Prevalence of dental, oral, and maxillofacial traumatic injuries among domestic violence victims: A systematic review and meta-analysis.

BACKGROUND/AIMS: Domestic violence (DV) encompasses a series of abusive behaviors, perpetrated in a family environment, against individuals of all ages and genders. Injuries to the head, neck, and face are frequent findings among victims of abuse, negatively impacting their quality of life. Although oral and maxillofacial injuries (OMFI) and traumatic dental injuries (TDI) are commonly diagnosed among DV victims, their prevalence is still unknown. This systematic review was aimed to assess the prevalence of OMFI and TDI among victims of DV. METHODS: The protocol of the review was registered in PROSPERO (CRD42023424235). Literature searches were performed in eight electronic databases, up to August 7th, 2023. Observational studies published in the Latin-roman alphabet and reporting the prevalence of OMFI and/or TDI were included. The Joanna Briggs Institute's critical appraisal tool, checklist for prevalence studies, was used for quality assessment. Results were presented as qualitative and quantitative syntheses. RESULTS: Seventeen studies, totaling 12,375 victims of domestic violence, were included. Meta-analyses showed an overall prevalence of 29% (95% CI: 15%-48%, I2 = 99%) and 4% (95% CI: 1%-10%, I2 = 98%) for OMFI and TDI, respectively. Higher pooled prevalence for OMFI (41%, 95% CI: 13%-46%, I2 = 99%) was demonstrated in samples with only women. OMFI was less prevalent (20%) among DV victims under 18, while TDI was lower among adults (1%). Hospital samples presented higher pooled prevalence of OMFI (32%), and forensic data from fatal victims presented higher prevalence of TDI (8%). CONCLUSION: The overall prevalence of OMFI and TDI in DV victims was 29% and 4%, respectively. Women victims of DV presented higher rates of OFMI (41%) and TDI (6%).

Parenting styles and dental caries in Brazilian children and adolescents in foster care.

PURPOSE: This study aimed to analyse parenting styles as a possible factor associated with caries in foster children and adolescents who had been victims of domestic violence. METHODS: The study was carried out in nine foster shelters in Recife, Northeast Brazil, with a sample of 88 participants aged 8 to 17 years old. Data were collected through intraoral examinations to verify deft/DMFT indices, applying the Demandingness and Responsiveness Scales to determine parenting styles. In turn, sociodemographic data were retrieved from records filed at the institutions. Descriptive analysis was performed, with the Mann-Whitney and Kruskal-Wallis tests being used to compare the categories of numerical variables. RESULTS: The mean deft/DMFT was of 3.78 in children (8 and 9 years old) and 1.93 in adolescents (10 years old and older). Overall, the index was of 2.31. Neglect was the main reason for the children's admission to foster care, while neglectful was the most prevalent parenting style. CONCLUSION: Children of indulgent parents had higher caries indices in both deciduous and permanent teeth, while children of authoritative (permanent teeth) and authoritarian parents (deciduous teeth) had the lowest caries indices. However, no significant associations were found between caries and parenting styles.

High testosterone levels and sensitivity to acute stress in perpetrators of domestic violence with low cognitive flexibility and impairments in their emotional decoding process: a preliminary study.

Hormonal and neuropsychological impairment in intimate partner violence (IPV) perpetrators could play a role in domestic violence. For characterizing whether there is a specific psychobiological response to stress, participants who had previously been jailed for IPV and controls were compared for testosterone and cortisol levels, tested for 2D:4D ratio (as an indicator of masculinization), and given several trait questionnaires and neuropsychological tests related to executive functions and theory of mind. After performing the Trier Social Stress Test (TSST), IPV perpetrators experienced decreases in salivary testosterone (T) levels, a moderate worsening of mood, slight anxiety, and a salivary cortisol (C) level increase. Moreover, high basal T was related with high levels of anger and anxiety and worse mood. However, that basal mood does not significantly alter T levels in response to stress. Nonetheless, controls experienced smaller changes in T and larger changes in C and psychological mood. With respect to neuropsychological and cognitive empathic features, IPV perpetrators showed poorer executive performance and emotional recognition than controls. In addition, deficits in both neuropsychological domains were positively associated. Regarding emotional empathy, IPV perpetrators showed higher levels of personal distress than controls. The 2D:4D ratio was lower in IPV perpetrators than in controls. Moreover, only in the former a smaller 2D:4D ratio was related to large increases in T in response to stress and poor emotional recognition. Together with social aspects involved in IPV, differences in psychobiological variables and their relationships could play a relevant role in the onset and perpetuation of violent behavior.

