Editorial for DR OMFS Special (Volume 5, Issue 9)
Restore more than smiles in broken homes...the uncomfortable truth of domestic violence must be uncovered by the ethical dentist.
We focus on head and neck injuries of athletes or military veterans, but victims of domestic violence comprise an under-represented group.
An article from Journal of Aggression, Maltreatment and Trauma, reports that 75% of head and neck trauma associated with domestic violence, occurs with oral injury. Researchers have concluded that dentists are in the unique position to probably be the first and only health professional to evaluate a domestic violence victim.
Yet, dentists receive no education about identifying and discussing domestic violence with potential victims.
It is estimated that more than 4.8 million women are assaulted annually worldwide.1
Statistics show as rage, frustration and stress grows, men are also being subjected to violence.
An astonishing 2.9 million men are victims of intimate partner violence. 1
Violence between children, elderly and same-sex partners is also being seen.
The problem is more common than we assume, and it is possible that we are interacting with such patients on a daily basis - but it does not cross our mind.
Did you know that head and neck trauma is most common in domestic violence?
A number of studies have shown that the head and neck are the most frequently injured areas in abused patients, resulting in fractures, traumatic brain injuries, burns and traumatic dental injuries.
The aggressor's preference for the face of the victim can be associated with the symbolic nature of humiliation that this kind of violence represents. When women are attacked, face aggression is associated with the aggressor's intention of damaging a socially appraised attribute: a woman's beauty. The head is the most exposed and accessible body area that represents the individual. This region of injury can direct or indirectly devastate the victim's life by affecting their appearance and communication, and cause functional, esthetic, psychological and social problems.
Oral biomarkers of domestic violence
The oral biomarkers that could help dentists potentially identify domestic violence victims are majorly traumatic injuries of teeth.
A dental study in Brazil 2 collected data of domestic physical aggression from police records. The aggression in all cases occurred in the form of punches and slaps. There was a predominance of individuals with head and neck injuries and the frequency of traumatic tooth injuries was 2%. The most frequently injured teeth were maxillary incisors, followed by mandibular incisors and maxillary canines. Of the dental trauma cases, 59% were tooth fractures, 27% were luxations and 13% were avulsions. In conclusion, domestic violence was an uncomfortable, yet important etiologic factor of traumatic dental injury.
Child Abuse
According to the American Academy of Pediatrics, over 2.5 million cases of child abuse and neglect are reported each year.
A study in Arabia 3 assessing the occurrence of trauma in students, pointed that domestic violence was the second most common cause of injury. They highlighted that as information was obtained from the children's parents, it may even be the top common cause, since parents may not confess towards the true degree of aggression against their own children. Children's abuse was seen as contusions, burns or laceration of the tongue, lips, oral mucosa, palate (hard and soft palate), alveolar gingiva and frenum, injuries to the facial bones, and mandibular fractures.
Dental neglect
Dental neglect may be an indicator of domestic violence. The aggressor typically doesnot care enough for the victims to get their treatments done or restricts them from seeking help or health care. The victims may not have the confidence to approach a health care facility on their own and may be too mentally and physically exhausted to undertake a strict and consistent oral hygiene regime at home.
Routine conditions showing dental neglect, which may at times be related to domestic violence are:
- untreated decay
- facial pain
- lesions in the mouth
- long standing cases of complete edentulousness
- new and old facial bruises or
- facial lacerations.
How to diagnose - Clinical signs & symptoms of domestic violence
When injuries are seen in cases with no proper history and severe signs and symptoms, the likelihood of abuse should be strongly suspected 4:
- Missing or avulsed teeth
- Unexplained oral trauma
- Bruises, both old and new
- Lacerations in the mouth or around the face
- Neck trauma, including marks or bruises
- Evidence of trauma or scarring in the perioral area
- Lesions in the mouth
- Unexplained orofacial pain
- Untreated or rampant decay
Additional Clinical Signs of Domestic Violence 4:
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