Intervention of Domestic Violence
dentists in the US do not screen for domestic violence, even though they have the
opportunity to do so.
The national survey of 321 dentists by
researchers in the UCSF School of Dentistry found many didn'tt screen even when
patients presented with visible signs of trauma on their head or neck.
The study, "Dentists Attitudes and
Behaviors Regarding Domestic Violence -- The Need for an Effective Response," appears
in the January issue of the Journal of the American Dental Association. Dentists
throughout the country were asked about their attitudes and clinical practice behaviors
related to domestic violence, said lead author Barbara Gerbert, PhD, UCSF professor and
chair of the division of behavioral sciences in the School of Dentistry.
"The health consequences of domestic
violence are severe," Gerbert said. "It is the most common cause of serious
injury to women and accounts for more than 50 percent of all female homicides."
Another study published by the American Medical Association on "Diagnostic and
Treatment Guidelines on Mental Health Effects of Family Violence" estimated that
women in the United States face a 20 to 30 percent lifetime risk of battery. Contrary to
commonly held beliefs, abuse happens to women of all ages, races, religions, income and
education level, and sexual orientation.
Research also has shown that the majority (68
to 94 percent) of domestic violence victims suffer head and neck injuries including
lacerations, bruising and fractures, Gerbert said. "Given that oral health care
professionals routinely assess a patients head and neck, dentists have a unique
opportunity to recognize that a woman is being abused and to intervene," she said.
Research on physicians response to
domestic violence has found that identifying women who are being abused can be difficult
due to many factors, Gerbert said. Domestic violence victims are reluctant to disclose
abuse to their providers, mainly due to fear of their partners retaliation, shame,
humiliation, denial about the seriousness of the abuse, and concern over confidentiality.
According to physicians responses, the patients evasiveness and failure to
disclose information is a major barrier to the identification of domestic violence.
Gerbert said that while many studies focused primarily on physicians responses to
domestic victims, there are few focused on dentists responses.
The dentists in the UCSF study reported that
the major barriers to their screening for domestic violence were the presence of a partner
or children during the office visit; the dentists lack of training in dealing with
the issue, concern about offending patients, and the dentists own embarrassment
about bringing up the topic of abuse.
Because of these and other barriers to
screening in the oral health care setting, the UCSF researchers do not recommend universal
screening for domestic violence. "But dentists must be enabled to recognize and
respond appropriately to signs of abuse," Gerbert said.
The most hopeful finding from the study was
that domestic violence education increased the likelihood that dentists would screen for
abuse and intervene. Dentists with domestic violence education were more likely to make a
note in the patients chart, express concern for the patients safety, give
referrals and/or arrange for the patients safety. In addition, more than half of the
dentists surveyed reported that they would like more training in this area. These data
support the recent efforts of the American Dental Association to enact domestic violence
educational programs for dentists. To address the barriers uncovered in the study, Gerbert
suggested that this type of education focus on specific intervention behaviors, become
standardized and be incorporated into dental school and continuing education classes.
The Gerbert study offers a model for
intervening called AVDR. This limits the dentists tasks to the following areas:
Asking patients about abuse;
- Giving validating messages which acknowledge
that battering is wrong and confirm the patients worth;
- Documenting presenting signs, symptoms and
disclosures in writing and with photographs; and
- Referring victims to domestic violence
specialists in the community.