{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:14:43Z","timestamp":1785413683568,"version":"3.56.0"},"reference-count":44,"publisher":"AOSIS","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Dental neglect is defined as the \u2018wilful\u2019 failure of a parent and\/or guardian to provide optimal oral healthcare, leading to pain and infection. Child abuse and neglect, including dental neglect, are significant public health issues with long-term consequences for victims.\nAim:\u00a0Given the early childhood caries (ECC) prevalence and socio-economic circumstances of South Africa\u2019s (SA) population, the aim of this review is to explore whether ECC constitutes child neglect in SA.\nMethod:\u00a0This study explored existing literature on ECC prevalence in SA and its association with dental neglect. It examined SA\u2019s child protection policies and considered the socio-economic context contributing to dental neglect.\nResults:\u00a0Evidence suggests that dental neglect, including untreated caries, may indicate broader neglect. However, SA\u2019s historical injustices, poverty, unemployment and lack of access to quality healthcare and education have resulted in high economic disparity among its population, perpetuating ill-health. Early childhood caries in SA is a broader social problem shaped by political, social and economic forces. Societal neglect shifts focus away from parents and towards examination of harmful government policies and actions which impose constraints on families, leading to diseases such as ECC.\nConclusion:\u00a0Child safety, optimum healthcare and prevention of neglect should be priorities of SA\u2019s health and government systems as the country works towards universal health coverage and health system reform.\nContribution:\u00a0This study raises awareness about dental neglect as a child health issue, addresses the root causes of ECC within a societal context, advocates for policy changes and aligns with national and global health priorities.<\/jats:p>","DOI":"10.4102\/hsag.v30i0.3129","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T12:26:52Z","timestamp":1762345612000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early childhood caries: Exploring the ethical implications for dental neglect in South Africa"],"prefix":"10.4102","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3601-5428","authenticated-orcid":false,"given":"Nashna","family":"Rampersad","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00h2vm590","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Western Cape"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2184-2648","authenticated-orcid":false,"given":"Nadia","family":"Mohamed","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00h2vm590","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Western Cape"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2025,11,6]]},"reference":[{"key":"ref0","unstructured":"American Academy of Pediatric Dentistry, 2020, Definition of dental neglect, American Academy of Pediatric Dentistry, viewed 17 July 2022, from https:\/\/www.aapd.org\/research\/oral-health-policies--recommendations\/dental-neglect\/."},{"key":"ref1","unstructured":"American Public Health Association, 2019, Public health code of ethics, viewed 17 July 2022, from https:\/\/www.apha.org\/getcontentasset\/43d5fdee-4ccd-427d-90db-b1d585c880b0\/7ca0dc9d-611d-46e2-9fd3-26a4c03ddcbb\/code_of_ethics.pdf?language=en."},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Asaka, Y., Sekine, M., Yamada, M. & Tatsuse, T., 2020, \u2018Associations of socioeconomic status and lifestyle factors with dental neglect of elementary school children: The MEXT Super Shokuiku School Project\u2019, Environmental Health and Preventive Medicine 25(1), 1\u20139. https:\/\/doi.org\/10.1186\/s12199-020-00916-y","DOI":"10.1186\/s12199-020-00916-y"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Bagattini, A., 2019, \u2018Children\u2019s well-being and vulnerability\u2019, Ethics and Social Welfare 13(3), 211\u2013215. https:\/\/doi.org\/10.1080\/17496535.2019.1647973","DOI":"10.1080\/17496535.2019.1647973"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Besnier, E., Thomson, K., Stonkute, D., Mohammad, T., Akhter, N., Todd, A. et