Almost one-third of primary care dentists had concerns about a child patient being the victim of abuse or neglect over the course of the previous year, but just 8% made a formal report, according to new research.
The study also showed that "clear barriers" to reporting those concerns needed to be addressed if dentists were to meet their legal obligations under mandatory reporting laws.
The research, published in the Irish Journal of Applied Social Studies, involved anonymous questionnaires being sent to all salaried primary care dental managers (17) and senior and general dentists (239) in Ireland in March 2017, with almost two-thirds completed and returned.
According to the report: "It was found that although 30.8% of dentists had suspected at least one case of possible child abuse and neglect over the previous 12 months, only 8.1% of the HSE dentists had formally reported at least one case of concern over the same period."
The research was conducted before the introduction of mandatory reporting in December 2017.
As for what the dentists observed in the course of their work: "It was found that 20 of the 65 (30.8%) HSE dentists who answered the question reported they had encountered a situation over the previous 12 months that had caused them to suspect that a child was being abused or neglected.
16 of the 63 (25.4%) HSE dentists who responded reported to have raised concerns informally at least once over the previous 12 months about a child with either their line manager or the TUSLA Duty Social Worker.
"However, only 5 of the 62 (8.1%) dentists who answered the question reported to have formally reported (as per standard HSE protocol prior to December 2017) at least one case of concern about a child over the previous 12 months."
As for the reasons why they may or may not make a formal report, the researchers found that just 10.4% reported having no concerns about doing so and more experienced dentists were more likely to make a report.
"Some of the main concerns given were lack of certainty of the diagnosis (49.3%), fear of being identified as the reporter (35.8%), fear of violence or unknown consequences toward the child (34.3%), uncertainty about the consequences of reporting (32.8%), fear of violence to myself, other staff and/or my family (25.4%), lack of knowledge of the referral process (23.9%) and lack of confidence in the child protection service and their ability to handle such sensitive cases (20.9%).
"In the case of a dental neglect issue, 37.5% of the dentists said that they would prefer to support the family to attend with their child for dental appointments, rather than to report the case to TUSLA."
Fear of litigation was cited by almost 18% of respondents.
To address the issue, half of the HSE dentists and 45% of the dental managers indicated that they would like child protection courses with a larger dental component and all dental managers felt that they and their staff need further education and support in managing suspected CAN cases.
The research, written by staff in Cork Kerry HealthCare Organisation, HSE South, HSE Primary Care Reimbursement Service, Dublin 11, and the Dublin Dental University Hospital, can be read here: