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- 1. Violence/ Abuse: Role of Dental Education in Identification/Intervention www.hi-dentfinishingschool.blogspot.com
- 3. Epidemiology of Maxillofacial Injuries and IPV: n=12 Wilson, Dodson and Halpern,2008 Author Study Design Data Type Age(Range) N (%) Sex Injury Zacharides (1990) Retrospective Chart review 16 - 32 51 (9) Female H,N,F Fisher (1990) Cross-sectional Chart review 10-78 23(20) Female H,N,F Berrios and Gray, (1991) Retrospective Chart review 16-66 149 (68) Female H,N,F Ochs etal. (1995) Cross-sectional Cohort 18-51 15 (94) Female H,N,F Muelleman (1996) Cross-sectional Cohort 19-65 121 (51) Female H,N,F Hartzell (1996) Retrospective Chart review 15-63 7 (30) Female Ocular Huang etal. (1998) Retrospective Chart review 15-45 109 (36) Female H,N,F Perciacante etal (1999) Cross-sectional Cohort 24-56 34 (31) Female H,N,F Le etal. (2002) Retrospective Chart review 15-71 85 (30) Female H,N,F Halpern Dodson (2005-2006) Cross-sectional RCT Cohort 27-64 63 (31- 45) Female H,N,F
- 8. DV/IPV and Oral Health
- 11. Alaska Guam Romania Peru Ontario HI Israel Finland US Army Dental Command Mexico IHS The P.A.N.D.A. Explosion
- 20. TUSDM Faculty Supervision/ Education TUSDM VVIP “Model ” TUSDM VVIP Quality Patient Care Outcomes Assessment/Research Didactic Year ’01 Year ’02 Year ’03 Clinical Year ’03 Year ’04 TUSDM Student Education Mass Health Access Program (MAP) Dental Student Award: 2 Recipients from TUSDM TUSDM VVIP C.E. Courses: Training the Community Dentist
- 22. Schema: Diagnostic Protocol for IPV Females with non-verifiable injuries presenting to ED for evaluation and treatment Injury location HNF Other Questionnaire Questionnaire Positive Positive Negative Negative High Risk Low Risk Low Risk Low Risk
Notas del editor
- The dentist and his/her team are in a most pivotal position as you will see to identify a significant number of patients both in the office, school and in the community.
- Studies have found repeatedly that bruises are the most common injuries in cases of partner abuse, and the most common location of injury is the head, neck, or face. In fact, it has been estimated that 75 percent of physical abuse cases result in injuries to the head, neck, and/or mouth—areas that are clearly visible to the dental team during examination. As much as 75% of physical abuse involves injuries to the head , face, or neck 50% of adults visit the dentist at least once/year…..oral healthcare providers are in routine contact with affected patients! Abusers often avoid the same physician, BUTreturn to the same dental office * Children are more likely to have regular preventive care in the dental office: Poor dentition/nursing bottle cariesMost often, injuries are seen within the oral cavity ** Torn labial and lingual frenum Lip lacerations Fractured teeth Dental neglect: nursing bottle caries The dental professional often has established trust with the patient. A typical appointment is 30-45 minutes with the dental hygienist 30-60 minutes with the dentist as opposed to 7-10 minutes with their physician.
- Table 1 describes the summarizes the bivariate association between the SOP and the DP.
- “ Dentists may play an important role in recognizing and referring patients who are domestic abuse victims.” Even more, dentists may be the first—or only—point of contact for domestic violence victims in a health care setting, and they may be the most capable of recognizing the signs of abuse.
- Education about violence and abuse in the training of dentists has been insufficient even when the signs of abuse are present. Reasons for lack of identification may be divided into two types; 1. Inadequate education on the approach to identify victims, and 2. Barriers to questioning that include patients accompanied by their partners, family members, cultural norms, and personal embarrassment by the doctor.
- Educators in the oral health have taken a variety of major steps to provide the knowledge base for dentists regarding the above stumbling blocks. The Prevent Abuse and Neglect through Dental Awareness (PANDA) coalition was started in Missouri in 1992 and Dr. Lynn Mouden, DDS, was one of its co-founders. The PANDA coalition was comprised of the Missouri Dental Association and Delta Dental Plan of Missouri, as well as, the Missouri Division of Family Services and the Missouri Bureau of Dental Health. As of January 2004, 46 states have replicated Missouri's program along with international coalitions in Romania, Guam, Peru, Canada, Finland, Israel, Belgium, Iceland, Nigeria, South Africa, the Federated States of Micronesia and Papua New Guinea .PANDA educational programs are given, which include information on the history of family violence in our society, clinical examples of confirmed child abuse and neglect and discussions of legal and liability issues involved in reporting child maltreatment. While originally intended for dental audiences, the PANDA education programs are also presented for physicians, nurses, teachers, day care workers and anyone that has an interest in preventing family violence.
