Child sexual abuse and the pediatric dentist.

c h i l d sexual abuse has increased dramatically over the last decade. An estimate of the incidence at the beginning of the 1980s put the number of sexual assaults on children at 300,000 annua1ly.l Most authorities agree that these estimates are probably low, due to underreporting as a result of a number of factors: 1. Cultural mores make sexual abuse a stigma for victim, perpetrator, and family and an issue not easily broached. 2. Victims are often young children whose fear, lack of awareness, or lack of language skills make them easy prey and victims who may not be ready or believable witnesses.2 3. Health professionals may be unaware of the signs or symptoms of child sexual abuse.3 4. Child sexual abuse often is hidden with no visible physical manifestations .2 5. Health professionals may be unwilling to report cases of sexual abuse where clear physical evidence is lacking for fear of error, reprisal, or loss of patients. 6. Verification of sexual abuse by physical examination may be beyond the legal extent of practice for many professionals. One other reason for low reporting is the lack of an accepted definition of sexual abuse. Not all states agree on a legal definition of sexual abuse. Federal statues define sexual abuse in the context of child abuse and include such acts as child pornography, rape, molestation, incest, and child prostitution. The