Key points

Introduction

“Interpersonal violence (violence and abuse) is the intentional use of physical force or power, threatened or actual, against oneself, against another person or against a group or community, which results in a high likelihood of injury, death, psychological harm, maldevelopment, or deprivation” (WHO, 2011). It occurs in the context of a broad range of human relationships including violence within the family: child abuse and neglect, intimate partner violence (IPV), and elder abuse. It is estimated that more than 2.5 million women are abused annually, and 30% to 50% of all female homicides are perpetrated by former or current intimate partners. Within the past 2 to 3 decades, violence and abuse (V/A) has been recognized as a significant public health problem among female patients. Beyond the physical and psychological repercussions, a significant number of female victims have lower health-related quality of life and more frequent use of health services.

A growing awareness of the scope and effects of V/A have led various health care bodies, including the American Medical Association (AMA), the American College of Obstetricians and Gynecologists (ACOGS), and, most recently, the Institute of Medicine (IOM), to recommend that all patients be asked routinely about abuse, regardless of their presenting injury or symptoms. The American Dental Association (ADA) developed an educational policy for identifying all victims of abuse. Dental providers were advised to look for symptoms such as conflicting histories of injury, behavioral changes, and multiple injuries at various stages of healing, as well as recoil behavior during dental examinations. In 1999, the American Academy of Pediatrics and the American Academy of Pediatric Dentistry concurred that “in all 50 states, physicians and dentists are required to report suspected cases of child abuse to social service or law-enforcement agencies and to collaborate in order to increase the prevention, detection, and treatment of these conditions.”

In a viewpoint article of the ADA News (2006), Colangelo summarized the importance of increasing the dental community’s understanding of and response to domestic violence, because of the common involvement of the head, neck, and oral cavity. An estimated 75% of physical abuse cases result in injuries to the head, neck, and/or mouth, areas that are clearly visible to the dental team during examination. With more than 50% of adults and children visiting the dentist at least once per year, oral health care providers are in routine contact with affected patients. However, studies show that these providers are not always aware of the pivotal role they can play even though the dentist and his or her team are in an ideal position to identify a significant number of patients who have experienced V/A. In a survey of dentists, only 6% of respondents reported that they commonly suspected spousal abuse among their female patients. Concerns reported among these dentists that may affect their likelihood to inquire about IPV include inadequate professional training in detecting an abuse victim and ambiguity in orofacial signs of abuse. Likewise, there may be various reasons for why female patients do not report IPV, including reluctance to admit the true cause of an injury, shame, denial, fear, poor communication between the provider and patient, or desire to protect the assailant.

This article provides compelling evidence that supports the unique position occupied by dental professionals within the arena of the detection, intervention, and prevention of V/A. The authors review the epidemiology of orofacial risk factors for V/A, and diagnostic tools and surveys for identifying victims of all ages, and suggest interdisciplinary educational curricula and specific algorithms to provide the necessary core competencies for identifying victims in the oral health care environment. In addition, evidence is presented to characterize the disproportionate number of female patients who are victims. By doing so, the oral health care provider will successfully identify and prevent future injuries to their patients within the community setting.