. But when the proverbial hits the fan and actually, if something happens, is that easy to find?

Because I don’t expect anyone to remember the policy step by step by step. But that’s the point where it should be easy to dig out and have a clear practice plan to follow to help someone. So I guess the next step to then uncover this is when you have that feeling in both those scenarios that you describe, what’s the first thing the dentist should do, whether it be something in the nurse, or a question that’s asked to parents?

Obviously it’s very broad ’cause it kind of depends on the nuances, but what’s a guideline approach that you recommend as first line?

[Christine]
Yeah, so definitely you’ve kind of, you’ve picked a few things there, Jaz. So the fact that actually practicing this before it actually happens is really important, and knowing what everybody’s going to do in the team. The worst thing is if a dentist or a nurse gets left to deal with it on their own at half past four on a Friday afternoon, when they can’t get through to anybody, and all the rest of the team are going, not my problem, I’ll see you later.

That is probably, that’s the hardest bit. So my first suggestion is to talk through these things with your team. So whoever it is in your practice, so if you’ve got practice managers, if you’ve got nurses, if you’ve got receptionists, talk through what you’re going to do. So if you have to make a referral to social services at four o’clock on a Friday afternoon, is it going to be such an urgent case that you need to phone the police?

If it is, who does that? If it’s one that you’re just phoning for advice, where do you keep the child if you’re not sure whether to send them home? If they are sending them home, who’s had that conversation to say, look, I’m a bit concerned about this, I don’t think things are sitting a hundred percent right with me, it’s my professional responsibility to refer this child. And then in your team, who’s going to support the person who does that? You know, who’s going to be the one to say, we’ve got your back?

Who is it in your practice that if you’re not sure about something, who are you going to phone? Is it going to be…

[Jaz]
A safeguarding lead? Is that what you mean, like a practice…

[Christine]
Yeah, a safeguarding lead, or in the trust or health board in which you work, you might have a child protection advisor. It varies up and down the country. So, in Glasgow, for example, we have child protection advisors that even I would phone if I’m not sure about something.

And you might have a lead doctor for safeguarding, a lead nurse for safeguarding in your trust as well. So who do you phone? And never worry about phoning them. Don’t think that anything is too small. You’re not going to get a row from someone saying they don’t think this is really important. The fact that you’re the health professional who’s got that concern, don’t let them fob you off by saying, I actually don’t think that’s really important at all.

So practicing those scenarios. I’m always really happy to share different scenarios that I use in my teachings, for example. What do you do if you see someone, a parent, hitting a child in the head in your waiting room?

What would you practically do then? You know, who gets everyone’s name and address who’s been witnesses for it? Who phones the police? Who deals with it in that situation? Do you still see the patient? Do you not? As you mentioned, it will be specific on what the situation is, but always reaching out to the broader team is so important.

So leaning on your nurses, leaning on the other dentists in your practice, your practice manager as well, so that you’re supporting what’s happening at the moment, but then also the team going forward, because it can sometimes be really difficult because you don’t always get to see the end of the story.

And you’re left with that uncomfortable feeling of, did I do the right thing? I always think wondering whether you’ve done the right thing is better than wondering whether you should have done something. So my research shows that most dentists are worried about getting it wrong. They’re worried about making a referral when there’s nothing to be concerned about, or worse, not making the referral when there is something to be concerned about.

That’s what they’re most worried about. So it’s fear about what’s going to happen, and because you don’t, you can’t predict the future, so you don’t a hundred percent know what the consequences are, and dentists are worried that the parents are going to be angry and upset, and that could affect their practice as well if a whole family suddenly decides not to attend.

So it’s really just dependent, having that conversation in your practice that you work in to work out how you’re going to support everybody who is involved in it, having those chats about, this happened on Friday, let’s discuss it at the team meeting. What else could we have done? What should we do?

How is our practice presenting itself to do with child wellbeing? Are we focused on all of our patients, including our pediatric patients? So it’s not a surprise to anybody if we see something and we’re concerned about it, and we say, I’m concerned about this, even if it’s a bruise that would be unusual, so that they know, okay, you’re a dentist, but you’re concerned about a bruise, or you’re concerned about a bruise when you’re a dentist.

