Dental Tribune America

Interview: “Domestic violence lies in the dark alley of society”

The role dentists play in recognizing potential cases of domestic violence is rarely discussed. In a recent interview, Dental Tribune International spoke with Timothy Ellis, lead author of a paper on the dental and oral biomarkers of brain injury in domestic violence, to find out more about the topic and about what can be done if such cases arise in a dental practice.

What led you to investigate the unique position dentists have in recognizing domestic violence?
Dentists are considered experts of head and neck anatomy and, in our previous work done on brain injury, Dr. Jonathan Lifshitz and I realized that a majority of brain injuries in domestic violence situations also include injuries to the head, face, oral cavity and neck. This led us to begin searching for specific oral biomarkers for dentists to recognize as indicators of domestic violence.

What are some of the key signs dentists can look out for that might point to domestic violence being an issue?
Signs of domestic violence range from the subtle to the obvious. They can present in hard and soft tissue found both inside and outside of the oral cavity. Bony fractures, such as of the zygomatic-orbital complex, maxilla or mandible, blunted roots and pulpal necrosis may accompany such trauma or be a sign of a previous dental trauma that warrants further inquiry and investigation. Even more subtle indications may be seen in the temporomandibular joint, resulting in dysfunction or malocclusion. A deviated nasal septum, torn frenum or unique buccal bruising, especially when an intraoral appliance is present, may indicate previous trauma. Intraoral buccal or labial bruising and lingual frenal lacerations and tears in a nonambulatory individual and intraoral injuries in nonambulatory infants are pathognomonic for abuse.

How can dental professionals best act if presented with a patient suffering from domestic violence?
The message for dentists, hygienists and other dental support staff is that they should speak up if they detect anything of concern. Without doubt, it is much easier to accomplish a dental visit without inquiring about the source of an injury or the specific nature of an odd finding on a comprehensive oral exam. Yet, the potential exists for dentists and their teams to make a meaningful connection with patients by guiding potential victims to additional support and care. Domestic violence lies in the dark alley of society; a universal community effort to identify, refer and treat will empower individuals to live the lives they imagine for themselves.

What kind of further education could benefit dentists in dealing with patients who might be suffering from domestic violence?
Awareness and education are critically important. Many resources are under development or are already available that make the connection between traumatic brain injury and domestic violence by raising awareness and presenting the epidemiology of the subject. To this end, dental health care professionals can seek out continuing education and independent learning on the subject. Future dentists, hygienists and other paraprofessionals could benefit from a dedicated curriculum as part of their initial training.

I imagine that the purpose of the paper was to bring dentistry and its subspecialties into the conversation about traumatic brain injury. What impact has it had since publication?
You are absolutely correct. The goal was to bring dentistry and its subspecialties into the conversation. The paper has been well received, and multiple media sources continue to share the insights with others. On social media, worldwide acknowledgment and distribution of reports on the article are evident. Local news networks, schools, organizations, medical professionals and individuals have shared in the discussion and expressed an appreciation for our approach to the topic. We are pleased that a conversation has begun. This is a first step toward addressing the issue of traumatic brain injury in domestic violence.

Editorial note: The study, titled “Restoring more than smiles in broken homes: Dental and oral biomarkers of brain injury in domestic violence,” was published online on April 11, 2019, in the Journal of Aggression, Maltreatment and Trauma, ahead of inclusion in an issue.

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