39.5 Safeguarding Children and Vulnerable Adults

6. Safeguarding Children & Vulnerable Adults

Dental professionals occupy a frontline role in safeguarding because 50% to 65% of all physical injuries in non-accidental trauma to children occur on the head, face, neck, and mouth.

Four Primary Categories of Abuse

1. Physical Abuse: Non-accidental bodily injury inflicted or knowingly not prevented.
2. Emotional Abuse: Persistent emotional ill-treatment or rejection causing severe adverse effects on emotional development.
3. Sexual Abuse: Forcing or enticing a child or vulnerable adult to participate in sexual activities.
4. Neglect: Persistent failure to meet basic physical, emotional, and psychological needs.
   • Dental Neglect Defined: "The persistent failure to obtain and provide necessary dental treatment to maintain oral health, resulting in persistent pain, infection, extensive untreated dental caries, nutritional compromise, or school absence, where parents or carers have been repeatedly advised of the need and barriers to care have been addressed."

Orofacial Indicators of Non-Accidental Injury (NAI)

Safeguarding Reporting Pathways and Legal Primacy

• Practice Safeguarding Lead: Every UK dental practice must appoint a designated Safeguarding Lead.
• Reporting Hierarchy: When a safeguarding concern is identified:
  1. Discuss immediately with the Practice Safeguarding Lead.
  2. Consult or refer to the local Children's Social Care / Multi-Agency Safeguarding Hub (MASH) or Local Authority Designated Officer (LADO).
  3. If a child or adult is in immediate physical danger, dial 999 for emergency police protection.
• Confidentiality vs. Safeguarding: Under the Children Act 2004, the Data Protection Act 2018, and GDC standards, the professional duty to safeguard a child or vulnerable adult supersedes the duty of patient confidentiality. Clinicians do not require parental consent to make a safeguarding referral if seeking consent would place the child at increased risk of harm.

Recognising Dental Neglect

Dental neglect has a working definition that candidates are expected to know: the persistent failure to meet a child's basic oral health needs, likely to result in the serious impairment of a child's oral or general health or development. It is recognised by a pattern rather than a single finding — untreated, extensive, obvious dental disease; a parent who does not seek treatment, repeatedly fails appointments or does not complete an agreed treatment plan; and disease that persists despite the family having been informed and offered care. Dental neglect may be an indicator of wider neglect, and its presence should prompt consideration of the whole child rather than of the teeth alone.

The recommended response is graded. Preventive dental team management means raising concerns with the parent, offering support, setting targets and keeping careful records. Preventive multi-agency management means liaising with the health visitor, school nurse or general medical practitioner and agreeing a joint plan. Child protection referral is made where there is significant harm or where the graded response has failed. At every stage the concern, the discussion and the plan are recorded.

Duties, Thresholds and Confidentiality

Safeguarding is where the duty of confidentiality is most clearly displaced. Where a registrant has a reasonable concern that a child or an adult at risk is suffering or is likely to suffer significant harm, information may and should be shared with the relevant safeguarding agency without consent, and the GDC expects registrants to act on their concerns rather than to wait for certainty. The threshold for referral is reasonable suspicion, not proof; it is not the dentist's role to investigate or to confirm abuse, and delay while seeking certainty is itself a failure.

Every practice must have a named safeguarding lead, a written safeguarding policy with current local contact details for children's and adults' social care and the police, and all team members must undertake safeguarding training appropriate to their role, updated regularly. Registrants must know how to refer and to whom, must record their concerns factually and contemporaneously with verbatim quotation where a child has disclosed something, and must follow up a verbal referral in writing. Female genital mutilation carries a specific statutory duty: regulated health and social care professionals in England and Wales must report to the police any case in which a girl under 18 discloses that she has undergone FGM, or where it is observed on examination.

Adults at Risk

Safeguarding adults follows the Care Act 2014 in England, which places duties on local authorities and sets out the categories of abuse: physical, domestic, sexual, psychological, financial or material, modern slavery, discriminatory, organisational, neglect and acts of omission, and self-neglect. The principle of making safeguarding personal means that, unlike with children, an adult with capacity generally decides what happens about their own situation; information is shared without consent only where there is a risk to others, where a serious crime is involved, or where the person lacks capacity to make that decision. Recognising that difference in approach between children and capacitous adults is a favourite examination discrimination.