General dental practitioners (GDPs) have a professional duty of care to identify and respond to domestic abuse, neglect and sexual violence when observed in their patients. Furthermore, the dental team may be ideally placed to detect some forms of violent crime; physical abuse often manifests as an assault on the person’s head and face, and such injuries are likely to present at dental practices. Despite this, a number of perceived barriers exist to the dental team’s becoming involved in protecting vulnerable patients. These include a lack of knowledge of the area, the isolation of dentistry from other health care providers, the perceptions of dentists regarding their role in protection of vulnerable patients and a disproportionate focus in dental research on child abuse.

One of the greatest problems is a lack of knowledge of the signs of abuse and the mechanisms for dealing with instances of abuse when identified. Many GDPs also have little confidence in dealing competently with domestic and sexual violence. Since 2005, mandatory training in the protection of vulnerable patients has been introduced as part of the core continuing professional development requirements for continued registration with the General Dental Council.

GDPs are often isolated from other health care professionals and from people involved in social services or law enforcement. It is thus more difficult for GDPs to consult informally with others about their concerns or to learn about protection mechanisms through experience or observation.

Dentists may not feel that recognising and reporting abuse is their responsibility. In the case of reporting domestic violence, they may feel that such actions will have detrimental consequences for themselves and their practice and will involve them in complex social and legal issues.

It is also true that dental research in the UK has given considerable attention to orofacial signs of physical abuse in children, whereas far less attention has been paid to domestic violence, emotional abuse and sexual abuse.

The neglect of domestic violence and the abuse of vulnerable adults in the mainstream UK dental literature suggest that these are areas that should be targeted in future educational programmes for dentists, as they will see patient with problems (see Box 13.1). As with child abuse, the recognition and management of domestic violence and the abuse of vulnerable adults are discussed more fully in the dental literature emanating from the USA.