Dentistry’s Role in Preventing Family Violence

by Lynn Douglas Mouden, DDS, MPH, FICD, FACD

A young patient presents to your office with bilateral injuries to the face.  She reports that she fell at home.  Ask yourself an important question: “How likely is someone to injure both sides of their face in a single fall?”  Is this a case of suspected child abuse? A middle-aged woman comes to your office with a painful tooth.  But in the course of your talking with her, you notice multiple bruises of varying colors on her neck and arms.  Because only you and your chairside assistant are in the room, your question this time is to the patient, “are you safe at home?”  Is this a case of suspected domestic violence? Do the bruises indicate many incidents over time?

Either of these cases may have you asking yourself, “why should I, as a dentist, be concerned about suspected family violence?”  The short answer is because we are healthcare professionals.  The rest of the answer for us is that as much as 75% of physical violence involves injury to the head, neck, and mouth.

Family violence is physical, sexual or emotional injury inflicted by someone with a relationship with the victim.  It can include child abuse – and neglect – domestic violence (also called intimate partner violence, IPV), and elder abuse – and neglect.  Any of these can result in severe permanent injury or even death.

While state laws vary in their reporting requirements, ALL states mandate that dentists and dental hygienists are required to report suspected cases of child abuse and neglect.  Many states expand that requirement to include suspected cases of elder abuse and neglect. 

The issue of reporting suspected intimate partner violence is more complicated.  Only a few jurisdictions require reporting of IPV.  The difference is that competent adults can make decisions regarding their own health and safety.  Required reporting may take away that decision.  Keep in mind that leaving or staying in a relationship is complicated and that the most dangerous time in an IPV relationship may be when the victim tries to leave.  Familiarize yourself with local resources.  Every state has coalitions against domestic violence that can provide resources, training and information.  Also, many communities have shelters that provide a haven for victims as a way to leave their situation.

Our role as dental professionals is NOT to make definitive diagnosis of abuse or neglect – not to play CSI, or forensic pathologist.  The requirement is to report suspected cases.  Use your professional judgement.  Learn to differentiate between accidental injuries or disease entities from intentional injuries.  Training is available in many states under programs specially for dentists.  Some resources may also be found online.

An ancient saying is that “whoever saves one life saves the life of the world.”  All that is asked of you is to help save one life so that together we can save many.