A Child's Injuries and a Request for Silence
A 7-year-old boy, Devon, is seen in a Dover practice for a cleaning. He has eight untreated carious teeth, a swollen upper molar with a sinus tract, and poor oral hygiene. His mother says, 'We've had a rough year; I can't afford the dentist.' While the hygienist is polishing, she sees a yellowish bruise on his cheek and a torn upper labial frenum. Devon flinches when his mother raises her hand to answer her phone and says, 'Please don't tell her I told you.' The mother then asks the hygienist not to 'write anything down that will get us in trouble.' The child has missed three previous appointments. The dentist is out of the office and the front desk says, 'We don't report; we just give them a referral.'
1. Does the hygienist have a duty to report? What standard applies, and to whom?
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Yes. Dental hygienists in New Hampshire are mandated reporters of child abuse and neglect. The standard is reasonable suspicion, not proof. A swollen tooth with a sinus tract, eight untreated carious teeth, a torn labial frenum, a bruise, flinching, and missed appointments together are enough to require a report. The hygienist should report promptly to the New Hampshire Division for Children, Youth and Families (DCYF) and, if there is immediate danger, to law enforcement. She should not investigate, question the mother, or wait for the dentist. A referral to a pediatric dentist is good care but does not satisfy the reporting duty. The mother's request not to write anything down does not override the legal obligation.
2. What should the hygienist document, and what should she not do?
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Document objective observations and direct quotes: which teeth, the sinus tract, hygiene, the bruise location/color/size, the frenum, the child's statements and behavior, the mother's statements, and the fact that a report was made (time, agency, person contacted). Do not write conclusions like 'mother is abusive.' Do not photograph without following policy and consent, and do not promise confidentiality. Continue to provide needed care or an urgent referral. Keep the record factual; if a child-protection investigation follows, the record may be evidence. Do not confront the mother, and do not tell the child he 'got someone in trouble.'
3. The mother asks to see the record and demands removal of the note. How should the office respond?
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The mother may request a copy of the record under the office's privacy policy, but the hygienist cannot remove or alter the note. The dentist or records custodian should handle the request and consult counsel if there is an active investigation. The hygienist should tell the mother that she cannot change the clinical record and refer her to the dentist. If the mother demands deletion, document the request but do not comply. Protecting the child and preserving an accurate record take priority over the mother's discomfort.