Improving Oral Health, Identification and Care in the Dental Setting of Patients Experiencing Domestic Abuse: A Scoping Review
This scoping review of 17 studies finds that while educational and practice-based interventions effectively improve dental professionals' knowledge and confidence in identifying and responding to domestic abuse, evidence regarding their actual impact on clinical practice and patient outcomes remains limited due to systemic barriers and a lack of robust research.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Every year, millions of people endure domestic abuse, a pattern of controlling or violent behavior that leaves deep physical and psychological scars. While this violence often strikes the face, mouth, and jaw, leaving behind broken teeth, bruised skin, and signs of strangulation, the people who see these injuries most often—dentists and their teams—frequently feel unprepared to act. They know they should be able to spot the signs and offer help, yet many report feeling unsure of what to say, where to turn, or how to approach a patient who might be in danger. This gap between what dental professionals are expected to do and what they feel capable of doing is the central puzzle a new review of research seeks to solve. The researchers wanted to know: what actually works to help dental teams identify abuse, respond with care, and connect patients to safety?
To find the answer, the team at Cardiff University gathered and examined every available study that tested a specific way of improving dental care for abuse survivors. They looked at 1,608 records from medical databases and other sources, eventually narrowing their focus to 17 studies that met strict criteria. These studies came from countries including the United States, the United Kingdom, Canada, and Australia, and they tested everything from short online tutorials to full-day workshops and changes in how dental clinics operate. The goal was not just to see if people learned more facts, but to understand if those lessons changed how they treated patients in the real world.
The most common approach tested was education. In study after study, dental students and practicing professionals took part in training sessions designed to teach them how to recognize the signs of abuse and how to talk about it. These sessions often used role-playing, where students practiced difficult conversations with actors, or interactive computer tutorials that walked them through specific steps. The results were clear and consistent: after this training, dental professionals knew more about abuse, felt more confident in their ability to spot it, and were more willing to ask patients about their safety. One study found that even a brief fifteen-minute tutorial could significantly boost a dentist's knowledge. Another showed that when students practiced speaking with survivors through role-play, their comfort levels stayed high for months afterward.
However, the story becomes more complex when looking beyond the classroom. While training made dentists feel better prepared, the evidence that this feeling translated into actual changes in daily practice was much weaker. The review found that knowing what to do does not always mean a professional will do it. In some cases, dentists reported they intended to screen patients for abuse, but later studies showed they rarely followed through. One major hurdle was the lack of clear, simple systems in the dental office. For example, a pilot project in the UK tried to introduce a new way of working that included software to prompt dentists to ask about abuse and a direct line to a specialist advocate. While the training worked well, the project struggled because dental clinics did not have a unified computer system to track these sensitive questions and referrals. Without a smooth, easy-to-use path to get help for a patient, even a willing dentist might hesitate.
The researchers also looked at how to make the dental visit itself safer for someone who has been abused. They found that the way a dentist speaks and behaves matters as much as the medical treatment. Concepts like "trauma-informed care," which means treating patients in a way that avoids re-harming them and builds trust, were highlighted as essential. Studies showed that when dental teams worked closely with social workers and staff from domestic violence shelters, patients felt more supported and were more likely to seek care. One program that brought dental residents into a shelter to provide care saw high satisfaction among the women receiving treatment, who reported feeling less anxious and more willing to return for future visits.
Despite these promising signs, the review concludes that the current evidence is limited. Most of the studies relied on people saying they felt more confident or intended to change their behavior, rather than measuring whether they actually identified more cases of abuse or successfully referred more people to help. The researchers noted that many studies were small, short-term, or lacked a control group to compare against, making it difficult to say with certainty that any single method is the perfect solution. They also pointed out that most research focused on women, leaving a gap in understanding how to support men and other groups who experience domestic abuse.
Ultimately, the paper suggests that while education is a powerful first step, it is not enough on its own. To truly help patients, dental teams need more than just a workshop; they need clear policies, reliable technology to handle referrals, and ongoing support from their colleagues and the wider community. The path forward requires building systems where a dentist who spots a sign of abuse can immediately and safely connect a patient to the right help, turning a moment of recognition into a lifeline. Until those systems are in place and tested, the full potential of the dental profession to protect its patients from domestic violence will remain only partially realized.
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