Written By Kevin Kerfoot / Reviewed By Ray Spotts 

A new study published in the Journal of the American Dental Association states that roughly half of U.S. dentists experienced verbal or reputational aggression by patients in the past year. Nearly one in four endured physical aggression. The study - led by researchers at NYU College of Dentistry - is the first to document aggression toward dentists in the U.S.

"Workplace violence toward health care professionals is both widespread and widely overlooked," says Kimberly Rhoades, a research scientist in the Family Translational Research Group at NYU College of Dentistry and the study's lead author. "The purpose of this study was to provide an initial estimate of rates of patient aggression in dental practices in the United States."

Rhoades says that workplace aggression toward health care professionals is common with health care settings second only to law enforcement in the rate of violent incidents. Surprisingly, there are no studies of aggression toward dentists in the U.S. and only four studies have been conducted in other countries.

"Dentistry is rife with situations that can elicit strong negative emotions, such as fear, pain, distrust, and anger,” she continued. “Many patients also experience high levels of anxiety and vulnerability, which may increase negative responses or aggression. Establishing that aggression toward dentists is a problem and how often it occurs can help us develop interventions to prevent aggression in dental practices."

21 types of aggressive behavior

Researchers surveyed 98 dentists practicing in the New York City metropolitan area. Participants completed a confidential online survey assessing whether they had experienced any of 21 specific types of aggressive behaviors from their patients, including types of physical, verbal, and reputational aggression.

Dentists reported experiencing aggression from patients in the past year, including physical (22.2%), verbal (55%), and reputational (44.4%) aggression. An even larger proportion of dentists surveyed were subjected to physical (45.5%), verbal (74%), and reputational (68.7%) aggression at some point during their career.

Rates of aggression did not differ by dentists' sex, race, ethnicity, specialty, age, years practicing, or average number of patients treated per day. The rates of patient aggression toward dentists are high and comparable with those reported in other health care settings.

A larger, national study is needed to determine the true prevalence of aggression in U.S. dental settings. Dental practices should consider implementing training that incorporates strategies for handling workplace violence with training that addresses how to prevent patient aggression, and manage or de-escalate aggression when it does occur.

Dentists are first line of defense against domestic violence

A recent article in the Journal of Aggression, Maltreatment and Trauma reports that as much as 75 percent of head and neck trauma associated with domestic violence occurs with oral injury. Researchers concluded that dentists are in the unique position to be the first line of defense in identifying evidence of assault, and then reporting potential cases of domestic violence.

While dentists receive little to no education about identifying and discussing domestic violence with potential victims, yet they may be the first and only health professional to evaluate a domestic violence victim.

Oral biomarkers that can help dentists potentially identify domestic violence victims include tears, fractures, breaks and chips in the teeth and mouth that would be inconsistent with personal history and raise the index of suspicion.

Other signs of violence that may indicate brain injury include jaw or tooth fractures, trauma to nerves in the mouth and jaw, as well as damage to the nasal bone. Tooth discoloration, blunted roots and pulpal necrosis - the death of cells and tissues in the center of a tooth - also may be signs of a previous dental trauma warranting further investigation.

"The overall purpose of the paper – published by The University of Arizona College of Medicine -- Phoenix and Midwestern University is to bring dentistry and its subspecialties into the conversation about traumatic brain injury – referred to as TBI - specifically in cases of domestic violence," says Midwestern University dental student Timothy Ellis, lead author of the study.

Dental education and Traumatic brain injury

An estimated 41.5 million individuals will experience some type of domestic violence during their lifetime, and 20.75 million will sustain a TBI. Of the victims that sustain a TBI, 8.3 million will live with some form of long-term physiological or psychological consequences of the injury.

"In our society, and others around the world, domestic violence is more common than many would suspect,” Ellis continued. “Survivors recount 'too many times to remember' that they were abused and blacked out or were struck in the head. Thus, oral and facial trauma may be treated or identified by dentists and dental sub-specialists, opening another avenue for patients to gain access to proper care or needed assistance.

"I have spoken with several dentists regarding the topic," Ellis added. "Many find it interesting, however, they have little experience. The most common answer I receive is that they had just never thought about it or believed that such a case would be more likely to present in a medical facility and thus, it does not cross their mind when interacting with patients on a daily basis. That said, many dentists are intrigued by the topic and the response has been positive. It is interesting that very stringent protocols exist in pediatric dentistry, but a large gap exists when dealing with teens, young adults and adults in general."

"This is a societal need and we have to call on all health care providers and mandatory reporters to join the fight," added Dr. Lifshitz Ph.D. and director of the Translational Neurotrauma Research Program at the UA College of Medicine – Phoenix. "This paper is creating additional touchpoints between victims and the health-care delivery system. It is an opportunity for dentists to be early detectors who can refer those individuals for follow-up care."

"All dentists should be educated on the identification of potential injuries sustained as a result of domestic violence," added Sheri Brownstein, DMD, director of preclinical faculty at the Midwestern University College of Dental Medicine -- Arizona and a co-author of the study. "As health-care providers, we are already obligated to report suspected abuse. I do not feel that this will add an undue burden to dentists."

Next steps may include collecting data from dentists to document oral biomarkers of injury with the objective to help at least one patient and their situation.

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Written By:

With over 30 years of writing and editing experience for newspapers, magazines and corporate communications, Kevin Kerfoot writes about natural health, nutrition, skincare and oral hygiene for Trusted Health Products’ natural health blog and newsletters.

Reviewed By:    

Founder Ray Spotts has a passion for all things natural and has made a life study of nature as it relates to health and well-being. Ray became a forerunner bringing products to market that are extraordinarily effective and free from potentially harmful chemicals and additives. For this reason Ray formed Trusted Health Products, a company you can trust for clean, effective, and healthy products. Ray is an organic gardener, likes fishing, hiking, and teaching and mentoring people to start new businesses. You can get his book for free, “How To Succeed In Business Based On God’s Word,” at www.rayspotts.com.

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