So things like that, Jaz, I would definitely say. And having the numbers somewhere you can access, because I don’t know all the numbers off by heart. And sometimes it depends where your patient’s based, it might be a different number to who your practice is. So just making sure that you have them somewhere easily, or that you’re using, I mean, most of the search engines will give you your safeguarding contacts for your trust or your health board.

[Jaz]
Or you can do a nice ask to your ChatGPT now.

[Christine]
Exactly.

[Jaz]
I work in Liverpool. What’s my next step? Like literally to have somewhere that can actually, okay, obviously take AI with a pinch of salt, but one good thing about AI is the way it’s developed is if, for example, when I have asked ChatGPT, should I eat this three-day-old chicken?

It will always give me like, but you know what, you probably shouldn’t. Even though you probably could, like you probably should. It’ll give you the safer advice. Now, in the same way, it’ll actually tend to give you safer advice, even if it’s just, okay, I think I need to speak to someone who is near this postcode.

And then it’ll actually do a decent job of telling you. Now what you reminded me of, Christine, is in our practice we have IT support, and underneath the computer there is a phone number that if you need IT support, call that number. Why don’t we all have, or do the homework ahead of time, our local safeguarding department just below that IT number? ‘Cause that’s another important, right?

Because if it’s not there, we are saying it’s not important enough. Or when the computer goes down, we can’t make any money. That’s important. But when something like this happens, if you don’t have a number, we’re saying to the universe, this is not important. So it’s important to have your leads ahead of time. And so how intricate does this policy need to be? Because like you mentioned, that scenario of a child being hit around the head, for example, in the waiting room. I wouldn’t know at that moment in time, I’d be like, is this even covered in our policy?

So it’s a very difficult one. It’s a bit like dental trauma. When dental trauma happens, yes, we know roughly about avulsion and stuff, but when it comes, we all want to just, let me just have a quick look at the guidelines just to make sure it’s current and remind me of the steps, ’cause it’s something that you see infrequently, but it’s important.

So infrequent and important, it’s good to remind yourself of guidelines. Are there a particular set of guidelines that are just so brilliant that are the equivalent to the dental trauma guide for safeguarding that covers a range of scenarios?

[Christine]
So I would say the best ones for neglect, dental neglect concerns, would be the British Society of Pediatric Dentistry’s guidelines on that. They’re the best ones for neglect. The other things about physical abuse, there’s not a particular guideline for that. But what I would say is if an adult wouldn’t take it, it’s probably a crime. So you wouldn’t sit and do nothing if you saw somebody getting punched in your waiting room. If an adult punched another adult, the adult who was the victim would report that crime.

So, the child can’t do it. But if a crime has happened against that child, then you are duty bound to report that. So it is illegal in the whole of the UK to hit any child on the head or with an object. So if you’ve seen that in your waiting room, it is a crime. So then phone the police, get advice from that way, and they’ll advise you. They will advise you what to do and for their, you need, obviously you can’t stop people…

[Jaz]
Let’s talk about this tough scenario. Let’s go deep into this hypothetical scenario, because from this scenario we can learn a lot, right? So you see that happen. You need to step up and speak to the parents, say, hey, please be kind to the child, please stop, okay, like the de-escalate scenario. But now, like if you feel as though you need to, ’cause a child’s crying and maybe they’re in pain, like to have to call the police. Like, I get it.

But what a tough thing for a general dentist or any team, practice manager, whoever, to do. Any advice you can give to, because it’s not this specific advice, but anytime you see something that you are concerned about in practice that is worthy of escalation, any advice you can give to general dentists listening or watching this right now, in terms of when you see something to that level where your adrenaline’s pumping that this is not good, that we need help. Any advice?

[Christine]
So what I would say is don’t feel you have to keep the people there. So if it happens and it’s a child that the crime has been perpetrated against, and the adult perpetrator is there, don’t put yourself in danger. Don’t feel that you have to keep them there. You have to report it.

