Role of the odontologist in the investigation of domestic violence, neglect of the vulnerable, and institutional violence and torture

Battered and Brain Injured: Traumatic Brain Injury Among Women Survivors of Intimate Partner Violence-A Scoping Review

OBJECTIVES

The objective of this scoping review is to examine the extent, range, and nature of literature targeting health-care professionals on the prevalence and outcome of intimate partner violence (IPV)-related traumatic brain injury (TBI). The purpose is to gain an understanding of prevalence, investigate screening tool use, generate IPV/TBI-specific support recommendations, and identify suggestions for future research.

METHOD

The review was guided by Arksey and O'Malley's five stages for conducting a scoping review. A comprehensive search of nine databases revealed 1,739 articles. In total, 42 published research papers that focused specifically on TBI secondary to IPV were included in the study.

SYNTHESIS

The literature reports inconsistencies in prevalence rates from IPV-related TBI. There are no current standardized screening practices in use, though the literature calls for a specialized tool. Frontline professionals would benefit from education on signs and symptoms of IPV-related TBI. Empirical studies are needed to generate reliable data on prevalence, experience, and needs of brain-injured survivors of TBI.

CONCLUSIONS

Findings from this study demonstrate the need for the development of an IPV-sensitive screening tool, more accurate data on prevalence, an interprofessional approach to care, and raised awareness and education on the diffuse symptoms of IPV-related TBI.

Patient preferences on sharing private information in dental settings

BACKGROUND

The authors conducted a study to understand patients' preferences and comfort levels in discussing personal medical, behavioral, and social information with their oral health care providers.

METHODS

A self-report survey was completed by US adults 18 years and older (N = 387) using Amazon Mechanical Turk, an online research portal for survey-based research. The survey assessed comfort discussing demographics, physical health, behavioral health, oral health, and living conditions with oral health providers.

RESULTS

Factor analysis suggested that participants were comfortable discussing demographics and standard dental questions but were less comfortable answering questions about trauma, stress, coping, and living and behavioral patterns. Demographics did not predict comfort with disclosure, and many participants did not feel personal information was relevant to oral health care.

CONCLUSIONS

Community education efforts can focus on helping patients understand how oral health is related to behavioral health and social conditions.

PRACTICAL IMPLICATIONS

Dental education should focus on helping oral health care providers communicate comfortably around these topics, balancing education with respect for a patient's willingness to disclose.

Methods in population study of orofacial injuries in Victorian family violence homicides

This study standardized the methods used in the determination of orofacial injuries in Victorian family violence homicides and informed potential control selection for an analytic study. Dental service contacts with family violence victims may be intervention avenues due to the presence of abusive injuries in the orofacial region. All Victorian family homicides from January 2000-September 2018 were identified by determining the kinship/relationship and grouped by age. A 20% random sample of adult cases, aged 18-64 years was selected. The median number of orofacial injuries in categories of injury mechanisms/age/gender and the nature of abusive orofacial injuries was reported for the sample. Of 357 closed cases of family homicide, 261 were adults aged 18-64 years. Offender information and injury mechanism data was available for all closed cases, enabling case selection. Of a random sample of 50 adults, 8 cases were excluded. After 2006, CT scans and photos were present in 20 (91%) and 19 (86.4%) of 22 cases, respectively. The nature and median number of orofacial injuries showed correlation to the reported injury mechanism. Strengths and limitations of the used methods were assessed. Not all cases were compatible for assessment of orofacial injuries, thus serving as an additional criterion for exclusion in our methodology. Further detailed study of the whole population of adults should be limited to the period 2006-2018 where the data is more complete. The mechanism of injury may influence control selection for analytic studies. We present preliminary evidence of the frequent occurrence of orofacial injuries in family violence homicides.

Role of a Dentist in the Diagnosis of Child Abuse and Neglect: A Literature and Narrative Review

Background:

Child Abuse (CA) is defined as any physical or psychological harm inflicted upon children. The most commonly affected anatomical region in these cases is the orofacial complex, thereby placing dentists in a dominant position for detecting CA. The statistical figures referred to CA are high, and many cases go unreported.

Objective:

To determine the level of knowledge, the aptitudes and capacity of dentists in reporting cases of CA; the barriers facing the reporting of cases; and the key clinical characteristics for the detection of CA.

Methodology:

A search was made of the PubMed (MEDLINE), ScienceDirect, LILACS and SciELO databases for articles published up until March 2019, involving analytical observational and descriptive studies relevant to the objectives of our study. All articles were independently reviewed by two authors.

