Domestic violence screening and intervention programmes for adults with dental or facial injury

Paul Coulthard, Sin Leong Yong, Linda Adamson, Alison Warburton, Helen V Worthington, Marco Esposito, Mohammad O Sharif

Domestic violence exists in all communities across the world. Healthcare services have a pivotal role in the identification, assessment and response to domestic violence. As the face is a common target in assault, dentists and oral and maxillofacial surgeons are in a unique position to screen for domestic violence in the context of presentation of dental and facial injury. Owing to lack of training, dentists and oral and maxillofacial surgeons may not be the best persons to give advice to someone experiencing domestic violence. Improper advice such as encouragement to leave an abusive relationship may escalate the frequency of violence. It may be more appropriate to refer to specialist agencies for intervention and support. It would, therefore be useful to know whether screening and intervention programmes are effective. (1) To assess the benefits and harms of intervention programmes employed to reduce and or prevent domestic violence in adults with dental and/or facial injuries.(2) To assess the benefits and harms of screening and the use of different screening tools in the detection of the proportion of adult victims of domestic violence who present with dental and/or facial injury. The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 18 May 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 2), MEDLINE via OVID (1950 to 18 May 2010), EMBASE via OVID (1980 to 18 May 2010), PsycINFO via OVID (1950 to 18 May 2010), LILACS via BIREME (1982 to 18 May 2010) and CINAHL via EBSCO (1980 to 18 May 2010). There were no restrictions regarding language or date of publication. Randomised controlled trials (RCTs) involving adults aged 16 years and over presenting with dental and/or facial injury relating to domestic violence in any healthcare setting. Screening of eligible studies was conducted in duplicate and independently by two reviewers. Results were to be expressed as random effects models using mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence interval. Heterogeneity was to be investigated including both clinical and methodological factors. No eligible RCTs were identified. There is no evidence from RCTs to support or refute that screening for domestic violence in adults with dental or facial injury is beneficial nor that it causes harm. Screening tools to detect domestic violence exist but no RCTs have specifically evaluated their effectiveness for patients presenting with facial and or dental injuries. There is also lack of evidence (from RCTs) that intervention programmes are effective at reducing frequency of physical assaults and at reducing the severity of facial injuries.