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n activist group of dentists and hygienists is pushing the profession to use checkups to screen patients for signs of domestic abuse — and take action to help patients who may be vulnerable.

“A lot of dentists say, ‘I only do teeth.’ We put everything in a silo,” said Sue Camardese, a dental hygienist working on the issue. “But this is health. This is part of health.”

Camardese runs the mid-Atlantic branch of an initiative dubbed P.A.N.D.A., short for “prevent abuse and neglect through dental awareness.” The group has created a course to train dentists and hygienists in detecting abuse and neglect — and lobbied state medical officials to make it mandatory.

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In 2015, Maryland began requiring dentists to take two hours of continuing education on abuse and neglect in order to renew their licenses. Dental professionals in Tennessee, North Carolina, South Carolina, and Pennsylvania have reached out to see how they can get a similar effort underway.

“That’s the first step, to actually admit we need to have some education in abuse and neglect,” Camardese said.

It’s estimated that 70 percent of injuries from abuse are on the head and neck. That can put signs of the abuse front and center for dentists — who, with a twice-annual cleaning, might be seeing some patients more often than a primary care provider.

But dentists and hygienists, while well-trained to detect signs of child abuse, often aren’t given extensive training to spot and address signs of intimate partner violence.

One survey of domestic abuse victims found that over half had visited a dentist when signs of abuse were present, but nearly 90 percent of those individuals weren’t asked about their injuries. The majority said they wished their dentist had asked.

Dental schools are trying to train the next generation of providers to do just that.

“Every dentist should be prepared to care for and triage such patients,” said Dr. Colette Catalino, a dentist and instructor at Tufts University School of Dental Medicine.

At Tufts, first-year dental students are taught broadly about the signs of abuse and the health implications of violence. In their second year, they go deeper. In their third year, they start seeing patients and are encouraged to ask when they see something suspicious.

Some victims of violence show up at the dentist’s office with visible bruises or other injuries. Other signs are more subtle. Victims might miss an appointment, or be late. They might be particularly jumpy in the dentist’s chair. Sometimes, a perpetrator won’t leave a victim’s side during the appointment.

“They present with a lot of anxiety, and they don’t like anything going into their mouths,” said Dr. Kanchan Ganda, a physician who teaches at the dental school at Tufts and who started the school’s Dental Outreach to Survivors program.

The program gives free or low-cost, confidential dental care to victims of intimate partner violence from dozens of shelters across Massachusetts. The program, which is funded through grants, has served more than 500 patients since it opened in 2004.

The program also provides a training ground for dental students, who are armed with a list of questions: Did someone hurt you or interfere with your seeking care? Was it a family member? Was it a spouse? Would you like to tell me what has happened or what is happening?

Other dental schools are considering setting up similar programs and have asked for advice, Ganda said.

“Every dentist, no matter where they’re practicing, needs to be aware there are individuals who are hurting,” said Ganda.

Nationally, dental schools have made strides in bolstering their curriculum on treating patients who’ve been victims of intimate partner violence. An annual survey of dental school courses found that in recent years, schools have increased their instruction on the topic.

Activists within the profession hope more colleagues will responsibility for patients who’ve been abused.

“We need to be looking out for them,” said Ganda. “We need to be caring for them.”

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  • This is a well-intentioned program. But the reality of the current healthcare world is that mental health care is becoming more limited by the day. Insurance carriers have imposed harsher restrictions in 2017, making access yet more difficult and the potential for viable referrals extremely limited. Further, dental offices are not the time, place, or milieu for sensitive mental health evaluation or intervention. Any brief CEU course is going to offer deceptively simplistic formulations which will be vastly overmatched to the reality of the problem.

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