- Dentistry and Family Violence -
What Does The Dental Team Need To Know
For example, dental professionals may observe physical injuries such as chipped or cracked teeth, poor dental hygiene, a broken jaw, a black eye, a broken nose, bruises on the earlobes or chin, and fingermarks on the neck, upper arms, or wrists.
Multiple studies confirm that head, face, and neck injuries occur in more than one-half of child abuse cases.
In cases of partner abuse, one study of 218 female domestic violence victims who were examined at a hospital emergency department found that the most common injuries were bruises
(70 percent), and the most common location of injury was the face (68 percent).
A similar study found that 94.4 percent of domestic violence victims had head, neck, or facial injuries, and a third study of 98 battered women found that 58 percent had injuries to the face and head.
In elder abuse cases, the types of abuse most frequently reported included bruises and welts, broken dentures, fractured and avulsed teeth, and abrasions and lacerations.
Given that dental professionals routinely assess the head, face, and neck of patients, they are in a unique position to identify the signs of family violence.
In fact, these victims may seek out dental treatment for injuries related to violence. A 1998 national survey revealed that 16.7 percent of women who sought health care for rape injuries visited dentists, and 9.2 percent of women who sought care for physical assault by a partner saw a dentist.
In addition, routine dental visits may alert dental professionals to evidence that patients are being abused and lead to early intervention.
Lack Of Recognition And Intervention
Despite the likelihood that dental professionals will interact with a victim of abuse in a clinical setting, few recognize family violence as a problem their patients encounter.One study found that dentists (n=247) and dental hygienists (n=271) were the least likely of all clinicians surveyed to suspect child, spouse, or elder abuse. Close to one-half of the dental professionals surveyed did not view themselves as responsible for dealing with these problems.
In a second survey of dentists (n=321), 87 percent said they never screened for domestic violence, and 18 percent did not screen even when patients had visible signs of trauma on their heads or necks. Respondents intervened only minimally to help patients they had identified as victims.
A third survey of dentists (n=400) found that 29 percent of them had suspected at least one patient to be a victim of child abuse and 14 percent had reported at least one such case. Only 7 percent had suspected a case of elder abuse, and slightly more than 1 percent had reported at least one such case.
About 30 percent of respondents indicated they had suspected at least one case of spouse abuse and 3 percent had reported such a case. Less than 1 percent of all child abuse reports nationwide are made by dental professionals even though all 50 states require dentists to report suspected cases of child abuse and neglect, and 41 states require the same of dental hygienists.
Barriers to Intervention Reported by Dental Professionals
- Limited knowledge of family violence issues.
- Lack of practical experience on how to intervene.
- Misconceptions about the nature of intervention.
- Fear of litigation.
- Lack of local referral information.
- The presence of a partner or children.
- Concern about offending patients.
- Embarrassment about bringing up the topic.
This bulletin seeks to:
- Promote training for dental professionals on their role in intervening in patient cases of family violence.
- Encourage the inclusion of dental professionals in community efforts to coordinate response to family violence.
Critical Need for Education
The likelihood that dentists and dental hygienists will suspect or intervene in family violence appears to depend on the amount of related education they receive.
Of all the clinicians sampled in one survey, dentists and dental hygienists reported the smallest proportion of education in child, spouse, and elder abuse.
As a group, they also suspected abuse the least often. Another survey found that dentists who received domestic violence education were significantly more likely to screen for domestic violence and intervene as necessary.
The study’s authors concluded that education on domestic violence needs to be “standardized and incorporated into dental school and continuing education curricula, thus ‘normalizing’ intervention with victims and making it a standard part of a dentist’s professional responsibility.”
Family Violence: An Intervention Model for Dental Professionals
Clearly, there is a need to better prepare dental professionals to intervene on behalf of patients who have been abused and neglected.
The University of Minnesota’s Family Violence: An Intervention Model for Dental Professionals training program was developed for this purpose. It includes a 6-hour curriculum, instructional videos, a training manual, a poster for office display, resource directories, and marketing materials.
The comprehensive curriculum educates dental professionals about the symptoms and patterns of abuse, methods for creating a safe environment for disclosure, appropriate interventions when abuse is suspected, and patient referrals.
The curriculum, which includes overheads, slides, and a template, can be duplicated and integrated into dental school and dental hygiene programs. It can be used in two segments for training students or as an all-day seminar for practicing dental professionals.
Do
- Assure patients of confidentiality to the extent allowed under the state’s mandatory reporting laws.
- Listen to the patient.
- Respond to the patient’s feelings.
- Acknowledge that disclosure is scary for the patient.
- Tell the patient that you are glad she or he told you.
- Provide the patient with options and resources.
- Document the information in the patient’s chart.
- File mandatory reports.
- Schedule a followup visit.
Don’t
- Joke about the violence.
- Minimize the issue or try to change the subject.
- Discuss the abuse in front of the suspected perpetrator.
- Violate confidentiality, unless it falls under the state’s mandatory reporting laws.
- Give advice or dictate an appropriate response.
- Shame or blame the patient.
- Grill the patient for excessive details of the abuse.
- Lie about the legal and ethical responsibilities to report the suspected abuse.