al., 2021, \u2018Which public health interventions are effective in reducing morbidity, mortality and health inequalities from infectious diseases amongst children in low- and middle-income countries (LMICs): An umbrella review\u2019, PLoS One 16(6), e0251905. https:\/\/doi.org\/10.1371\/journal.pone.0251905","DOI":"10.1371\/journal.pone.0251905"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Bradbury-Jones, C., Innes, N., Evans, D., Ballantyne, F. & Taylor, J., 2013, \u2018Dental neglect as a marker of broader neglect: A qualitative investigation of public health nurses\u2019 assessments of oral health in preschool children\u2019, BMC Public Health 13, 370. https:\/\/doi.org\/10.1186\/1471-2458-13-370","DOI":"10.1186\/1471-2458-13-370"},{"key":"ref6","unstructured":"Burton, P., Ward, C.L., Artz, L. & Leoschut, L., 2015, The Optimus study on child abuse, violence and neglect in South Africa, Centre for Justice and Crime Prevention, Cape Town, viewed 15 July 2022, from http:\/\/www.ci.uct.ac.za\/overview-violence\/research-bulletin\/optimus-study-on-child-abuse-violence-neglect-in-SA."},{"key":"ref7","unstructured":"Cukovic-Bagic, I., Welbury, R.R., Flander, G.B., Hatibovic-Kofman, S. & Nuzzolese, E., 2013, \u2018Child protection: Legal and ethical obligation regarding the report of child abuse in four different countries\u2019, Journal of Forensic Odonto-Stomatology 31(1), 15\u201321."},{"key":"ref8","unstructured":"DICAG, 2016, National Health Insurance for South Africa: Toward universal health coverage, Dullah Omar Institute for Constitutional Law, Governance and Human Rights & Disabled Children\u2019s Action Group, viewed 16 July 2022, from https:\/\/dullahomarinstitute.org.za\/women-and-democracy\/reporting-on-childrens-rights\/national-health-insurance-for-south-africa-towards-universal-health-coverage\/view."},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez, C., Borjas, M., Cambr\u00eda-Ronda, S. & Zavala, W., 2020, \u2018Prevalence and severity of early childhood caries in malnourished children in Mendoza, Argentina\u2019, Acta Odontol\u00f3gica Latinoamericana 33(3), 209\u2013215. https:\/\/doi.org\/10.54589\/aol.33\/3\/209","DOI":"10.54589\/aol.33\/3\/209"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Fisher-Owens, S.A., Gansky, S.A., Platt, L.J., Weintraub, J.A., Soobader, M.J., Bramlett, M.D. et al., 2007, \u2018Influences on children\u2019s oral health: A conceptual model\u2019, Pediatrics 120(3), e510\u2013e520. https:\/\/doi.org\/10.1542\/peds.2006-3084","DOI":"10.1542\/peds.2006-3084"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Francis, D. & Webster, E., 2019, \u2018Poverty and inequality in South Africa: Critical reflections\u2019, Development Southern Africa 36(6), 1\u201315. https:\/\/doi.org\/10.1080\/0376835X.2019.1666703","DOI":"10.1080\/0376835X.2019.1666703"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Harris, J. & Whittington, A., 2016, \u2018Dental neglect in children\u2019, Paediatrics and Child Health 26(11), 478\u2013484. https:\/\/doi.org\/10.1016\/j.paed.2016.07.003","DOI":"10.1016\/j.paed.2016.07.003"},{"key":"ref13","unstructured":"Hugar, S.M., Govan, E., Mohandass, S., Gokhale, N.S., Kukreja, P. & Hugar, S.S., 2016, \u2018Knowledge, attitude and perceptions among the parents of preschool children regarding oral health and early childhood caries (ECC)\u2019, Manipal Journal of Dental Sciences 1(1), 13\u201320."},{"key":"ref14","unstructured":"Jamieson, L., Sambu, W. & Mathews, S., 2017, Out of harm\u2019s way? Tracking child abuse cases through the child protection system in five selected sites in South Africa, Children\u2019s Institute, University of Cape Town, Cape Town, viewed 24 November 2022, from https:\/\/open.uct.ac.za\/items\/2e67a069-c7af-46a5-91f1-59f172a58911."