In the Family Violence course at the University of Arizona, our group was tasked with creating a program to improve the lives of victims of assault. Oral health education is exceptional for recognizing the symptoms of abuse to stop them, but lacking in providing competent services to put people who have been assaulted at ease. This ongoing education program, devised by N. John F. Porter and developed by a team of fellow public health students, looks to fix that problem, generating more business for oral health professionals and helping people in need get the care they deserve.

1. Abuse Sensitivity Training for Oral
Health Professionals Seminar
John Porter, Alexis Lopez, Aleah Smith, Ashley Duru, Selene
Brambl, Roianne Tran, Samantha Smith, Shannon Davis

2. Presentation Outline
1. Statement of Purpose
2. Program Overview
3. Program Curriculum
4. Defining the Program
5. Barriers to Providing or Receiving Care
6. Strategies for Adopting a Comfortable
Environment
7. Community Outreach
8. Advocacy Group Members
9. Template E-mail
10. Incentives for Participating in the Program
11. Moving Forward
12. References

3. Statement of
Purpose
Oral health professionals are
responsible for ensuring that victims
of domestic violence (DV) receive
competent care. Those who have
received sensitivity training are
more likely to recognize and report
domestic violence while providing
care that is accommodating to the
needs of victims.
Disparities exist between health
outcomes of victims and non-victims,
and competent care can reduce these
negative health outcomes.
Why?

4. Program Overview

5. Defining the Program
Healthcare professionals are constantly continuing their education by means of online
courses and seminars to keep on the cutting edge of their field, making them more
competent in their care while helping them stand out in their communities.
We created a 1-hour seminar specifically designed for oral health professionals (OHP’s).
A group of public health workers would travel to individual communities & will educate
them on:
❖ Common barriers victims face to receiving their care
❖ How OHP’s can adjust their standards of care to accommodate victims’ specific
needs
❖ How OHP’s can work with advocacy groups in their area to provide better care and
increase their business

6. ASTOHPS Format and Implementation
OHP’s continue their education via online courses and in-person seminars &
workshops. Our program is styled in a similar format- an in-office seminar.
Access to presentation equipment will be needed, as well as at least 1 presenter. The
community resources should be tailored to the community in which the seminar is
taking place.
The seminar itself will be 1 hour: 35-40 minutes of the presentation, a 5 minute
break, then 20 minutes of answering questions and the presenter(s) creating a plan
of action with participants. This will include what modifications to care can be
implemented and what community program to contact.

7. Presentation Content

8. Barriers to Providing or Receiving Care
...For medical care personnel
❖ Lack of education
❖ Limited resources and time
❖ Lack of understanding and sensitivity
...For DV victims
❖ Having to lie down for treatment
❖ Dentist’s hands over mouth/nose
❖ Fear of severe gagging/being sick
❖ Being alone with a person more
powerful than oneself
❖ Experiencing or anticipating pain
❖ May trigger memories or feelings of
past abuse

9. Strategies for Adopting a Comfortable Environment
● Allow the patient to be in control; get consent for each separate treatment
● “Inform before you perform” (Tell-Show-Do)
● Allow the patient to have a chaperone with them, whether a friend or dental
assistant
● Provide the patient with a “stop” hand signal
● Be understanding of frequently canceled appointments, and allow for same-day
appointments when the patient feels ready
● Using vinyl gloves and avoiding aftershave (to prevent flashbacks triggered by
smell of latex or aftershave)
...and more

10. Community
Outreach
A list of domestic abuse shelters,
victim advocacy groups, and other
non-profit organizations and non-
governmental organizations will be
provided.
Oral health providers who are
participating in the program and are
committed to providing competent
care for DV victims are encouraged
to reach out to these organizations to
collaborate with them in identifying
more barriers and their solutions
which may be unique to their area.
Who?

11. Advocacy Organizations
National organizations
❖ National Coalition Against Domestic
Violence (NCADV)
❖ National Organization for Victim
Assistance (NOVA)
❖ American Overseas Domestic Violence
Crisis Center (AODVCC)
Local organizations (tailored to Tucson)
❖ Emerge! Center Against Domestic
Violence
❖ Anti-Violence Project at the Southern
Arizona AIDS Foundation
❖ Southern Arizona Center Against Sexual
Assault (SACASA)
❖ Casa de los Ninos

12. Template E-mail: From OHP’s to Advocacy Groups

13. Incentives for Participating in the Program
❖ Existing patients will feel more comfortable while receiving treatment, which will
potentially increase patient retention & referrals.
❖ Advocacy groups and shelters often offer services to help participants enroll in public
assistance programs, including state insurance. Therefore, advocacy group members will
be recommending insured patients to their business (customers that can pay).
❖ Completing the program is another chance to stand out in the community. They can
promote their commitment to helping victims of DV and all patients with PTSD. This
will likely increase positive recognition for their business.
❖ Increased business (there are many victims that need care) will likely more than offset
the increased expense of providing more competent care.

