Intimate Partner Violence for Dental Professionals

The dental community can play a vital role in identifying and halting the cycle of IPV by simply offering screening services to every single patient. However, one study of dental professionals found that “…61.5% of participants reported being unprepared to appropriately screen for IPV and 64% felt they could not correctly refer patients to local support services.”²³ Not only is preparedness a barrier for screening for IPV, but some practitioners fear losing a patient because of asking “taboo” questions or a potential lawsuit, the dental health professional being uncomfortable with the topic, and, if male, assuming that patients would more likely disclose to a female practitioner.²⁴ However, more than half of the victims surveyed in 2009 in Texas had seen a dentist when physical signs of their abuse were visible, and “…more than two-thirds indicated that they would have appreciated being asked” about the etiology of their injuries.²⁴

If a patient reports being a victim of IPV, the dental professional should offer empathetic support and referral options. Signs of IPV may be observable physical wounds or other marks. Almost 75% of IPV victims have injuries to their head and neck regions, which is exactly the area of specialty for dental professionals.^11,24 They could also include certain types of behavior or behavioral changes. Specific signs include:

• Public and private demeaning actions by an intimate partner. The partner may be reluctant to leave the victim alone during the appointment, domineering during the appointment, or answering all questions for a patient who would otherwise be capable of answering themself.²⁶

• Psychological abuse is associated with periodontal diseases.²⁶

• Stress from abuse can also lead to TMD disorders and chronic pain.²⁶

• Injuries to the neck, head, and face that may be in different stages of healing including:

  • intraoral bruising, patterned bruising around the neck due to strangulation;

  • abscessed, avulsed, or non-vital teeth;

  • lacerations or burns;

  • fractures to teeth, mandible, maxilla, or nose;

  • torn frenum or mucosal linings;

  • complaints of headaches;

  • bite marks;

• Various types of behavior changes, either observed or reported, including:

  • chronic pain or inability to sleep,

  • personality changes,

  • frightened behavior when with the opposite sex,

  • afraid to return home,

  • report of injuries caused by an intimate partner,

  • drastic behavioral changes in the presence of an intimate partner,

  • victim appears embarrassed, vague, anxious, or depressed,

  • low self-esteem,

  • blaming self or others for everything,

  • changes in the patient’s routine , including patients who used to come in for regular check-ups and who suddenly stop.

  • exaggerated startle response

  • spontaneous tears

  • dissociation from eye contact (or a sudden fading out of the patient’s attention/responses to cues)

  • inability of the patient to talk clearly due to breathing patterns or panic

  • reluctance or insecurity in answering questions posed by the dental professional