You will have to phone the police and report that you have witnessed a crime. But don’t put yourself in danger. If they’re going to take the child away and they don’t like what you’re saying, let them go. You will probably be asked by the police for names and addresses of who’s been involved. So if they’re your patients, then you will be asked to give those details and like…

[Jaz]
And we’re okay to do that, right? Because ’cause usually, yeah, so if police ask that, usually they need some sort of a, I don’t know, a warrant or something. I’m trying to remember now. But usually you like to get permission from the parent, but in this scenario with a safeguarding issue, that’s probably not applicable. Am I right?

[Christine]
Yeah, I mean, we would always love to, but if they’re leaving and you can’t physically do it, then that’s okay. You can always act in…

[Jaz]
The child’s best interest.

[Christine]
Absolutely. And you can always speak to your indemnity provider if you want some advice or reassurance in that moment. That’s what your indemnity advisor, that’s partly what you pay your money for, is that they can give you that backup to say, absolutely, you’ve witnessed a crime, you’re well within your rights to give the police the information that they want.

Similarly, if you were to see that happen in the street, you would probably be a bit concerned about it. If you saw a child getting hit in the head in the street, you would be concerned about it and phoning the police at that stage.

When it happens in your practice, what I would say is be kind to yourself from the other point of view. Don’t, you know, if you have to stop what you’re doing, then be kind to yourself and explain to patients, I’m really sorry, we’ve had a terrible incident earlier, things are going to be delayed, or, I need to cancel your appointment today and rebook.

We’re concerned about all our patients, but we’ve had a really dreadful, horrible experience this morning, and we need to make sure everyone’s okay. The same way if your practice went on fire, you wouldn’t keep seeing your patients. As a dentist, if you were ill and unwell and had to be taken to hospital, your book would get canceled.

So don’t keep struggling on. I know we all feel so responsible to all of our patients, but remember to look after yourself as well. It’s really important, especially in safeguarding. As you mentioned, Jaz, it takes a lot out of you and it can be really involved. So look after yourself and your team.

[Jaz]
That’s really important. Now the other scenario then I wanna talk about, which is a bit more. So I think that’s great advice on how to de-escalate, make yourself safe. They don’t have to stay in the building, obviously, but then it’s given you then that space to block the rest of the morning or whatever and call the authorities, which I think is really clear and I like that.

So I think that’s good advice to give. But the scenario where there’s a bit more grey, whereby, and something that we see far more often, is poor oral hygiene, odour, just looking like the child’s not being well looked after, kind of like the first scenario you described, right. This is a bit more nuanced because at this point you may wish to express to the parent that, look, I am generally concerned.

What is the next step? Like, do you say to a patient, or to a parent, I’m generally concerned, is it okay if I contact blank? Like what’s the best script to use in that scenario?

[Christine]
Yeah, so that’s a lovely example, Jaz, that sort of, is it okay if I contact, although sometimes I won’t say, is it okay, because they may well say no, and you have to do it anyway.

[Jaz]
So that reminds me, Christine, of a funny story about that. One thing I teach about bruxism and stuff is never ask a patient, do you grind your teeth? Because you are the clinician. You’ve done your grind-scene investigation, you’ve seen the evidence.

There’s no point asking. It’s like asking as a parent, do you neglect their child’s health? Obviously they’re gonna say no. But they have been, right? Yeah. So there’s no point asking in that way. So I get that, and I appreciate that very much. Okay. So what’s the better way to do it?

[Christine]
So I guess my sort of script is, I’ve had a look, this is what I’ve seen, I’ve noticed there’s dental decay in X, Y, and Z. I’ve also noticed, I guess the other things you might see are head lice infestation, or that their clothes are quite dirty today. I have concerns about your child and I am going to pass them on. So you’re really wanting to inform them that it’s going to happen…

[Jaz]
Pass them on to? Do you need to specify?