Recovery of immune control over herpes simplex virus type 1 in female victims of intimate partner violence.

OBJECTIVES: To assess the course of immune control over Herpes simplex virus type 1 (HSV-1) through three salivary measures: neutralization of HSV-1, levels of specific antibody against HSV-1 (HSV-1-sIgA) and total immunoglobulin A (total sIgA), and to determine the factors that contribute to its recovery or deterioration. Several studies have demonstrated that intimate partner violence (IPV) affects immune responses in women, but none have investigated the impact longitudinally over time. METHODS: Women (n = 60), who participated in our previous cross-sectional study (T-1) and who had been either physically/psychologically (n = 22) or psychologically abused (n = 14) by their partners, were evaluated 3 years later (T-2). A control group of women (n = 24) was included for comparison. Saliva samples were collected twice a day (8 AM-9 AM, and 8 PM-9 PM) on 2 days spaced 2 weeks apart. Information about psychological and lifestyle variables was obtained by structured interviews. RESULTS: Physically/psychologically abused women had a significant improvement in both the capacity to neutralize HSV-1 and HSV-sIgA levels, and at T-2 the capacity of their saliva to inhibit virus was no longer different from the other two groups. Regression analysis indicated that the cessation of physical IPV was the main predictor of this recovery. CONCLUSIONS: This study shows that recovery of immune control over HSV-1 is possible in women who had been exposed to physical/psychological IPV despite an initially low antiviral capacity. Other longitudinal studies are needed to determine which factors best predict the restoration of physical and emotional well-being in order to design more effective intervention programs.

The cortisol awakening response as a function of PTSD severity and abuse chronicity in sheltered battered women.

Although intimate partner violence (IPV) is a significant social problem associated with severe psychiatric problems, most notably PTSD, only a handful of studies has examined PTSD and associated physiological factors in battered women. Further, no research to date has investigated impact of abuse chronicity on HPA functioning. The present study examined the impact of PTSD severity and abuse chronicity on the cortisol awakening response in a sample of 52 sheltered battered women. Results suggest that IPV-related PTSD and abuse chronicity have opposite effects on waking salivary cortisol curves in battered women. PTSD severity was associated with significantly greater cortisol output the first hour after awakening, while more chronic abuse was associated with lower total cortisol output in the first hour after awakening. Implications of findings and suggestions for future research are discussed.

Knowledge, attitudes, practices, and training needs of Kentucky dentists regarding violence against women.

Dentists may be the first (and perhaps the only) health care professionals to treat patients who have experienced oral facial trauma resulting from domestic violence. Dentists are likely to see the signs of abuse while performing an oral examination and they often develop relationships with patients that could allow them to detect subtle changes in patients that may indicate signs of domestic violence. This study sought to assess the knowledge, attitudes, practices, and training needs of Kentucky dentists regarding domestic violence against women (VAW). A written survey was sent to a population of 1,892 eligible licensed dentists in Kentucky; 790 (42%) were returned. Ninety percent of the respondents were general dentists and the distribution by practice location was almost equal among urban, suburban, and rural dentists. Only 7.0% of respondents reported having any training in the prevention of VAW. When asked "... are you legally required to report suspected cases of VAW to the appropriate authorities, regardless of the patient's wishes?", 42% answered "no." An overwhelming majority (82%) indicated that they would like more training and information regarding VAW identification and management. Based on analysis of the data, Kentucky dentists would benefit from and be interested in additional education opportunities concerning recognizing, referring, and managing patients who may be the victim of domestic violence.

