Victims of abuse from an intimate partner may be reluctant to discuss their predicament, but dentists and physicians can recognize the abuse through telltale injuries and offer assistance, according to a new study.
The study found that there are many distinctions between facial injuries caused by intimate partner violence (IPV) and those caused in other ways (Archives of Facial Plastic Surgery, January/February 2009, Vol. 11:1, pp. 48-52).
— John McDowell, D.D.S., M.S.
The victims of IPV are primarily women, the authors noted. The yearly incidence of IPV in American women is 9 cases per 1,000.
The study authors reviewed the medical and dental records of 326 adult female facial trauma patients treated by otolaryngologists and oral/maxillofacial surgeons at the University of Kentucky Medical Center. The information included date of injury, dates of presentation for medical attention, mechanisms of injury, diagnoses, and treatments.
They identified 45 patients (13.8%) as assault victims. Of these, 19 were documented victims of intimate partner violence or family violence, while the remaining 26 could not or did not identify their assailant.
The authors noted that the causes of injuries correlated with patterns of injuries, and the victims of assault were likely to sustain mandible fractures, zygomatic complex fractures, orbital blowout fractures, and intracranial injuries.
The victims of intimate partner violence were more likely to have zygomatic complex fractures, orbital blowout fractures, and intracranial injuries, while victims assaulted by unknown or unidentified assailants were more likely to have mandible fractures.
"Our study indicates that periorbital injuries positively correlate with IPV and that women assaulted by unidentified or unknown assailants had a higher than expected incidence of mandible fractures than other female facial trauma patients," the authors wrote.
Intimate partner violence accounts for 34% to 73% of facial injuries in women. This puts facial plastic surgeons and other healthcare providers who treat patients with maxillofacial injuries in a unique position to identify these victims and refer them to local domestic violence service programs, according to the authors.
"The ability to build trust with patients and to recognize patterns of injury associated with IPV would be helpful for medical professionals who assess for victimization in patients and treat them according to nationally recognized standards of care," they wrote.
The authors noted that such cases are usually underreported, and physicians can play a significant role in bringing such abuse to light.
"It has been estimated that only 25% of cases of IPV are reported to authorities," they wrote. "Physicians who treat maxillofacial trauma in particular have a significant role not only in the repair of physical injury but also in identification of IPV victims as patients with layers of physical, mental health, and safety needs."
John McDowell, D.D.S., M.S., an associate professor at the University of Colorado Denver School of Dental Medicine has written extensively on this subject and thinks this study can be of value to dentists as well as physicians.
"It is not uncommon for the victim of domestic violence to give a denial or equivocal history," he stated in an e-mail interview with DrBicuspid.com. "The healthcare provider must evaluate the history (especially important are timing of presentation for care, are there various stages of healing, and do the injury patterns fit the history given), the physical exam (prior evidence of soft- and hard-tissue injuries), and the results of any tests performed (for instance, evidence of fractured teeth or bone)."
Dr. McDowell emphasized that physicians and dentists all need to play a more active role in identifying victims of domestic violence.
Intimate partner violence is a serious cultural problem with psychosocial ramifications that have yet to be fully studied, and underreporting prevents appropriate social intervention for many victims, the study authors noted.
"While our study was limited to facial trauma victims, it demonstrates that universal screening and examination of the patterns of presentation, including patterns of injury, can assist medical professionals in identifying these patients and initiating appropriate medical and social intervention," the authors concluded.
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