Dental appointment nonattendance as a marker of potential child abuse and neglect in pediatric patients

Many instances of child abuse and neglect (CAN) remain undetected, despite the availability of established risk assessment tools. Previous research has associated missed medical appointments with hospitalization due to CAN; however, no studies have explored the relationship between documented child abuse and the risk of dental appointment nonadherence. This 12-year retrospective analysis aimed to determine whether children with a history of CAN exhibit higher rates of no-show (NS) or late-cancellation (LC) for dental visits compared to matched control children. A retrospective review of electronic health records (EHR) from a tertiary medical center was conducted for patients aged 0 months to 16 years from 07/01/2010 to 06/30/2022. Patients with documented histories of CAN were compared to a control group matched on age at first scheduled dental encounter and sex in a 1:5 ratio. Outcomes included rates of NS, LC, timely cancellations (TC), and completed appointments. A total of 354 patients with a history of CAN and 1770 matched controls were analyzed. In multivariable models, group membership was significantly associated with counts of LC, NS, and completed appointments, but not with TC (incidence rate ratio [IRR] = 0.98; 95% confidence interval (CI) 0.91–1.05). Compared to controls, the CAN-exposed group had a 29% higher average number of LC (IRR = 1.29; 95% CI 1.08–1.53), 109% higher odds of having at least one NS (odds ratio [OR] = 2.09; 95% CI 1.61–2.72), and among those with at least one NS, a 26% higher average number of NS (IRR = 1.26; 95% CI 0.99–1.59). Additionally, the CAN-exposed group had a 10% lower average number of completed appointments (IRR = 0.90; 95% CI 0.85–0.95). NS and LC rates were higher among children with a history of CAN compared to controls. These patterns may occur more frequently in children at risk for CAN, suggesting a need for further investigation, heightened awareness by dental providers, and consideration of referral to child welfare professionals when concerning patterns are observed.