Interpersonal violence, circumstances of aggressions and patterns of maxillofacial injuries in the metropolitan area of Campina Grande, State of Paraíba, Brazil (2008-2011). / Violência interpessoal, circunstâncias das agressões e padrões dos traumas maxilofaciais na região metropolitana de Campina Grande, Paraíba, Brasil (2008-2011).

The aim of this study was to determine the circumstances of aggressions and patterns of maxillofacial injuries among victims of interpersonal violence. This was a cross-sectional and exploratory study conducted from the analysis of 7,132 medical-legal and social records of interpersonal violence victims seen in a Forensic Medicine and Dentistry Center. Descriptive and multivariate statistics were performed using Multiple Correspondence Analysis. Three groups with different victimization profiles were identified. The first group was mainly composed of men of different age groups, victims of community violence that resulted in facial bones or dentoalveolar fracture. The second group was mainly composed of adolescents (10-19 years) of both sexes, victims of interpersonal violence and without specific pattern of injuries. The third group was composed of adult women (≥ 20 years) victims of domestic violence that resulted in injuries of soft tissues of face or other body regions. The results suggest that sociodemographic and circumstantial characteristics are important factors in victimization by maxillofacial injuries and interpersonal violence.

[Domestic violence: an analysis of injuries in female victims]. / Violência doméstica: análise das lesões em mulheres.

This study aimed to evaluate the prevalence of head and neck injuries in females based on complaints registered as bodily harm or cruel and unusual punishment at the Women's Defense Precinct in Araçatuba, São Paulo State, Brazil, in 2002. A total of 204 police inquiries were conducted in 2002, resulting in 33 police reports of bodily harm and cruel and unusual punishment to females. The police reports were examined as to victim's age and site of injury. The results showed that injuries are inflicted on various age brackets, with a higher prevalence in children and adolescents. In addition, the highest prevalence of injuries was in the head and neck, encompassing the area where dentists work and where they should be prepared to treat victims of such violence.

[Injuries due to domestic violence against women: sites on the body, types of injury and the methods of infliction]. / Letsels door huiselijk geweld tegen vrouwen: locaties op het lichaam, soorten letsel en wijzen van toebrengen.

OBJECTIVE: To obtain insight into the characteristics of intentional injuries in adult women, such as the sites, types, methods of infliction and the inflictors. DESIGN: Descriptive. METHOD: 11 trained and experienced forensic physicians collected data from 450 adult women who had reported domestic violence to the police in Amsterdam, the Netherlands, during the period from 1 April 2001 through 31 March 2005. RESULTS: In 42% of the cases of domestic abuse, the partner was named as the inflictor; in 26% this was the ex-partner. Of the injuries inflicted, 85% were found on more than one area of the body. The most common sites of injury were the eye, the side of the face, the throat or neck, the upper and lower arms and the upper and lower legs; injury to the mouth, the outside of the hand, the back, the scalp, the shoulder and the thorax was somewhat less common. In 76% of the victims there was more than one type of injury. In 64% of the cases the injury had been inflicted in more than one way. In 79% of the victims the injury was at a site that was visible to the outside world, such as the head or the back of the hand. CONCLUSION: In women with injuries due to domestic violence, there was a recognisable pattern with regard to the multiplicity of the injuries, the types of injury, the preferred sites of injury and the visibility of these sites to the outside world.

Facial trauma as physical violence markers against elderly Brazilians: A comparative analysis between genders.

The aim of this study was to characterize the profile of elderly Brazilians with injuries resulting from physical violence and identify victimization differences. A descriptive and exploratory study was conducted involving the analysis of medico-legal and social records of 259 elderly victims of physical violence treated at an Institute of Forensic Medicine and Dentistry over four years (from January 2008 to December 2011). The forensic service database was evaluated by researchers properly trained and calibrated to perform this function between January and March 2013. Socio-demographic variables of victims, aggression characteristics, aggressor's profile and types of lesions were evaluated. Descriptive and multivariate statistics using Multiple Correspondence Analysis (MCA) were performed. The prevalence of facial trauma was 42.9%. Based on the MCA results, two groups with different victimization profiles were identified: married men aged 70-79 years, victims of community violence at night, suffering facial injuries; and single, widowed or separated women aged 60-69 years, victims of domestic violence during the day, suffering trauma in other areas of the body. The results suggest that there is a high prevalence of facial injuries among elderly Brazilians victims of physical violence and there are important differences related to victimization characteristics according to gender.

Adult safeguarding; guidance for dental professionals.

The legal responsibilities of all those involved in the care of adults at risk of harm were set out in the 'Care Act 2014' which became law in England in April 2015. In the same month, the General Dental Council (GDC) announced that 'safeguarding vulnerable adults' was to become a recommended topic for continuing professional development (CPD), along with 'safeguarding children and young people.' This paper updates on relevant legislation, and outlines the role of dental professionals in adult safeguarding. It then advises on issues surrounding safeguarding concerns, using three scenarios for illustration. Rather than covering the very broad topic of abuse of adults in general, the paper focusses on 'adults at risk' to whom statutory safeguarding law applies.

Gender differences in homicide in Contra Costa County, California: 1982-1993.

INTRODUCTION: Homicide is the third leading cause of injury death for women in the United States. However, few studies have examined the circumstances specific to female homicide. This study examines gender differences in circumstances surrounding homicides in Contra Costa County for a 12-year period. METHODS: Uniform Crime Reporting (UCR) data for Contra Costa County from 1982 through 1993 were analyzed. Variables examined were gender of the victim, victim-offender relationship, age of victim, weapon used, location of homicide, precipitating circumstances, and gender of the offender. RESULTS: Forty-six percent of the women were killed by their spouse, other family member, or intimate partner, compared to only 11.4% of men. In contrast, men were more likely to be killed by a stranger than women (17.9% versus 10.9%, P = .02). A higher percentage of women than men were killed with a blunt object, a personal weapon (i.e., fists, feet, and teeth), or other weapon (24.9% versus 10.6%, p < .01), and in a residence (60.1% versus 34.8%, P < .001). Men were more likely than women to be killed by a firearm, in a public place (i.e., a parking lot or street), and while a felony was being committed. CONCLUSIONS: These findings are consistent with the hypothesis that many female homicides may be the result of domestic violence, belying the myth that the principal perpetrators of homicides against women are strangers. The differences between female and male homicides indicate that gender-specific prevention strategies need to be pursued.

Making prevention of abuse and neglect through dental awareness green.

Family violence encompasses child, spouse, and elder abuse and neglect and is viewed as a serious public health threat in our society. Unfortunately, abuse and neglect are commonplace in our society and are not limited to the civilian sector. The military community mirrors the civilian sector in the prevalence of abuse and neglect. Traditionally, identification and intervention of suspected cases of abuse and neglect was thought to be the role of the medical provider. Reports that up to 94% of family violence injuries have head and neck components, which is the very site that dental providers focus their attention, justifies the need for dental involvement. The U.S. Army Dental Command's Health Promotion and Disease Prevention Program's newest initiative is a family violence awareness program called Prevention of Abuse and Neglect through Dental Awareness (PA.N.D.A.). The program augments the Army Family Advocacy Program and gives dental-specific knowledge to our providers. The goals of this article are to describe the new program of the U.S. Army Dental Command that focuses on providing education and awareness to the dental community regarding family violence and to report the results of a survey that has been administered during the family violence training. More than 71% of individuals attending the P.A.N.D.A. training claimed to have previous training in family violence, whereas only 44% were knowledgeable about military regulations governing abuse and neglect.

Forensic dentistry. Recognizing the signs and symptoms of domestic violence: a guide for dentists.

Non-accidental trauma (NAT) is a leading cause of death and injury in America. Women and elderly persons are much more likely to be injured by a family member or by someone known to them than by any other individual. This aggressive, violent behavior directed against an individual within the home or family has been defined as "domestic violence." Intrafamily violence effects one in two American families and occurs in all segments of society. Studies have shown that unless intervention occurs, the violence tends to escalate often resulting in serious injury or death. Because greater than half of all domestic violence injuries occur in the head and neck area, the dentist is often the first to treat the domestic violence victim. Each member of the dental team must be a participant in the early recognition of domestic violence and other forms of non-accidental trauma. Intervention can only begin after the victim is recognized. While acknowledging the important role of the forensic odontologist in the diagnosis and documentation of intentionally inflicted injuries, the general dentist and the dental team play an equally important role in stopping domestic violence.

PTSD, comorbid depression, and the cortisol waking response in victims of intimate partner violence: preliminary evidence.

Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are two highly comorbid and debilitating disorders experienced by more than half of intimate partner violence victims (IPV). Hypothalamic-pituitary-adrenal (HPA) abnormalities are common in both disorders, though the direction of abnormalities often differs. The present study examined the relationship between comorbid PTSD and MDD, and the (salivary) cortisol waking response in 104 recently abused IPV victims. Waking cortisol levels, area under the waking curve with respect to ground (AUCg), and AUC with respect to increase (AUCi) were examined to determine the relation of HPA dynamics to comorbidity for basal versus more dynamic measures. Prior to accounting for comorbidity, women with PTSD or MDD showed significantly greater AUCi than women without the respective disorder. Accounting for comorbidity, PTSD only did not differ from other groups, while MDD only and PTSD + MDD showed greater AUCi than women with neither disorder. Results were nonsignificant for waking cortisol levels or AUCg. Results suggest that MDD drives elevated waking cortisol response, but not basal cortisol activity in recently abused IPV victims. Results demonstrate the importance of examining comorbid diagnoses and HPA activity from a dynamic perspective. Therapeutic implications are discussed.

Violence and abuse: core competencies for identification and access to care.

Violence and abuse (V/A) is recognized as a significant public health problem, especially in females. Injuries to the head, neck, and/or mouth are clearly visible to the dental team during examination. This article provides compelling evidence that supports the pivotal position occupied by oral health care professionals within the arena of detection, intervention, and prevention of V/A. This article reviews the epidemiology of orofacial risk factors for V/A, diagnostic tools and surveys for identifying victims of all ages, and suggests interdisciplinary educational curricula/specific algorithms to provide the necessary core competencies for identifying victims in the oral health care environment.

Occurrence of traumatic dental injury in cases of domestic violence.

The purpose of this study was to investigate the prevalence and types of traumatic dental injuries in situations of domestic violence. A coross-sectional study was conducted and data were collected from the police occurrence records to domestic physical aggression between 2001 and 2005. Of the 1,844 subjects who underwent medical evaluation, 15 had information pertaining to traumatic dental injuries. From the medical records, the forensic medical reports completed by the forensic medical experts who examined the victims after the aggression were reviewed and data of individuals with dental injuries (e.g., fractures, luxation and avulsion) were collected. In the selected sample, there was a predominance of individuals with injuries to the head and neck region (38.7%), and the frequency of traumatic dental injuries among all injuries to the head and neck region was 2.0%. The most frequently injured teeth were the maxillary incisors (31.8%), followed by the mandibular incisors (27.3%) and the maxillary canines (9.1%). In 31.8% of the injured teeth, the forensic experts did not specify the nomenclature. Of the dental trauma cases, 59.1% were fractures, 27.2% were luxations and 13.7% were avulsions. In conclusion, domestic violence was an important etiologic factor of traumatic dental injury. The aggression in all cases occurred in the form of punches and slaps. Fracture was the most common type of traumatic dental injury, and the most frequently injured teeth were the incisors.