[Christine]
Social services or social work. If you’re that concerned, that this situation is complicated or it’s not getting any better. Perhaps it’s a situation you’ve been trying to improve. And so we’ve tried X, we’ve tried Y, we’ve tried Z. Their oral hygiene isn’t getting any better. They’re getting more caries. I’m still noticing that their clothes are unwashed. So…

[Jaz]
So I think what we’re trying to say is there’s a difference between the first time you see a family and then maybe the third time. I think maybe what we’re trying to say here is the first new patients, maybe then to give the advice, maybe just limited to oral hygiene initially, and then see if they engage with that before you then say, okay, oh, what about the clothes and stuff?

But it’s a very difficult line to cross, which we shouldn’t as healthcare practitioners, as healthcare. So we are in a right to say, okay, are they being looked after, or have they showered, kind of thing. But I think the easiest thing to talk about is their oral health and put our energy there to see if they’re engaging. It’s like a yellow card before you give ’em the red card. Is that a good way to go?

[Christine]
That’s a nice way to put it. So what we might do initially, if it was something that I’d seen for the first time, is I might just go, right, the oral hygiene is really poor, and give them some easy targets. So you need to be brushing twice a day with an adult-strength fluoride toothpaste.

You need to bring them to the appointments that I’m giving you here. This is what they need from a dental health point of view. And give them those easy, not easy because it’s not easy for all families, but give them the targets that you would think would be the sort of lowest level. So bringing them to appointments with me, brushing twice a day with an adult-strength fluoride toothpaste, with an adult helping them if they can’t do it themselves, and then if they’re not engaging with that, and you’ve given them those targets and they’ve gained those…

[Jaz]
So for example, I’m just thinking out loud here, like, so it might be that, okay, I wanna see you every three months, but actually can you come in two weeks with the toothbrush and let’s do some toothbrushing together, and then that can actually check that, are they still bringing ’em to the appointments? And that gives you the second yellow card.

Potentially, not because you want to dish out red cards, but because you’re generally concerned about this child. And then this is like a little test?

[Christine]
Yeah. And also you want to make sure that it’s not just because they don’t have the knowledge and they don’t have the toothbrush. So you’re not wanting to condemn families, if you like, just because they don’t have those, they didn’t know how to do it. No one’s ever shown them how to brush their teeth. So how on earth do they know how to brush their child’s teeth if no one’s actually given them that lesson?

You can imagine if an adult has a neglected dentition themselves, they probably don’t have the knowledge and skills to be able to teach their children how to brush their teeth properly. So they need the input from dental services, from dentists or therapists or hygienists to say, this is actually how you brush your teeth, and then bringing them back to check that they are doing it.

And do they need help in any other way to try and get the teeth brushed? Are they able to get a toothbrush? Are they able to get toothpaste? Helping in practical ways, and then moving on. You would then, you’re sort of almost building evidence, either evidence that things are getting better, or evidence that things are not getting better.

Or you’re getting those, the sort of disguised non-compliance where they’ve made an appointment but they cancel on the day and rebook another one, and then they cancel on the day and rebook another one. So suddenly it looks like they’re always going to come to see you, but there might be months or years or huge gaps in dental attendance, and that can be very tricky. It can be obviously very damaging.

We know to children’s dental health, because we’ve seen that in our patients. When it happens, you suddenly, and we saw it in the pandemic, when we suddenly didn’t see them for a year, and then they, the impact that had on all the kids’ health.

If they didn’t have somebody at home who knew how to brush their teeth, who knew what they should be eating or drinking, and that kind of thing as well. So the BSPD policy document’s actually really good with that. It gives you the sort of first stage, so dental practice management, and then if things are not getting better, it gives you the second stage, which is your multi-agency involvement.

So if they’re under five or preschool, getting the health visitor involved. If they’re school age, perhaps contacting the school nurse, who won’t necessarily know that child. But if you contact them, then they’ll find out who that child is, if you think he needs some help from other healthcare professionals to try and get that child’s…

[Jaz]
The thing where I get stuck here, Christine, I think what a lot of colleagues will get stuck here is first line makes a lot of sense. Work on local measures, bring them back and make sure they’re engaging, and that’s fantastic. That’s really good advice. Second line of multi-agency, it’s always, I think that there’s not a hard thing to do, but the hard thing about that is getting the parent’s consent.