},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Kiatipi, M., Davidopoulou, S., Arapostathis, K. & Arhakia, A., 2021, \u2018Dental neglect in children: A comprehensive review of the literature\u2019, The Journal of Contemporary Dental Practice 22(2), 199\u2013204. https:\/\/doi.org\/10.5005\/jp-journals-10024-3019","DOI":"10.5005\/jp-journals-10024-3019"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Kimmie-Dhansay, F., Barrie, R., Naidoo, S. & Roberts, T., 2022, \u2018Prevalence of early childhood caries in South Africa: A systematic review\u2019, BMC Oral Health 22(1), 32. https:\/\/doi.org\/10.1186\/s12903-021-01982-6","DOI":"10.1186\/s12903-021-01982-6"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Kimmie-Dhansay, F., Barrie, R., Roberts, T. & Naidoo, S., 2021, \u2018Risk indicators for early childhood caries in South Africa: Protocol for a systematic review\u2019, JMIR Research Protocols 10(6), e25795. https:\/\/doi.org\/10.2196\/25795","DOI":"10.2196\/25795"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Lalumandier, J.A. & Molkentin, K.F., 2004, \u2018Establishing, funding, and sustaining a university outreach program in oral health\u2019, Health Affairs 23(6), 250\u2013254. https:\/\/doi.org\/10.1377\/hlthaff.23.6.250","DOI":"10.1377\/hlthaff.23.6.250"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Magan, A., 2020, \u2018Individual and social determinants of oral health in South Africa in the context of COVID-19\u2019, South African Dental Journal 75(8), 440\u2013444.","DOI":"10.17159\/2519-0105\/2020\/v75no8a4"},{"key":"ref20","unstructured":"Mann, J., Gruskin, S., Grodin, M.A. & Annas, G.J., 1999, Health and human rights: A reader, Routledge, Boston, MA."},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Maphumulo, W.T. & Bhengu, B.R., 2019, \u2018Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review\u2019, Curationis 42(1), e1\u2013e9. https:\/\/doi.org\/10.4102\/curationis.v42i1.1901","DOI":"10.4102\/curationis.v42i1.1901"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Mohamed, N. & Barnes, J.M., 2018, \u2018Early childhood caries and dental treatment need in low socio-economic communities in Cape Town, South Africa\u2019, Health SA Gesondheid 23, a1039. https:\/\/doi.org\/10.4102\/hsag.v23i0.1039","DOI":"10.4102\/hsag.v23i0.1039"},{"key":"ref23","unstructured":"Mohamed, N. & Naidoo, S., 2014, \u2018A review of child abuse and the role of the dental team in South Africa\u2019, South African Dental Journal 69(6), 250\u2013256."},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Moodley, I. & Singh, S., 2018, \u2018Exploring community-based training opportunities for dental therapy students in non-governmental private sectors in KwaZulu-Natal Province, South Africa\u2019, African Journal of Health Professions Education 10(3), 176\u2013182. https:\/\/doi.org\/10.7196\/AJHPE.2018.v10i3.1031","DOI":"10.7196\/AJHPE.2018.v10i3.1031"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Mukhari-Baloyi, N., Ramphoma, K. & Phalwane, M., 2022, \u2018Association of parental factors and delayed dental care for children\u2019, South African Dental Journal 76(10), 607\u2013612. https:\/\/doi.org\/10.17159\/2519-0105\/2021\/v76no10a4","DOI":"10.17159\/2519-0105\/2021\/v76no10a4"},{"key":"ref26","unstructured":"Peerbhay, F. & Barrie, R.B., 2012, \u2018The burden of early childhood caries in the Western Cape Public Service in relation to dental general anaesthesia: Implications for prevention\u2019, South African Dental Journal 67(1), 14\u201316."},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Plutzer, K. & Keirse, M.J.N.C., 2010, \u2018Incidence and prevention of early childhood caries in one- and two-parent families\u2019, Child: Care, Health and Development 37(1), 5\u201310. https:\/\/doi.org\/10.1111\/j.1365-2214.2010.01114.x","DOI":"10.1111\/j.1365-2214.2010.01114.x"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Rampersad, N. & Mohamed, N., 2023, \u2018Early childhood caries: Exploring the ethical implications for dental neglect in South Africa\u2019, Population Medicine 5(Suppl.), A1473. https:\/\/doi.org\/10.18332\/popmed\/163702","DOI":"10.18332\/popmed\/163702"},{"key":"ref29","unstructured":"Ramphoma, K.J., 2016, \u2018Oral health in South Africa: Exploring the role of dental public health specialists\u2019, South African Dental Journal 71(9), 402\u2013403."},{"key":"ref30","unstructured":"Sajadi, F.S., Torab, M., Salari, Z. & Shamsolmaali, B., 2018, \u2018Effect of social-behavioral factors on dental caries in 3\u20136-year-old children in Kerman, Iran\u2019, Journal of Oral Health and Oral Epidemiology 7(4), 182\u2013190."