Violência interpessoal, circunstâncias das agressões e padrões dos traumas maxilofaciais na região metropolitana de Campina Grande, Paraíba, Brasil (2008-2011) / Interpersonal violence, circumstances of aggressions and patterns of maxillofacial injuries in the metropolitan area of Campina Grande, State of Paraíba, Brazil (2008-2011)

RESUMO O objetivo deste estudo foi determinar as circunstâncias das agressões e os padrões dos traumas maxilofaciais entre vítimas de violência interpessoal. Tratou-se de um estudo transversal e exploratório feito a partir da análise de 7.132 registros médico-legais e sociais de vítimas de violência interpessoal atendidas em um Centro de Medicina Legal e Odontologia Forense. Foi feita estatística descritiva e multivariada, usando Análise de Correspondência Múltipla. Três grupos com perfis distintos de vitimização foram identificados. O primeiro grupo foi formado majoritariamente por homens, de diferentes faixas etárias, vítimas de violência comunitária, resultando em fratura de ossos faciais ou fratura dentoalveolar. O segundo grupo foi composto essencialmente por adolescentes (10-19 anos), de ambos os sexos, vítimas de violência interpessoal e que não apresentaram um padrão específico de trauma. O terceiro grupo reuniu mulheres, adultas (≥ 20 anos), vítimas de violência doméstica, resultando em lesão de tecidos moles da face ou em outras regiões do corpo. Os resultados sugerem que as características sociodemográficas e circunstanciais são fatores importantes na vitimização por traumatismo maxilofacial e violência interpessoal.

Abstract The aim of this study was to determine the circumstances of aggressions and patterns of maxillofacial injuries among victims of interpersonal violence. This was a cross-sectional and exploratory study conducted from the analysis of 7,132 medical-legal and social records of interpersonal violence victims seen in a Forensic Medicine and Dentistry Center. Descriptive and multivariate statistics were performed using Multiple Correspondence Analysis. Three groups with different victimization profiles were identified. The first group was mainly composed of men of different age groups, victims of community violence that resulted in facial bones or dentoalveolar fracture. The second group was mainly composed of adolescents (10-19 years) of both sexes, victims of interpersonal violence and without specific pattern of injuries. The third group was composed of adult women (≥ 20 years) victims of domestic violence that resulted in injuries of soft tissues of face or other body regions. The results suggest that sociodemographic and circumstantial characteristics are important factors in victimization by maxillofacial injuries and interpersonal violence.

Oral injuries in victims involving intimate partner violence.

INTRODUCTION: Current literature states that dental medicine can have an important role in diagnosing situations of domestic violence, namely cases of intimate partner violence, since many of the injuries that occur in this context concern the head and neck areas. The aim of this study was to characterize oral injuries in these cases in a Portuguese population, and to determine the kind of permanent consequences that they might represent. MATERIAL AND METHODS: 332 forensic reports of domestic violence survivors were analysed. The reports concerned examinations performed in the North Branch of the National Institute of Legal Medicine of Portugal in 2007. Reports were assessed in order to obtain data regarding victim and offender demographic characteristics, and to characterize the nature and number of sustained injuries and their permanent consequences. MAIN RESULTS: Most victims were females with a mean age of 33.7 years; the most frequent offender was the spouse; the majority of oral injuries affected soft tissues; permanent body consequences were found mainly in the teeth and periodontal tissues; permanent functional consequences were described as chewing difficulties, feeling pain or soft tissue mobility changes; permanent consequences for life activities referred mostly to social life aspects. CONCLUSIONS: Oral injuries and their consequences were observed in 13.4% of intimate partner violence cases, and though being suggestive of this kind of violence, oral injuries alone are insufficient to identify this kind of abuse, and additional diagnostic criteria and evidence should be used.