That’s always the bit where it gets a little bit scary for the dentist because they’re worried about backlash from the parent. They’re worried about emotions. They’re worried about all sorts of consequences. So any advice on dentists who are scared about how parents may react?

Because obviously like, as a father, we look after our children very well, and sometimes things happen in life. And if someone was to say to me, share a concern, you may be thinking that you’re doing a good job, you’d be livid. You’d be all like the, all the seven stages of denial, not denial, grief, like in grief, about that.

And then you can get anger and denial and all that kind of stuff. So, that’s probably the challenge in the managing the parent and getting permission and consent. So when it comes to like contacting the school nurse, for example, yes, ideally we need consent to do that.

[Christine]
Ideally, yes, but if you have got a welfare concern, then you can do it without consent. If you’re raising a notification of concern, there’s usually a tick box on that form. If you’re referring to social services or raising an early notification of concern, those forms are called different things, but on it somewhere will say, parent is aware of referral, and there’ll be a tick box, and sometimes I have to tick no.

Because I can’t get hold of the parent to tell them. They will find out that it was dental, because there’ll be some concern about teeth and somebody will want to look in their mouth, so they will find out. I find those conversations easier if I’ve been able to talk to them before. You do get upset parents who think you’re judging them.

I usually explain, like, my priority is your child’s health, as I am sure it is yours, and I want to work together with you to make sure that they’re okay and they can have the best outcome from dental health and their broader health, and I have to make that referral to get you some help with this.

So I would say probably lots of your breaking bad news skills come into it as well. And generally, dentists should be reassured, we’re actually quite good at that. Because often we have to give bad news, teeth coming out, unable to give them the smile that they want. You know, we use our skills that way.

So it is an extension of those skills as well. I don’t think we give ourself enough credit, because we are actually much better at doing that, because we probably do it more commonly than people think. So, yeah. But I totally get your point. And I’m a parent myself, and if the school phoned me and said, oh, we are concerned, my initial reaction would be probably one of shock, but you always…

[Jaz]
Shock, embarrassment, all these kind of things. As a parent, you think, but you know what, if at that stage a parent is embarrassed, it shows that they do care maybe, and they might then say that, you know what, I’m really sorry, there’s been other things going on, I’m gonna engage. And that’s the ideal response you want from a parent.

[Christine]
And long term you’re thinking, at least they have my child’s wellbeing at the core of what they’re doing. It does take a bit and a bit of logical thinking for the parent to get to that, but yeah. So sometimes if I’m struggling, and I’m human, so I struggle with these emotions as well, just be careful you’re not taking on their guilt, so that you’re not taking on the parent’s guilt. You didn’t put the caries there. You’re the dentist, you’ve seen it, but we’re all quite empathic. Lots of dentists are really empathic, so be really careful that the feelings that you are feeling are not the parents’ feelings. You’re not taking them on. You didn’t put the caries there. Your job is to help and do what you can to help.

And you will feel rubbish that you’ve upset someone. And that’s human. That’s human. But the guilt and the feeling of that isn’t yours.

[Jaz]
Well done.

[Christine]
That’s not yours.

[Jaz]
That’s such a great point. I think to always have that frame of, I am doing this for that child. I’m doing this for this child’s future. And when you wear, when you put that hat on, rather than I’m gonna let someone down, it’s much more powerful to say, I’m gonna help this child, rather than I have to give bad news. And I think when that self-talk, that pep talk is there in that way, I can imagine that being very helpful.

Thankfully, I’ve never had to make such a referral. When I was in the NHS, had some times where we discussed it as a practice, but I can imagine it’s a very tough thing to do. But what you’ve given today is some good exercises, some good scripts. The biggest takeaway for me is not to ask the parent that, hey, is it okay if I refer here?