},{"key":"ref31","unstructured":"Schmidt, K. & Azzi-Lessing, L., 2019, \u2018Neglect of young children in South Africa: Implications for prevention, identification, and intervention\u2019, Child Welfare 98(6), 29\u201352, viewed 08 July 2022, from https:\/\/www.jstor.org\/stable\/48623211."},{"key":"ref32","unstructured":"Scorca, A., Santoro, V., De Donne, A., Grattagliano, I. & Introna, F., 2013, \u2018Early childhood caries (ECC) and neglect in child care: Analysis of an Italian sample\u2019, Clinical Therapeutics 164(5), e365\u2013e371. https:\/\/doi.org\/10.7417\/ct.2013.1614"},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"Seow, W.K., 1998, \u2018Biological mechanisms of early childhood caries\u2019, Community Dentistry and Oral Epidemiology 26(S1), 8\u201327. https:\/\/doi.org\/10.1111\/j.1600-0528.1998.tb02090.x","DOI":"10.1111\/j.1600-0528.1998.tb02090.x"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Shaw, M. & De Jong, M., 2018, \u2018Child abuse and neglect: A major public health issue and the role of child and adolescent mental health services\u2019, The Psychiatrist 36(9), 321\u2013325. https:\/\/doi.org\/10.1192\/pb.bp.111.037135","DOI":"10.1192\/pb.bp.111.037135"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Smit, D.A., Barrie, R.B. & Louw, A.J., 2017, \u2018The burden of dental caries in the Western Cape and a recommended turn-around strategy\u2019, South African Dental Journal 72(8), 360\u2013365. https:\/\/doi.org\/10.17159\/2519-0105\/2017\/v72no8a3","DOI":"10.17159\/2519-0105\/2017\/v72no8a3"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Smit, D.A. & Osman, Y.I., 2017, \u2018The availability of the basic oral health care package in the Western Cape\u2019, South African Dental Journal 72(4), 162\u2013166. https:\/\/doi.org\/10.17159\/2519-0105\/2017\/v72no8a3","DOI":"10.17159\/2519-0105\/2017\/v72no6a2"},{"key":"ref37","unstructured":"StatsSA, 2021, Recorded live births, 2020, Statistics South Africa, viewed 15 July 2022, from https:\/\/www.statssa.gov.za\/?p=14902."},{"key":"ref38","unstructured":"StatsSA, 2022a, Money CAN buy happiness! Statistics South Africa, viewed 15 July 2022, from https:\/\/www.statssa.gov.za\/?p=15224."},{"key":"ref39","unstructured":"StatsSA, 2022b, South Africa\u2019s youth continue to bear the burden of unemployment, Statistics South Africa, viewed 15 July 2022, from https:\/\/www.statssa.gov.za\/?p=15407."},{"key":"ref40","unstructured":"The World Bank, 2015, Global monitoring report 2014\/2015 \u2013 Ending poverty and sharing prosperity, viewed 19 July 2022, from https:\/\/www.worldbank.org\/content\/dam\/Worldbank\/gmr\/gmr2014\/GMR_2014_Full_Report.pdf."},{"key":"ref41","doi-asserted-by":"crossref","unstructured":"Thomas, J.C., Sage, M., Dillenberg, J. & Guillory, V.J., 2002, \u2018A code of ethics for public health\u2019, American Journal of Public Health 92(7), 1057\u20131059. https:\/\/doi.org\/10.2105\/ajph.92.7.1057","DOI":"10.2105\/AJPH.92.7.1057"},{"key":"ref42","unstructured":"World Health Organization (WHO), 2021, Seventy-fourth world health assembly \u2013 Oral health, World Health Organization, viewed 19 July 2022, from https:\/\/apps.who.int\/gb\/ebwha\/pdf_files\/wha74\/a74_r5-en.pdf."},{"key":"ref43","unstructured":"World Health Organization (WHO), 2022, Social determinants of health, World Health Organization, viewed 19 July 2022, from https:\/\/www.who.int\/health-topics\/social-determinants-of-health#tab=tab_1."}],"container-title":["Health SA Gesondheid"],"original-title":[],"link":[{"URL":"https:\/\/hsag.co.za\/index.php\/hsag\/article\/view\/3129\/6455","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T12:26:59Z","timestamp":1762345619000},"score":1,"resource":{"primary":{"URL":"https:\/\/hsag.co.za\/index.php\/hsag\/article\/view\/3129"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,6]]},"references-count":44,"URL":"https:\/\/doi.org\/10.4102\/hsag.v30i0.3129","relation":{},"ISSN":["1025-9848","2071-9736"],"issn-type":[{"value":"1025-9848","type":"print"},{"value":"2071-9736","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,6]]},"article-number":"a3129"}}