14. Moving
Forward
As our program exists now, it will only serve to
inform oral health professionals and help them
contact advocacy groups.
While they will be able to advertise that they
are making efforts to provide more competent
care for victims of domestic violence, the
program has not been reviewed for efficacy.
Data will need to be collected from victims of
domestic violence that seek help from advocacy
group members to measure how effect they are
in solving victim health disparities.
Ultimately, if the program is effective, it could
be recommended by the American Dental
association which will increase national interest
in the program.
What next?

15. Questions?

16. References
Da Silva Júnior, I. F., Goettems, M. L., & Azevedo, M. S. (2016). Oral health status of children and adolescents victims of abuse: a
literature review. RSBO, 13(2), 104-108.
Dental Phobia and Sexual, Physical, or Emotional Abuse. (2016). Dentalfearcentral.org.
Retrieved 20 November 2016, from http://www.dentalfearcentral.org/fears/abuse-survivors/
Duda, J. G., Biss, S. P., Bertoli, F. M. D. P., Bruzamolin, C. D., Pizzatto, E., Souza, J. F., & Losso, E. M. (2016). Oral health status in
victims of child abuse: a case–control study. International journal of paediatric dentistry.
Dickinson, C. M., & Fiske, J. (2005). A review of gagging problems in dentistry: 2. Clinical assessment and management. Dental Update, 32(2), 74–80.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4309219/.
Dougall, A., & Fiske, J. (2009). Surviving child sexual abuse: the relevance to dental practice. Dental update, 36(5), 294–304. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4309219/.
Enhancing Dental Professionals Response to Domestic Violence. (n.d.). Retrieved November 17, 2016, from
https://www.ihs.gov/DOH/portal/feature/DomesticViolenceFeature_files/EnhancingDentalProfessionalsResponsetoDV.pdf
Guideline on Oral and Dental Aspects of Child Abuse and Neglect. (2010). American Academy of Pediatric Dentistry, 37(6), 172-175.
Retrieved November 20, 2016, from American Academy of Pediatric Dentistry.

17. References (cont.)
Kundu, H., Basavaraj, P., Singla, A., Kote, S., Singh, S., Jain, S., ... & Vashishtha, V. (2014). Domestic Violence and its Effect on Oral Health
Behaviour and Oral Health Status. Journal of clinical and diagnostic research: JCDR, 8(11), ZC09.Mission. (2016). Retrieved November 20,
2016, from http://www.866uswomen.org/our-mission/
Larijani, H. H., & Guggisberg, M. (2015). Improving Clinical Practice: What Dentists Need to Know about the Association between Dental Fear and a
History of Sexual Violence Victimisation. International Journal of Dentistry, 2015, 452814. http://doi.org/10.1155/2015/452814.
Littel, K. (2004). Family violence: an intervention model for dental professionals. U.S. Department of Justice: Office for Victims of Crime. Retrieved from
http://www.ovc.gov/publications/bulletins/dentalproviders/ncj204004.pdf.
Nelms, A. P., Gutmann, M. E., Solomon, E. S., DeWald, J. P., & Campbell, P. R. (2009, January 9). What Victims of Domestic Violence Need
from the Dental Profession. Journal of Dental Education, 73(4). doi:http://www.jdentaled.org/content/73/4/490.long
Stalker, C. A., Carruthers Russell, B. D., Teram, E., & Schachter, C.L. (2005). Providing dental care to survivors of childhood sexual abuse. The Journal of
the American Dental Association, 136(9), 1277-1281. Doi http://dx.doi.org.ezproxy3.library.arizona.edu/10.14219/jada.archive.2005.0344.
Strøm, K., Rønneberg, A., Skarre, A. B., Espelid, I., & Willumsen, T. (2015). Dentists’ use of behavioural management techniques and their attitudes toward
treating paediatric patients with dental anxiety. European Archives of Paediatric Dentistry, 16(4), 349-355. Doi: 10.1007/s40368-014-0169-1.
Walker, E. A., Milgrom, P. M., Weinstein, P., Getz, T., & Richardson, R. (1996). Assessing abuse and neglect and dental fear in women. The Journal of the
American Dental Association, 127(4), 485–490. doi: 10.14219/jada.archive.1996.0240.
Women's Shelters. (2016). Retrieved November 20, 2016, from https://www.womenshelters.org/det/casa-del-los-ninos