- As of January 2004, 46 states have replicated Missouri's program along with international coalitions in Romania, Guam, Peru, Canada, Finland and Israel. Efforts are currently underway to start PANDA coalitions in, Belgium, Iceland, Nigeria, South Africa, the Federated States of Micronesia and Papua New Guinea. PANDA educational programs are given, which include information on the history of family violence in our society, clinical examples of confirmed child abuse and neglect and discussions of legal and liability issues involved in reporting child maltreatment . While originally intended for dental audiences, the PANDA education programs are also presented for physicians, nurses, teachers, day care workers and anyone that has an interest in preventing family violence. For information on PANDA contact Delta Dental of Missouri at 314-656-3000 or 800-392-1167.
- In 2008; Gibson-Howell etal published the results of 2 surveys; one sent in 1996 to associate deans of US and Canadian dental schools ; the other in 2007 to US schools only. . The surveys were forwarded to faculty member that taught a course on the topic of identifying pts who may be victims of V/A. The topics relevant to D/V as part of a curricula were scored from………….
- Created in 1997, the Minnesota School of Dentistry and the Program Against Sexual Violence designed Family Violence: An Intervention Model for Dental Professionals for dental school and continuing education curricula. It educates dental professionals about the signs of abuse and neglect and teaches proactive and appropriate intervention. Two instructional videos are available: “Clinical Implications,” which shows injuries and descriptions of how these injuries would occur, and “Healing Voices,” which discusses effective intervention strategies for dental professionals. One of the most important factors in intervention is providing a safe environment for disclosure. According to the dental intervention model, nonverbal cues—such as family violence literature or posters in the waiting room—and questions about family violence on dental history forms create opportunities for patient disclosure. If a dentist suspects abuse, Dr. Skelton says, “He or she should document significant physical findings and ask specific questions regarding the etiology of the injury. The dentist should be very supportive and nonjudgmental. If the patient responds positively to screening questions and/or reports physical abuse, the caregiver should assess safety, make appropriate referrals, and report the case according to state regulations.” The State board of Dentistry approves 6 hours of CE for completion of the training program.
- Preliminary studies were undertaken to examine am expedient way to identify victims of abuse. Early work was done in Atlanta at a Level 1 Trauma Center examining women and men who came to the Ed with head, face and neck injuries. It was found that more women with HNF were victims of violence/abuse. Ye only using HNF did not rule in disease as precisely. Another tool was added . A questionnaire that was used in ED’s across the country; PVS. This allowed a greater rule in and out of IPV. The question was can this tool be applied at other centers across the country or generalized throughout the population. Myself and other s decided to use this tool in another geographic area of the country to see if the results were valid
- Based on our preliminary experiences at Grady, we developed the following protocol to identify women at increased risk for IPV-related injuries. Again, the sample is composed of women at risk for IPV injury defined as women presenting to the ED for evaluation and management of nonverifivable injuries. The first element to consider is injury location – HNF or other. If a patient has multiple injuries at least some of which are localized to the HNF region, she is included in the HNF group. Other injuries must be confined to regions other than the HNF region. The second element of the protocol are the subjects responses to the IPV screening questions. If the subject responds affirmatively to one or more questions, she is classified as questionnaire positive. Finally, we combine the finding of the two elements, injury location and screening questionnaire. Patients classified as at being at high-risk of IPV related injuries are those that have HNF injuries and are questionnaire positive. All other combinations are classified as low risk for IPV injury.
- When the predictive model was applied to the validation sample, there was excellent agreement between the observed and actual number of women with IPV-related injuries as evidenced by the accuracy, i.e. 93%, and the goodness-of-fit assessed (p=0.64, Hosmer-Lemeshow statistic). A p-value of 0.64 suggests that there was not a statistically significant difference between the predicted and observed outcomes.
- Both the general dentist and oral maxillofacial surgeons are in a unique position to recognize the impact that violence and abuse may play in their patient population. As stated by JP Kenney; “dental practitioners have four R’s of responsibility; recognize record, report and refer to protect our patients and their families from the cycle of violence. ” As such, the dentist or the oral and maxillofacial surgeon is often the first to see and evaluate victims of violence and abuse in the ER or the private practice environment. Now these practitioners need to do the steps to incorporate formal training in every dental school and residency program in the country .