Domestic violence is unfortunately common in the US. Estimates say that about five million women and perhaps two million men who are victims of intimate partner violence each year.
Domestic violence is a threat not just to the oral health of victims, but to their lives and to the lives of those around them. Dentists can help domestic violence victims, and we have a responsibility to help them. Here’s what we can do.
About 75% of domestic violence targets the head, neck, and mouth. Dentists can identify the signs of domestic violence with relatively quick screening tools. Some of the more common signs of domestic violence include:
- Missing or knocked-out teeth
- Unexplained trauma to the mouth
- Lacerations in the mouth, such as from the cheek striking teeth
- Neck trauma, including signs of strangulation
- Scarring and other evidence of trauma around the mouth
- Lesions in the mouth
- Unexplained orofacial pain
- Untreated or excessive decay
- Bruxism and other signs of stress
Patients who used to regularly make their cleaning visits and checkups but now attend sporadically may be victims who are not allowed to see healthcare professionals. They may only be allowed to see their dentist when the most visible signs of abuse are healed. In cases of sporadic attendance, dentists should look for older signs of violence.
Talk to Victims
Dentists have a responsibility to follow-up on signs of domestic abuse. Domestic abuse threatens the oral health and even the life of patients, so not following up represents a serious breach in care. In addition, most victims want their dentists to speak up. A 2009 study showed that about half of abuse victims saw a dentist when they had visible signs of abuse. However, 89% of those who saw a dentist said they weren’t asked about their injuries. Of those who weren’t asked, 69% said they wish they had been asked.
Dentists can and should ask simple, direct questions about domestic violence. The questions should include asking about who did the violence. Dentists should document the signs of abuse with photographs.
Listen to Victims
Make sure patients understand that the dentist’s office is a safe place for confidential communication. Don’t be judgmental and communicate your nonjudgmental attitude. Encourage patients to speak freely, and make it clear that in most cases Ohio law does not require you to report violence–that is their decision. For many people, a dentist is the only healthcare professional they see regularly. Even if they see other providers, they often spend more time with their dentist. And patients may still keep seeing a dentist even if they stop going to other doctors. They may trust you, and they need the opportunity to talk about what’s happening.
Ask victims if they want you to report their violence. Ohio law recognizes that victims have the best sense of the relative risk of reporting violence. Only in cases of gunshot wounds, stabbings, second or third degree burns, severe injuries, and child or elder abuse is reporting required.
Help victims understand what resources are available to them. Have copies of resource cards available to hand to victims if they want them.
Part of the healing process for domestic violence can include reconstructive dentistry to repair the damage caused by violence and/or neglect. By restoring a victim’s smile, we can help them learn to love their lives again.
And it’s important to remember that there are many dimensions of healing where dentists can provide assistance. For example, we recently helped a patient who suffered from post-traumatic stress disorder (PTSD) following her abuse. It made it hard for her to sleep, and her sleep was further impaired by sleep apnea. Treating her sleep apnea helped her get more rejuvenating rest so she could heal better.
Let’s Make a Difference
In the past, dentists may have felt it was not their place to intervene in domestic violence. But now we know that helping victims of domestic violence is an important part of our commitment to the health and safety of our patients. We will do what we must and all that we can to help victims of domestic violence.