VIOLENCE within families and in intimate relationships is now recognised as a widespread problem. Abuse tends to recur and may continue until the victim dies as a result of his or her injuries. Every effort should be made to intervene and stop this chain of events so that the cycle of violence will cease. Although victims are often reluctant to report their abuse, the fact that about 75 percent of physical injuries are inflicted to the region of the head, face, mouth, and neck which places dentists in a particularly good position to recognise the signs of abuse and take steps to intervene.

Domestic violence is a complex and pervasive problem affecting a large proportion of Guyanese society. The clinical signs and symptoms of violence in day-to-day practice become more readily apparent if we understand what to look for and appreciate the urgency of identifying victims of abuse and those at risk.

Domestic violence was once believed to be relatively uncommon. The problem is now recognised as a pervasive societal issue that affects thousands of individuals.

Tragically, it is estimated that 50 percent of the mothers of the abused children are victims of abuse themselves. Domestic violence issues – including battering and sexual abuse of women, children, and elderly people – are receiving increased attention as the public recognises the impact that these problems have on social programs, health care, and the family unit. Violence against individuals who are unable to defend themselves is attracting new interest, not only because of the moral implications but because of the financial burden inflicted on society. When one considers just the costs of treating injuries, the potential impact on health care is staggering.

Approximately 75 percent of the physical injuries suffered at the hands of an abuser are inflicted on the head, face, mouth, and neck. Even when persons suffering in abusive relationships avoid seeking medical attention, they often keep dental appointments for routine treatment. As a result, dentists and allied dental personnel are in an ideal position to identify the injuries associated with physical, emotional, and sexual abuse.

In addition to expedient judicial support, a major barrier to dentists’ reporting seems to be lack of training and experience in identifying abuse and neglect. This problem is apparent among other health care professionals as well. Studies have indicated that many pediatric admissions to hospitals may result from abuse, but are treated as isolated events without attention to environmental circumstances.

Physical signs of domestic abuse include fractured teeth, oral lacerations, fractures of the jaw, bruising, and scarring of the face and lips should be carefully evaluated as possible signs of physical abuse. Bruises and cuts to the ears, perforated tympanic membranes, broken or bruised noses, and cigarettes or ligature burns to the face, neck, or arms also may be clinical clues to abuse.

Many injuries of physical abuse are focused on the head because this is a readily accessible area. Additionally, the mouth is often a target because this is where communication originates. Injuries from violence perpetrated in an attempt to cut off communication and keep the individual quiet often involve the teeth and oral structures.
Injuries may take many forms including, but certainly not limited to, traumatic bruises and nonaccidental abrasions, lacerations, and contusions. Burns may be identified from such sources as cigarettes, lighters or matches, heated objects, and caustic chemicals.

In general, the nature of the injury observed at the time of examination does not fit the reported history of the injury. This contradictory information should serve as a signal to the dentist that something is wrong. In this case, it is vital to follow up with additional questions and a comprehensive examination in an attempt to find the truth behind the injury. Whenever possible, try to question the patient separately from the family member or caregiver and compare the explanations for the injury. Is there a discrepancy between explanations for the injury? Does one person seem to be misrepresenting the facts?

Arrangements should be in place whereby the reports of dentists on suspicion of domestic violence cases must be given priority for expeditious action by the relevant authorities.