clinic theory III family vioence

interpersonal vioence

• refers to family and community violence

• global problem and has no economic, geographic, or social boundaries - can happen anywhere!

• dental team must advocate for those experiencing family violence by identifying and reporting suspected cases

categories of family violence

• also called intimate partner violence, domestic violence, child abuse/ neglect

• highest risk : children

major types of family maltreatment

• physical neglect

• physical violence

• sexual violence

• emotional abuse

physical neglect

• willful or unwilful failure of the caregiver or parents to provide necessities to individuals in their care;

• abandonment

• medical, dental, and deprivation neglect

physical violence

maltreatment

• abuse and neglect

abuse

• violent physical, sexual, emotional, or verbal acts

neglect

• acts of omission

• failure to provide adequate care

dental neglect

• not seeking care of known treatment for freedom from pain or infection

PANDA

• dental focuses education and awareness program

  • Prevent

  • Abuse and

  • Neglect through

  • Dental

  • Awareness

physical abuse signs

• signs may include imprints or marks, bite marks, burns, fractures, lacerations, abrasions, head injuries, and delay of treatment

• bite marks:

  • adult bite rather than an animal or another child

• care-giver fabricated illness in a child

  • munchausen syndrome by proxy

  • when a caregiver falsifies and subjects a child to unnecessary and potentially harmful medical care

sexual abuse signs

• most vistims and perpetrators know each other

• immediate reactions include shock, fear, or disbelif

• oral indicators

  • condyloma acuminatum (veneral warts)

  • syphilis emerging as an ulcerated chancre or mucous patch

  • gonorrhea may appear as pharyngitis, tonsilitis, or gingivitis

  • herpes can manifest as gingivostomatitis

emotional maltreatment signs

• pattern of behavior, such as constant criticizing or belittling, or not providing love or guidance, that can seriously harm a child’s development or self esteem

• expressions of aggression

• disruptive behavior

• anger; rage

• unusual anxiety or fear

neglect signs

• typically, a failure by the parent, caregiver, or guardian to provide for basic physical, educational, or emotional needs

• oral manifestations may include

  • poor oral hygiene

  • untreated dental disease

risk factors for childe abuse and neglect

• under 1 y/o highest rate (child), female

• relational factors for abuse/neglect

• community and social factors; stress

consequences of child abuse

• death

• craniofacial, head, and neck injuries

• abuse should be considered in the differential diagnosis for any injury involving a child

• STI’s

general signs of abuse and neglect

• physical indicators

• behavior features

• social behavior

• emotional well being

• cognitive features

extraoral wounds and signs of trauma

• conditions that can mimic abuse

• common sites of children injuries

bruising

• accidental injuries

• idopathic thrombocytopenia purpura (systemic - blood cells not reproducing correcting)

• hemophilia

• may mimic abuse

burns / red lesions

• port wine stain

• accidental burn

• may mimic abuse

skin lesions

• bullous impetigo

• birthmarks

• may mimic abuse

common extraoral sites to observe for children’s injuries

• edema (swelling) and ecchymosis (bruising)

• “racoon sign” nose fracture

• retinal hemorrhaging - head trauma

• scarring

• lichenification (skin issues - scarring on top of scarring)

common intraoral signs of abuse and neglect

• lip and tongue laceratiosn or scarring, buccal mucosa, burns, fractured/ displaced/ broken tooth

munchausen syndrome by proxy

• general considerations

  • parent/caregiver fabricates or induces disease on a child

  • difficult to diagnose

  • disease does not follow normal history of clinical presentation

  • perpetrator may INDUCE symptoms

  • perpetrators wants to progress to more invasive procedures

• initiated by mother in 90% of cases

  • the perpetrator wants to become sick by way proxy

  • perpetrators have history of child mistreatment

  • hald are

human trafficking

• general considerations: modern day slavery, global issue

• sex trafficking- labor trafficking exploitation. one half under 18 and female

• risk factors for human trafficking: Hx of abuse / neglect, lack of support system, runaways, untreated mental health, undocumented worker, homeless, foster system, substance use

indicators of a patient involved in human trafficking

• submissive, fearful, aggressive, avoid eye contact, poor oral hygiene/ dental fractures

• unable to provide address

elder abuse and neglect

• general considerations

• all socioeconomic groups

• risk factors for elder abuse and neglect: female, ethnic minority cognitive impairment, social isolation/living alone, older than 74

types of elder abuse and neglect

• physical neglect

• phycological neglect and abuse

• financial exploitation

• self neglect

• sexual abuse

signs of elder abuse and neglect

• emotional/ phycological abuse: depression, hostility, flinching/fear, deferral to caregiver

• signs of financial exploitation: changes in access to bank account

• signs of neglect and abandonment: depression, open wounds (burns/cuts), caregiver wont let visitors alone with elder

• intra and extraoral injuries

intimate partner violence

• prevalence: 1 in 14 women, 1 in 2 men, homicide highest in women, LGBTQ community

• physical injury: back , neck, chest broken ribs, head injuries, abdominal injuries, many of the same as in other FV

• general health consequences of IPV: chronic pain and at risk for chonic diseases (HBP, CV issues), increases risk for alcohol or substance use, PTSD unintended pregnancy

• orofacial impact- most common sites include head, neck and face lacerations, broken teeth, buccal/gingival mucosa, mandible fracture or displaced TMJ

• role of the dental hygienist

the role of the dental professional

• assessment: ask questions such as “how are things at home?” when talking to a child ask age appropriate questions. “tell me about this red mark?” “is anyone hurting you?” “tell me how this happened?”

• planning/ diagnosis: referral

• documentation: document what you see and hear. you are not proving the case. use the persons own words whether it is an adult, elder, or child

• evaluation: how will you follow up

barriers for dental health professionals

• limited knowledge and training about issues

• lack of practical experience and how to intervene

• misconceptions about the nature of intervention

• fear of being sued

• lack of information on resources for reporting

• presence of others in the examination room

• concerns about offending the patient

• discomfort in bringing up topic

reporting abuse and neglect dental hygienist

• legally and ethically mandated reporters

• lack of confidence and feeling inadequate in screening and reporting abuse

• those bein abused want dental providers to ask and provide a referral

proper training for reporting

• PANDA: prevent abuse and dental awareness

• ADVR: ask, validate, document, refer

• RADAR: health care provider for awareness and assessment of IPV

• Routinely ask about IPV

• Ask directly about the violence of partner

• D

• A

• R

immediate oral/online report

• must be filed instantly (without waiting for proof) upon observation or clinical suspicion

web portal processing

• online submission via state intake portals can take up to 1 business day to process urgent situations requiring action in under 24 hours must use the 24/7 telephone hotlines

emergencies

• dial 911 immediately

forensic dentistry

• dental science that relates and applied dental facts to legal problems

• encompasses dental identification, malpractice litigation, legislation, peer review, and dental licensure

  • examination of bite marks

  • DNA from saliva

  • tooth impression/patterns

content of record

• date, time, place of exam

• obtain thorough history of injury from caregiver and patient

• record questions and answers in exact words

• carefully record all observations

factors to teach patient

• where help can be obtained: emergency assistance/phone numbers and referrals

• the tendency for maltreatment to get worse