Manifestation of child abuse symptoms is a very complex phenomenon. Concerning a several aspects of the child live as physical health, behavioural impairment, neglect, school and friends’ relationships. We distinguish between four types of violence – physical violence, sexual abuse, emotional violence and neglect (1). A dysfunctional family does not meet the emotional needs of its members, does not provide security or proper conditions for proper development and growth (2, 3). A child experiencing domestic violence rarely seeks help in an open manner, do not directly communicate the problem. So that the responsibility for identifying and responding to a problem lays on adults. Children exposed to domestic violence reported to a dentist present several symptoms that can help in detection of child abuse (4). In diagnosing some of the child’s somatic disorders, doctors often ignore the fact that many of the symptoms can be the result of violence against the child. To help them, the physician must be very attentive to any symptoms and effects of domestic violence. In dentistry the most common observation is dental neglect. Dental neglect is defined as the persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral health or development (5). Child neglect act is manifested in several ways: lack of caregivers’ interest in the acquisition of information related to dental care, lack of preventive care that shall be performed at home by caregivers (e.g. oral hygiene), dental appointment no-shows, severe untreated caries. Although the head and neck region and oral cavity is a frequent site of abuse in children, visible injuries are rarely observed in dentist everyday practice (6). Becker et al. reported that most frequent intraoral injury in cases of child abuse were in 43% contusions and ecchymosis, 28.5% were abrasions and lacerations of oral mucosa and 28.5% were dental trauma (7). Others report that, physical abuse can cause hematoma on lips may, lacerations, scars of previous trauma, burns caused by hot food or cigarettes, ecchymosis, excoriations. Gagging the mouth may result in bruises, lichenification, or scarring at the corners of the mouth (8, 9). In dental office, from the psychological point of view, children by contact with stressful situation may expose a specific behaviour which can help professionals in detecting child abuse. What’s more oral diseases may be direct expression of emotions or conflicts, while in other instances lesions of the mouth may be an indirect result of emotional problem (10). It has been proven that psychological disorders in people who are victims or witnesses of violence (long-term stress, depression) have their physical manifestations (11). Doctors must therefore be sensitive to more subtle effects of experiencing domestic violence – dental neglect, emotional and psychological effects and psychosomatic symptoms (changes in the mucous membranes, clenching, bruxism) (12-16). Physicians must be aware of the histories, behaviors and physical findings of maltreated children.

The aim of this review was to search the literature for original papers investigating the physical and psychological symptoms of domestic violence and describing the methods of detecting domestic violence in the dental office.

The systematic literature review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analyses PRISMA checklist (17). A review was performed in the following databases: PubMed, EBSCO, Wiley Online Library, EMBASE, Warsaw Medical University Library. The research was supplemented by hand searching by one professional. Key words that were used in search strategy were: “child abuse syndrome”, “domestic violence”, “dentist”, “violence”, “child”, “oral health”. The search strategy is shown in the table 1.

Inclusion criteria: original research, published after 2000 in English, Polish and Spanish language of children 0-18 years old assessing the methods of detection child abuse and neglect in the dental office-physical examination, interview with the parents/guardians, psychological examination and behaviour assessment.

Exclusion criteria: case reports, cross-sectional articles, literature reviews, books and books chapters, articles, guidelines, studies sampling exclusively undergraduate dentistry students; letters to the editor and/or editorials. All papers describing the situation of child abuse in the hospital environment (maxio-facial surgery department) were excluded.

The verification process is shown by the use of PRISMA flow diagram (fig. 1) (17).

Of 2721 potential studies screened, 52 studies were reviewed and 5 included (representing 1108 children). The full texts of the selected studies were revisited, and their data were extracted standardly. The information extracted and recorded from the studies were: the authorship; the year of publication; the country in which the study was developed; the sample size, age average, aim of the study. The characteristics of the qualified articles are presented in the table 2.

In selected articles different methods of research and obtaining information were used. They are presented in the table 3.