Please do not take it lightly if you are in a state requiring that you take courses about domestic violence or abuse.
I often think about why so many states require dental professionals to take continuing education courses on domestic violence or abuse. The following scenarios might explain the need, as well as some things that the dental team should consider when patients arrive in our operatories.
In the first scenario, Sadie arrived with her left arm in a cast from elbow to wrist. When I questioned her, she told me that she fell and broke her wrist a few days prior but did not want to cancel her dental appointment. She shared with me that she was being cared for by a "wonderful woman." Her daughter, who lived too far away, had gotten this woman to take care of Sadie.
Otherwise, Sadie appeared to be well cared for. Although she was left-handed and obviously restricted by the cast, her partials were clean and spotless. However, during her recare visit a few months later, my observations and knowledge about "elderly abuse" were implemented.
Sadie's cast was no longer there, and she was still dressed neatly. But obvious stains were on her clothes — unusual for her. Her eyes were locked in an odd, glazed stare, and her usual perky personality was absent. After checking her chart, I asked if her agility with the left hand had returned. Then I asked if she was on her own at this point in time.
Sadie responded that her daughter felt that she should not be alone any longer, but Sadie wanted to remain in her own home. As a compromise, they kept the woman referred to above. I realized that she no longer referred to the woman as a "wonderful woman." When I asked Sadie if she was still happy with this woman and if she minded having someone around day and night, her eyes fell to the ground and she did not answer.
This was my clue. Sadie was so sad! I began to wonder if she was being well cared for or if there was an underlying problem. Although this was not a dental problem, I decided to use some active listening and probe a little deeper.
I used her partials as a beginning, since they were no longer as clean as they had been in the past. In questioning her, Sadie shared that her strength in her left hand was not as it had been prior to the fall and that the aide was cleaning her teeth. I realized that the aide did not know how to clean the partials properly, so I called her in when Sadie was at the front desk. I asked if she would like me to show her how to care for the partials.
The aide was adamant that she knew how to do this and did not need my help. I offered some denture cleaner and let it go. But this exchange festered in me all day. How could such a sweet lady as Sadie be treated with such a lack of respect? Was this, in fact, what was happening? If not, was it something worse that made Sadie become so reticent and not wanting to share her problems with me as she had done for many years in the past?
I have always made it a policy to have the phone numbers or addresses of the children of my elderly patients in the chart. If there were ever a need to reach them, we could. Where did my responsibility now lie? When we notice a change in patients who have always been meticulous about their home care and personal appearance, I think that we do need to step in — gently and with the right party. We do not have to make accusations as such. But we should let the children or spouses know that the care that they thought was being given to their loved one might not be what they think ... and that they might want to look into it.
In the second case, five-year-old Johnny arrived for his prophy and fluoride appointment. He announced to me that he did not need this appointment. During the examination, I noticed that the commissures of his mouth had splits. His mouth appeared to be very sore, as well as loaded with plaque and debris. I questioned him about this, and he was very apprehensive about answering. So I played a guessing game with him. I guessed that he has not had a new toothbrush since his last appointment. Perhaps his activities interfered with his home care. I also guessed that his parents had not been at home when he was been going to bed or arising in the morning, and that he was skipping his daily rituals of good home care.
Bingo! His eyes lit up. "Wow, how did you know?" I let Johnny know that it is OK to share with me. I just knew that he was not the neat, happy, and clean young man that I knew from the past. He also wore long sleeves on a day when it was 90 degrees outside. I asked if he was very hot in the shirt. He responded, "Yes, but Daddy says that I have to wear it." I remembered that his father was a smoker, so asked Johnny if his father had successfully quit as promised earlier. Johnny indicated that his father was still smoking.
I asked Johnny to brush his teeth for me, so that I could help him with the places he was missing. When he realized that he could relax with me, he rolled up his sleeves. This was when I confirmed my original oral findings. Yes, there were burn marks on his arms, and the long sleeves were concealing them.
The reason I share these two stories is because there is abuse of all types out there. Oral signs include a change in home care habits or the cleansing of partials and dentures. The signs might be more overt — sadness in the eyes, odd types of clothing, mismatched clothing, and stained clothing. The clues tell us that something is not right.
Please do not take it lightly if you are in a state that requires you to take courses about domestic violence or abuse for CE credits. We can be of so much help to patients by being alert about this widespread epidemic.
Obviously, not all caregivers and parents are abusers. There are so many who are wonderful with the children they are rearing, the elderly that they are caring for, and to everyone that they come in contact with daily. But it is the aware and alert hygienist who can pick the odd ones out and hopefully make a change in the patient's life early enough before the abuse becomes irreversible.
Another form of abuse that I have had a personal experience with is that of verbal abuse to an elderly member of the family. My mother had to be cared for by someone while I was out of town. When I returned home, all it took was a look into her eyes to tell me that something was wrong. When we talked, it all came out. How awful I felt as the person who put this caregiver in my mother's life! But how thankful I was that I knew what I was seeing when I looked into her eyes and heard her voice.
If someone is being cared for and no one is allowed in to see them ... if the person sounds sad and morose ... if someone has this glazed, dark look in their eyes ... if any type of physical change for the worse is occurring, please take the next step. Look into it a bit deeper — carefully, though, for your own sake! Then see if you can reach a family member who will listen to you and try to help this person.
Thanks for reading this and understanding better why these courses are so very important for us to take over and over again.
A 1964 graduate of the Forsyth School for Dental Hygiene in Boston, Jane Weiner, RDH, is a practicing hygienist in south Florida. She is the owner of Board Reviews, Inc., which presents national board reviews and Florida state board law reviews. She is an adjunct faculty instructor at the predoctoral periodontal clinic at NOVA SE College of Dental Medicine in Ft. Lauderdale. Weiner can be contacted by e-mail at [email protected]