Domestic violence: a complex health care issue for dentistry today.

As a natural outgrowth of the dental professional's role in recognizing and reporting child abuse the topic has been broadened in recent years to domestic violence, that is child, spouse/intimate partner, disabled and elder abuse. Forty years ago in the US there were 662 cases of child abuse reported to authorities. Today that reported number is in excess of 3 million per year [D. Wiese, D. Daro, Current trends in reporting and fatalities; the results of the 1994 annual 50 state survey, National Committee to Prevent Child Abuse, Working Paper 808, 1995]. The "dirty secret" of spousal/intimate partner violence is believed to affect 3-4 million individuals per year in the US. Studies have also found that between 50 and 70% of these perpetrators also abuse their children or those of their intimate partner [J. Kessman, Domestic violence, identifying the deadly silence, Texas Dent. J. (2000) 43]. Just as child abuse is most often manifested in the head or neck regions, likewise the evidence of physical violence to intimate partners and the elderly can be seen in the head or neck regions. The insidious part of partner and elder abuse is that often the largest component of these behaviors is psychological, emotional and indirect neglect, which leave no physical evidence [M. Bowers, Forensic Dental Evidence: An Investigator's Handbook, Elesevier, San Diego, CA, 2004, p. 119].