Domestic abuse and dentistry: your duty of care

Would you know how to approach the topic of domestic abuse when you suspect a patient may be a victim? It's important to know what steps you should take as a dental professional, says Mark Foster of the Child Protection Company.

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Your professional safeguarding responsibility

As a member of the dental team, it is your professional responsibility to have not only an awareness for but an understanding of the various signs of abuse and neglect that could be visible in the patients visiting your practice.

It is your responsibility as a dental professional to understand the signs of all forms of abuse and neglect in order to notice when an individual is in need or at risk. You can and should empower yourself to understand the signs and indicators of abuse and neglect by taking regular safeguarding training, such as the British Dental Association-recommended online courses offered by the Child Protection Company (www.childprotectioncompany.com).

Safeguarding training is an essential part of your continuing professional development (CPD) and every member of the dental team, including non-clinical staff, will need to show evidence of their current verifiable safeguarding certificates in order to pass Care Quality Commission (CQC) inspections. These must be within date; an expired certificate will not be accepted by inspectors.

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Safeguarding policies, processes, and procedures change frequently, so it is important to always stay up to date with the latest information so that you are always best prepared to deal with any safeguarding concern you might encounter.

Domestic abuse

Domestic abuse is a huge concern in the United Kingdom. On average, two women are killed every week in England and Wales by their current or former partner, and domestic abuse is known as a gendered issue for its statistically higher number of female victims — however, this is not to say that men can't also be affected by domestic abuse.

Abuse can happen to any individual at any age, time, or place.

Over 80% of women in violent or abusive relationships will seek help from healthcare professionals, and as a member of the dental team, you could well be the first and potentially only point of contact for an individual in need. For this reason, it is incredibly important to know the correct way to react if a disclosure is made or if you suspect an individual might be at risk of experiencing abuse — or, indeed, if you suspect they might already be affected by domestic abuse.

Domestic abuse is one of the most common causes of non-accidental injury for women in the United Kingdom. However, it is also an extremely sensitive topic to raise with an individual you suspect might have been subjected to abuse. Victims are unlikely to spontaneously disclose their abuse for a number of reasons; however, we know that those affected appreciate being asked directly. You need to know when to report a concern and how to refer an individual for extra help and support from other agencies such as the police or social services.

Reporting concerns

When it comes to reporting a safeguarding incident or worry, set a low threshold for concern. It is always better to report a safeguarding concern than it is to overlook an issue that needed real intervention. Your choice to report or ignore a safeguarding incident or concern could — quite literally — mean the difference between life and death for an individual, so never be shy to raise the alarm where you suspect something isn't quite right.

The process for reporting and referring safeguarding concerns is designed to be confidential, so you do not necessarily need to supply your name or personal details at all in order to make a referral. Every dental practice should have a safeguarding lead who takes responsibility for handling reports and referrals, and this person should be your first point of contact in any non-emergency situation.

“Over 80% of women in violent or abusive relationships will seek help from healthcare professionals, and as a member of the dental team, you could well be the first and potentially only point of contact for an individual in need.”

However, if you suspect an individual is at immediate risk of danger or there is potential for harm to life, you should always dial 999 in the first instance.

Recognising domestic abuse

While every case of domestic abuse is unique and will not always follow the same pattern or display with the same signs, there are some indicators of abuse that you should know and pay attention to.

These are just some red flag issues that should always be a cause for concern if you notice a patient in your practice displaying any of these signs:

  • Inappropriate clothing Individuals who do not have appropriate clothing for the weather, eg an individual wearing a scarf and long sleeves when it is very warm. They may be covering bruises or other marks from physical violence

  • Signs of physical abuseObvious signs of physical abuse or assault such as scratches, bruising, burn marks, and bite marks, especially if these are displayed in sites common for non-accidental injuries (email help@childprotectioncompany.com to claim a free non-accidental injury body map poster to display in staff areas of your dental practice)

  • Difficult/challenging behaviourPatients who may be aggressive or apparently pose challenges to staff in your dental practice, particularly if there seems to be no logical reason for the reaction

  • Accompanied to appointmentsAdults who are accompanied to their appointments by a partner or significant other when there is no apparent reason why, especially if the partner insists on being present for the whole appointment and is not content to sit in the waiting room while the patient is being seen.

