Dentists will learn to prevent abuse

by Bei Hu

Several years ago, dentists at the Family Dentistry Clinic, with the assistance of the University’s Program Against Sexual Violence, managed a patient’s escape from her abusive partner.
Now, such piece-meal collaborations are about to blossom into a full-blown training program to help dental professionals develop skills in detecting and dealing with abusive situations.
In the next two years, University anti-family-violence activists and staff from the School of Dentistry will offer 14 training sessions in the state each year, with projected total participation of 1,400 dentists, dental hygienists, and other practitioners.
Research shows that domestic violence is the number-one reason for women’s emergency room visits, and a leading cause of injuries in women.
Although emergency rooms and dentist offices perform very different services, the nature of dental examinations make them logical places to discover potential abuse. Some studies have confirmed that most of the physical injuries from family violence are found in the head and neck areas, which are easily visible to dentists.
However, rates of referrals and intervention by dental professionals remain low. Only 1 percent of dentists have reported cases of family violence found in their clinical practice, said Jamie Tiedemann, director of the Program Against Sexual Violence.
“We do an excellent job of educating our young doctors — physicians and dentists — about abuse issues,” said Daniel Rose, a clinical supervisor of the University’s program in Advanced Education of General Dentistry, who is working with Tiedemann on the training project.
The new training sessions have been endorsed by the Minnesota Dental Association. Tiedemann said pilot courses will be administered in a rural Minnesota location for about 50 dental professionals as early as this fall.
The courses will include an overview of the issues of family violence, which is broadly defined to include sexual assault, domestic and child abuse. Instructors will lay out dental professionals’ ethical responsibilities in helping patients in abusive relationships. Video presentations and role-playing exercises will follow lectures to help dental practitioners identify signs of abuse and, in Tiedemann’s words, “present yourself as a caring, supportive professional resource.”
“It’s a whole gamut, really, in the whole six-hour training that we will be covering,” said Tiedemann.
Rose said although domestic violence issues have been addressed theoretically in classes, the newly-educated doctors still need practice at applying the ideas.
“But the actual clinical application of that knowledge appears to be lacking,” he added.
First of all, Rose said, dental professionals should create a safe clinical environment and use non-verbal cues to encourage doctor-patient discussions when family violence is suspected. More specifically, Rose suggested that clinics should display posters and other literature on abuse and violence intervention in waiting rooms, offices and other areas. He also proposed that in medical history inquiries, questions about family violence should be asked up front.
The next step is knowing how to bring in social workers with expertise on dealing with violence. “Health care professionals are trained to be fixers,” Rose said. “But maybe what you need to know is how to refer and where to refer.” The training program will provide dental practitioners with local resources on family violence intervention.
Although signs for physical violence, such as explained bruises, are usually obvious, emotional abuse is often hard to discern. Rose, who is also a practicing dentist, suggests that practitioners look out for abnormal behavioral patterns in patients, such as frequent appointment cancellations. Defensive and fidgety family members may also signal problems.
However, Rose warned that dental professionals should also develop cultural sensibilities in dealing with patients of particular population groups. “We don’t want to train a bunch of white knights and charging horses to go and slay every dragon, when there is no dragon,” he said.
Despite the practical difficulties, Tiedemann and Rose remain optimistic about the future of the project.
“We are looking at the potential for a major increase in reporting (of family abuse cases),” Tiedemann said.
She added that she had received inquiries about the program from all over the country. Although an instructional video is being developed in Massachusetts about dealing with family violence in dental clinics, the University’s program is unique in its comprehensiveness, she said.
“It could very well become a national model,” Rose agreed.