Dentistry responding to domestic violence and abuse: a dental, practice-based intervention and a feasibility study for a cluster randomised trial.Br Dent J 2022; https://doi.org/10.1038/s41415-022-5271-x

Domestic violence and abuse (DVA) can occur in the form of physical violence, sexual abuse, financial abuse, psychological abuse and/or controlling behaviour between individuals in intimate relationships or family members. There are approximately 15.4 million incidents of DVA annually in the UK, which can have short- and long-term consequences for an individual's physical and mental health. COVID-19 has highlighted an increase in DVA due to household isolation.

Dental health care professionals have a paramount role to play in handling DVA, as studies show 65-95% of assaults involve trauma to the face, mouth and teeth. As a result, dental personnel are in a unique position to recognise, document and refer DVA for appropriate assistance.

Currently, there are policy frameworks and National Institute for Health and Care Excellence quality standards on DVA which mention that healthcare professionals should be involved in identification, supporting and referring to specialist advocacy services. Uptake and implementation of these policies and quality standards are low in dental services. Furthermore, there is limited DVA training currently within dentistry and referral pathways.

Within dental services, there are many more barriers to identifying, referring and supporting victims of DVA; these include lack of training, presence of a patient's partner or children, concerns about offending patients, funding, IT limitations and a dentist's embarrassment about raising the topic.

Currently in general medical practices (GMPs), with regards to DVA advocacy, there is evidence-based training and a referral pathway that has been developed and commissioned nationally in over 40 areas. The Identification and Referral to Improve Safety (IRIS) care pathway has been used widely within GMPs to identify and support patients experiencing DVA and has been shown to improve the identification and referral of victims and survivors to appropriate specialist support agencies. The IRIS care pathway has never been used within GDPs, and this study aimed to explore the feasibility of adopting a similar intervention via a cluster randomised trial design in Greater Manchester GDPs.

Six GDPs were recruited for the feasibility study, with all practice staff receiving training over three workshops. The training was adapted to a dental setting. The dentists were keen to adopt the IRIS intervention and utilise the referral pathway; however, there were problems with translating the pathway from GMPs to GDPs. There were difficulties with the GDP software as it does not provide prompts and data collection due to there not being a unified dental IT system. Furthermore, coding for DVA diagnoses, procedures and outcomes has not been developed in the UK. This made it hard to prompt the staff and collect data digitally.

However, there was not enough quantitative evidence available, and as such more data from more areas in addition to Greater Manchester is needed.