How dentists can identify domestic abuse

Dentists are in a unique position to recognise and respond to signs of domestic abuse. This is often easier to do when patients feel supported and safe. By using the right tools as healthcare professionals, we can create an environment that supports disclosures of abuse.

If you are treating a patient and suspect domestic abuse, it is important to provide an environment for a private and secure conversation. Try to ask open questions sensitively, considerately and without judgement. Fear of being intrusive makes many healthcare professionals reluctant to bring up the subject, yet often patients find it acceptable to be asked.

Use your professional judgement to find the most appropriate way to ask questions. Patients tend to be more open if disclosures will be treated in confidence. Ensuring privacy and confidentiality is essential; provide reassurance but be clear about the limits to this such as child protection and vulnerable adults. You should reassure patients of this at the outset and listen empathetically.

Signs of domestic abuse patients may present with

Domestic abuse may not be immediately apparent, but the physical signs of abuse that dental teams may notice are neck, or intra-oral injuries. As well as the clinical indicators that may alert you to the possibility of domestic abuse, there are other signs that should make you suspicious, such as:

• Missed appointments and non-compliance with treatment
• An overbearing or overly solicitous partner who is always present
• Denial or minimisation of abuse or injuries
• Injuries which don’t fit the explanation of the cause
• Multiple injuries at different stages of healing
• Delays between an injury occurring and seeking medical treatment
• Appearing evasive, socially withdrawn and hesitant
• Children on the child protection register (In Scotland, Northern Ireland, and Wales), or are the subject of a child protection plan (England), or referred to other specialists for behavioural, emotional or developmental problems.

In some cases, perpetrators may attend appointments with the patient. In these cases, if you have concerns and want to speak to your patient alone, you could try suggesting a follow-up appointment for a review, ask the perpetrator to sit in the waiting room, or to leave while you take an x-ray.

It may not be safe in this situation to ask if your patient would prefer to be seen on their own, but you might be able to arrange for some private consultation time to carry out an examination. You should avoid asking questions in front of children and apart from when a professional interpreter is present, if someone is speaking for your patient this could be another sign of potential coercive control.

How to respond to domestic violence disclosures

Validate the experience by believing your patient, providing reassurance, and not apportioning blame. NICE guidelines provide a helpful template for enquiry and state that you should record exactly what the patient has said and note your own concerns separately. Keeping a record of the disclosure is one of the most important things you can do. You do not need consent to keep a record of concerns, but involving patients is always more constructive.

Domestic abuse is typically an established pattern of behaviour and incidents over time, so any evidence you have gathered and recorded is useful for any later legal proceedings. Your notes, alongside those of other professionals, may be considered by the police. When you record your thoughts, make sure to also take down things such as missed appointments, phone calls, how the patient is presenting, injuries, and demeanour.

Reporting abuse is the patient’s decision but be clear that although the conversation will be confidential, there may be certain circumstances in which you need to get a third party involved. If you have concerns, make sure to follow and refer to the internal safeguarding procedures for your practice.

Supporting and signposting patients

You will want to do everything you can to support and signpost your patient but remember to apply caution. Supportive leaflets or materials may not be safe to have in the house if found by the perpetrator. Signposting to websites and online resources may be a better option. With the patient’s consent, you could consider making a referral to an Independent Domestic Violence Advisor. This service offers a point of contact which helps assess risk levels, discuss options, and create safety plans where appropriate.