It’s like, hey, I have some concerns. I’d like to get in touch with the GP and, not, I’d like to, I’ll be getting in touch with the GP and the school nurse just to make sure that your child’s being well looked after, ’cause our priority is your child’s health. So, I’m just saying, you know, I’ll be doing that.

But we’ll be seeing you in a few months’ time for your appointment. Can you make sure that in time, can you do this, this, and this so that their health is well looked after?

[Christine]
Absolutely.

[Jaz]
How does that sound to you, Christine?

[Christine]
Absolutely, and I would say if anyone is ever struggling, what I always go back to is, what do I want that child to think about in years to come? When they’re grown up and they’re an adult and they can look back, do I want them to look back and say, that dentist Christine, she saw me and knew I needed help and did X, Y, Z, or, that dentist saw me and knew I needed help and did nothing. And I never…

[Jaz]
Because a child doesn’t know, like they don’t know that they, at that moment, you know? And that’s a tragic truth.

[Christine]
And I never want to personally be, and I never want any of my dental colleagues to be, the last health professional to see a child that something then horrific happens to.

[Jaz]
That’s a very powerful message. Christine, I’m gonna end at that point because that’s such a powerful thing, that you need to remember why we do this. And if you are involved in seeing children, that’s a real strong duty of care. Now thankfully, thankfully, it depends on where you practice in the world, but thankfully it’s not a common thing. But it’s an important thing. And it may, depending on, you may come across this, it’s a bit like oral cancer, right?

It’s not like super common. Like we do our oral cancer screening every single time, and in your lifetime you might find a few. And I imagine it’s similar here, like if you’re looking for it, firstly it starts as screening, looking for it. We all do the training for oral cancer, red patches, and then a bit like that, like quite a lot of times we refer and nothing comes of it, because actually it’s fine.

Or they have their management plan. So if we start treating these issues a bit like mouth cancer and not being afraid that it’s a dud referral, but actually sometimes like in painless, and they keep checking up and whatnot, and so I think that, I don’t know if that analogy works for you, Christine.

[Christine]
No, it absolutely does. And in the same way with oral cancer, you can absolutely save a child’s life or improve their life, improve their family’s life, improve the community’s life. You think what an awful impact that would have if something awful happened to the child, to the family, to the community you work in.

So you can make a huge difference. And don’t be hard on yourself about it.

[Jaz]
Christine, thank you so much for just a wonderful guidance that you’re providing dentists and all the research that you’ve done. I think you’ve made it really tangible for us. Where can we learn more from you? What are the resources you recommend?

Obviously, you can email me some, I’ll put them in the show notes, but tell us about if you wanna send some message or thanks or connecting. What’s the best way to do?

[Christine]
So if anyone does want to come and hear me speak, I’ll be speaking at the Scottish Dental Show in June. So that one’s in Glasgow, so it’s local for me, so that one’s easy. I usually, I run, if you’re in Scotland, I do some NES webinars there as well. I’m always very happy for anyone, anywhere, to email me about any questions they’ve got, so I can give you my email address, Jaz, you can share that. And definitely have a look at the BSPD guidelines on dental neglect. They’re really good.

[Jaz]
I’ll make those available as well.

[Christine]
Yeah, absolutely.

[Jaz]
Amazing. Thank you so much, Christine. We appreciate it.

[Christine]
You’re very welcome.

Jaz’s Outro:
Well, there we have it, guys. Thank you so much for listening all the way to the end. This is a recommended topic by the GDC, so you can claim your CPD for this and all the other episodes that we have.

If you are a paying member of Protrusive, head over to protrusive.co.uk/ultimate to find out how you can unlock CPD for the episodes and access our vast library of videos and masterclasses from splint course to crown preps and everything in between. Now below in the show notes, I’ll give a link to any of the guidelines that Christine promised.

And of course, if you want the full PDF premium notes, they are available for our members on the Protrusive Guidance app. If you find these episodes helpful, please tell a colleague, tell a friend. It really helps team Protrusive to grow and serve more dentists and therefore serve more patients.

Thank you, dear friends, I’ll catch you same time, same place next week. Bye for now.