A new campaign is calling for dentists to provide pro bono treatment to survivors of domestic abuse.
During my twenty years in the profession, I've seen dentistry come a long way in its understanding and provision of care for highly vulnerable patients who have suffered from situations of domestic abuse. But there is much still to be done.
In a recent study,
over 90% of those currently experiencing abusestated that it had worsened in some way during the pandemic. The treatment needs of these highly vulnerable patients are complex and dentistry is a vital part of multi-agency care provision.
I am therefore proud to be part of a new campaign that is looking at how dentistry supports domestic abuse survivors' access to oral health care.
Dentistry and domestic abuse
My involvement and awareness of this pressing issue began back in 2002 as a House Officer at Guy's Hospital. At the time, there was limited undergraduate and postgraduate education for dentists in terms of how we engage, interact and manage patients who have been subjected to domestic violence and abuse. Although we learned about the orofacial injuries that often come with abuse, there was no general training pertaining to different forms of abuse, and the political, social and legal context of effective safeguarding practices.
During my House Officer job, I researched and co-authored one of the first manuals on the management of abuse which later led to the publication of
The Manual of Abuse: A Resource Manual for the Dental Team in 2005. That was how I developed an understanding of the personal cost of abuse and neglect, and how it can take different forms, not just violence but also coercive and financial control.
"The idea for a registry of dentists willing to provide pro bono services started during lockdown."
The idea for a registry of dentists willing to provide pro bono services started during lockdown. On social media, I saw a request from Rachel Williams, the founder of Stand Up to Domestic Abuse, asking for dental care for a survivor of domestic abuse and I contacted her to see how dentists could support these patients. Since then, the idea of a registry has taken off.
It's early days and we want to ensure that both dentists, as providers, and patients wishing to access this service have the right support and governance in place. I am hopeful that with increasing awareness of the pressing need, we will be able to help those who are vulnerable and marginalised get access to the care they require.
What you need to know
With orofacial injuries accounting for between 65-95% of domestic abuse and violent assaults, dentists working in emergency departments and oral surgery will sadly be all too familiar with the devastating impact abusive relationships have on our patients.
Aside from orofacial injuries, domestic abuse can also lead to stress related issues like bruxism and tooth fractures in addition to incorporating symptoms of oral neglect such as a high caries rates, poor periodontal health status and untreated endodontic lesions; all of which negatively impact health and function. Some of those subject to abuse are prevented from accessing healthcare as a consequence of control.
"Dentists are uniquely positioned to notice any worrying changes in a patient's wellbeing over time"
As part of a pattern of problems this can indicate issues in a patient's emotional state or wellbeing. There are various points of entry for those subjected to domestic abuse within the healthcare system and dentistry may not be the first point. But as we often see the same patients for years and years, dentists are uniquely positioned to notice any worrying changes in a patients' demeanour and wellbeing over time.
As healthcare providers we need more training and support; these situations are highly complex and involve very vulnerable patients. It's quite a challenge in itself for a patient to come forward and ask for help when they have been subjected to a repeated pattern of abuse. And there may be dependents involved as well.
Given the prevalence of domestic violence and abuse, it is likely that all practitioners have at some point been in contact with a patient whose health and wellbeing has been negatively impacted by it. It's therefore essential that we work in a collaborative network with other healthcare providers to identify patients at risk so that we can guide them in the right direction as well as providing appropriate dental management.
Plans for a more coordinated approach, including a registry/database, are just beginning. We still have a long way to go in terms of defining what this would look like and how dentists can get involved as individual clinicians or group practices. Ensuring that dentists who wish to participate in the scheme have the correct training, guidance and support is an essential part of the remit.
Dentistry is full of professionals who are willing to help and who want to give their time. We need to carve a niche within the profession to help and support the most vulnerable who need urgent assistance.
Dentistry has an enormous impact on physical and emotional wellbeing and is an essential element in the care needed for survivors. So I want to see a review and reform of domestic abuse services within the government framework which includes dentistry as part of a holistic care offer.
"Existing delivery of domestic abuse services [should] be adapted to help survivors gain access to dental services within the existing frameworks."
I would also like to see the existing delivery of domestic abuse services be adapted to help survivors gain access to dental services within the existing frameworks. We are dealing with challenges in access that are unprecedented with some patients being told they cannot access NHS treatment until 2024. That is why it is vital for the campaign to be multi-organisational and I am pleased that the BDA is involved.
We need domestic abuse charities, professional representative bodies, healthcare practitioners and large private sector organisations on board. A joined-up approach can make change happen.
As plans for the registry move forward, I am proud to be a part of such a caring profession, and I hope that still more of my colleagues will lend their expertise and join us.
Dr Sonia S Joshi
BDS, MSC, MClinDent, MFDS RCS, MRD
Registered Specialist in Periodontics