What domestic abuse signs might I notice as a dental professional specifically?

There are some signs of domestic abuse you might notice specifically in your role as a dental professional that other individuals might not recognise or have a need to notice. It is particularly important for you to be aware of these signs and indicators in order to know when to raise the alarm.

Some of the signs of domestic abuse you might notice in a dental context include:

  • Lesions or damage to soft and hard palates

  • Bruising on patient's cheeks and ears, especially fingerprint-sized marks

  • Facial bone/jaw fractures

  • Misalignment of teeth as a result of a fracture

  • Fractured, displaced, or forcibly detached teeth

  • Discoloured teeth from previous traumas

  • Problematic substance use

  • Unease during consultations.

If you notice any of the above signs or indicators of abuse, they could be signs that your patient is affected by domestic violence and abuse. You should report your concern to either the safeguarding lead person or by following the procedures outlined in your practice's safeguarding policy.

Digging deeper

In some situations, it may be possible for you to ascertain more about an individual's situation by asking questions. There are some suggestions for how you could do this below.

Always bear in mind, when an individual discloses their abuse, they are expecting an appropriate professional response. You should not make any promises to a patient about what will happen next, and neither should you respond in an overly emotional manner. Be clear and concise in what you are telling the individual, listen carefully and respectfully, make notes if possible, be mindful of your words, and try to be as open as possible about what next steps you will take, especially if you will be informing other professionals such as the safeguarding lead. Best practice is always to discuss next steps with the patient, not to seek their permission but to let them know what your actions will be.

“Your choice to report or ignore a safeguarding incident or concern could — quite literally — mean the difference between life and death for an individual, so never be shy to raise the alarm where you suspect something isn't quite right.”

Remember that you have a professional duty of care for the individual who is disclosing their abuse to you, and it is your responsibility to ensure they feel heard, respected, and safe in the knowledge you are confident and trained to support them in finding help. Specialist training is available to support health care professionals to recognise and support patients affected by domestic abuse. Please refer to www.irisi.org for details of training available.

What questions can I ask if I suspect an individual has been a victim of domestic abuse?

Here are some questions you can ask that might open the gates to a disclosure, or will at least alert an individual to the fact you have noticed the signs.

  • 'Some women have these symptoms/injuries when they are at risk of abuse. Are you afraid of anyone at home…?'

  • 'Does anyone try to control you or what you do?'

  • 'How is your relationship with your husband/partner/family?'

  • 'Has someone hurt you?'

  • 'Do you feel safe?'

  • 'Are you ever afraid of, humiliated, or hurt by anyone?' (from IRISi - see www.irisi.org).

You should always use your professional discretion to figure out whether or not it is appropriate to ask the above questions. Be mindful of the fact many individuals still won't feel comfortable answering such questions even if you are alone and have good rapport with each other.

You should never ask about abuse if the individual is accompanied, even by a child. Asking these questions in the presence of the partner you suspect may be carrying out the abuse, or an apparently supportive family member, could make a situation worse for the individual in question.

It is still incredibly important to consider reporting your concerns even if an individual is not prepared to answer questions the first time you ask. There are many factors that might keep a victim of domestic abuse silent, but if you suspect something is not right behind closed doors, let your safeguarding knowledge and professional discretion empower your decision to act on a concern.

Remember: Safeguarding is everyone's business.

If you would like to learn more about safeguarding in the dental team, the Child Protection Company offer a range of excellent British Dental Association-recommended online safeguarding courses. For further information or to arrange immediate safeguarding training for your dental team, please visit www.childprotectioncompany.com, email help@childprotectioncompany.com, or call the Child Protection Company offices on 01327 552030 between 9 am to 5.30 pm, Monday to Friday.

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Foster, M. Domestic abuse and dentistry: your duty of care. BDJ Team 6, 18–20 (2019). https://doi.org/10.1038/s41407-019-0103-9

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