Results:

Injuries caused by CA are largely located in the orofacial region – the most prevalent being caries, burns and fractures. The most frequently identified risk factor is behavioral alterations on the part of the parents or caregivers. The reviewed studies reflect a discrepancy between suspected and reported cases of CA.

Conclusion:

Although dentists are able to detect injuries, there is a great lack of knowledge about how to report cases of CA to the authorities. It is interesting to establish guidelines for the detection and reporting of suspicious cases. Improved training in forensic and legal dentistry is needed, together with the establishment of detection and reporting protocols. The clinical signs detected in the case of CA and neglect include untreated caries, poor oral hygiene, traumatisms, burns, lacerations and biting. The recognition of such signs and correct case history compilation are essential for the detection of CA.

Examining the perceived versus the actual knowledge about forensic odontology: A cross-sectional survey among dentists

Dentists should have the basic essential skills and knowledge about forensic odontology, to better collaborate with law enforcement and investigations. The objective of this survey was to assess the perceived and actual knowledge toward forensic odontology among dentists and to question their willingness to attend training courses on this specialty. A cross-sectional survey based on a self-administered questionnaire was conducted in various districts of Saudi Arabia. Four hundred dentists responded to a questionnaire that tested their actual knowledge of forensic odontology based on answering 15 statements using the alternatives correct, incorrect, do not know. The perceived knowledge was registered as strongly agree, agree, neutral, disagree, and strongly disagree, then assigned scores respectively from four to zero. A willingness to attend a training course in the future was recorded by (yes/no). Scores were summated then subjected to descriptive statistics and regression analyses. Responses were received from 360 study participants (89% response rate). The percentage of correct answers, that is, the actual knowledge, was 67.9 (standard deviation [SD] ± 18.4). About two thirds of the responders (n = 251, 69.7%) indicated a willingness to attend a forensic odontology course in the future. Differences in both actual and perceived knowledge were identified on the basis of gender, work experience, education level, attended a course in forensic odontology, and having previously provided a past bite-mark examination. The perceived knowledge on forensic odontology among dentists was moderate to low. The gap between perceived and actual knowledge signifies low self-confidence. Dentists with higher education levels and experience tend to have better knowledge.

Educational needs in the field of detection of domestic violence and neglect: the opinion of a population of French dentists

OBJECTIVES

The attitude of French dentists concerning domestic abuse has hardly ever been documented upon so far. The purpose of this study is to investigate the attitudes, knowledge and practices of a population of French general dental practitioners towards the prevention and detection of signs of neglect and abuse in order to determine the educational needs both during undergraduate curriculum and continuing education sessions.

METHODS

A total of 418 general dental practitioners all practising in the French area of Puy de Dôme were invited to participate in the study. The survey was conducted with questionnaires including multiple-choice or open questions and VAS scales.

RESULTS

The response rate was 54% (228/418). Only 5.7% of the practitioners systematically look for signs of neglect or abuse when treating their patients. 36% declare having already come across one or several cases of abuse and 48% having suspected at least one. The patients concerned were mainly women (54%). Only 28% would adopt an attitude in compliance with the French legislation if confronted with a case of abuse or domestic violence. 75.9% of the practitioners would like more training and assistance in the detection and care of abused patients and particularly as regards signs of abuse and the legal framework.

CONCLUSIONS

More information and training concerning abuse and domestic violence is required in the French undergraduate dental curriculum in order to help practitioners deal with such patients.

Oral injuries in victims involving intimate partner violence

INTRODUCTION

Current literature states that dental medicine can have an important role in diagnosing situations of domestic violence, namely cases of intimate partner violence, since many of the injuries that occur in this context concern the head and neck areas. The aim of this study was to characterize oral injuries in these cases in a Portuguese population, and to determine the kind of permanent consequences that they might represent.

MATERIAL AND METHODS

332 forensic reports of domestic violence survivors were analysed. The reports concerned examinations performed in the North Branch of the National Institute of Legal Medicine of Portugal in 2007. Reports were assessed in order to obtain data regarding victim and offender demographic characteristics, and to characterize the nature and number of sustained injuries and their permanent consequences.

MAIN RESULTS

Most victims were females with a mean age of 33.7 years; the most frequent offender was the spouse; the majority of oral injuries affected soft tissues; permanent body consequences were found mainly in the teeth and periodontal tissues; permanent functional consequences were described as chewing difficulties, feeling pain or soft tissue mobility changes; permanent consequences for life activities referred mostly to social life aspects.

CONCLUSIONS

Oral injuries and their consequences were observed in 13.4% of intimate partner violence cases, and though being suggestive of this kind of violence, oral injuries alone are insufficient to identify this kind of abuse, and additional diagnostic criteria and evidence should be used.