Why aren’t we doing better? Are dentists and dental students prepared to support patients with lived experience of intimate partner violence and abuse?

Why aren’t we doing better? 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Are dentists and dental students prepared to support patients with lived experience of intimate partner violence and abuse? Sarah Farmer, Janice Ellis, Hayley Alderson This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4293306/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Introduction Intimate partner violence and abuse (IPVA) is a public health crisis with long term implications for an individual’s mental and physical health. IPVA can result in head and neck trauma, including oral injuries, placing dentists in a unique position to be able to identify at risk patients. It is therefore important to understand any barriers dentists may experience when supporting IPVA patients. Aims The aim of this study was to explore whether dentists and dental students are prepared to support patients with lived experience of IPVA. Method This study adopted a qualitative cross-sectional research design using focus groups and interviews. Data was collected using the principles of grounded theory and analysed using thematic analysis. Results Data was collected from 14 dentists and 22 dental students. Results showed that dentists and dental students did not feel confident or prepared identifying and responding to patients they suspected were experiencing IPVA. Barriers included a lack of practical knowledge and fear of ‘getting it wrong’ resulting in professional paralysis. Conclusion Improving current safeguarding educational frameworks at both undergraduate and postgraduate could be key to improving the confidence and practical knowledge of dental practitioners. Introduction Intimate partner violence and abuse (IPVA) is defined as psychological harm with physical or sexual violence including controlling behaviour, acts of aggression, sexual coercion and psychological abuse 1 . The impact of IPVA is substantial, with an estimated 30% of UK women expected to be affected within their lifetime 2 . The Crime Survey for England and Wales has reported a 14.4% increase in domestic abuse related crimes since March 2020, affecting an estimated 2.1 million people 3 , 4 . The vast majority of IPVA related physical trauma results in head and neck injuries 5 , 6 . This makes dentists well placed to identify vulnerable patients. National Institute for Clinical Excellence (NICE) and General Dental Council (GDC) guidance states that dentists have an obligation to make sure they can recognise, assess, and signpost these patients to appropriate services to the best of their abilities 5 , 7 . There is however a wealth of evidence that suggests this is not happening. The majority (87%) of dentists surveyed in the US did not screen for IPVA, even when tell-tale head and neck related injuries were present 8 , whilst only 5.7% of French primary care dentists systematically looked for signs of abuse or neglect 9 . Similar issues have been found in Saudi Arabia and India 8 , 10 , 11 . Early identification of vulnerable patients and signposting are key to improving this public health crisis alongside its associated health and social consequences, and it is therefore important to understand barriers that dentists experience when supporting IPVA patients. Aim The aim of this study is to explore whether dentists and dental students are prepared to support patients with lived experience of IPVA. Objectives: Explore dental undergraduates’ perceptions of their preparedness to treat patients who have experienced IPVA. Explore dentists’ views and experiences of treating patients who have experienced IPVA. Explore dentists’ and dental students’ perceptions of their training opportunities Identify facilitators and barriers to provision of care Compare and contrast the views of undergraduates and dentists. Methods Study Design This study adopted a qualitative cross-sectional research design; focus groups and interviews were conducted between November 2022 and April 2023 Sample and Recruitment Participants were recruited using the following inclusion criteria; 3rd -5th year dental students studying at Newcastle university. Dental practitioners currently working in primary care. Dental students at Newcastle University were recruited through university email. Dentists were recruited via email through Local Dental Committees. Interested participants were sent a participant information leaflet, consent form, and a screening questionnaire. Participants were able to withdraw their consent to participate at any time. A favourable ethical opinion was gained from the Newcastle University ethics committee. Data Collection Data generation followed the principals of grounded theory 12 . A combination of in person and online focus groups were offered to accommodate participant preferences. Due to the sensitive nature of the subject participants were offered the opportunity to request a one-to-one interview. A semi-structured topic guide informed questions to ensure that the data was reflexive. The focus groups were digitally recorded and transcribed with consent. Participants were assigned a code to maintain anonymity (either ‘D’ for dentist or ‘DS’ for dental student). Thematic analysis was used to analyse the data and identify recurrent themes using the model proposed by Braun and Clarke 13 . Results In total 14 dentists (6 interviews, 3 focus groups), and 22 dental students (4 interviews, 4 focus groups) participated. The main themes are discussed below. Awareness of IPVA issues All participants indicated an awareness of physical abuse as an aspect of IPVA. Most participants understood that abuse is complex and often multifaceted with emotional, financial and psychological abuse being highlighted as characteristics of IPVA. This is such an important subject in everybody's day to day life. that unless we have more knowledge. We don't know there is a problem. If you don't understand the definition of the abuse. – D17, interview, female IPVA also shares risk factors with child abuse 14 , and the presence of either form of violence increases the risk of the other, meaning that early identification of patients experiencing IPVA may benefit family issues 15 , 16 . The majority of dentists were not aware of this link. Being aware of population risk factors could help dentists identify high risk patients. I didn't really think about the link between domestic violence and child abuse in the same home. That's quite bad, but it's pretty obvious isn't it, I guess […] if they've got kids. So, then it would maybe make me think about reporting it more – D15, interview, female. Willingness to help Appropriateness All participants felt that dentists could play a role in helping patients who have experienced or were experiencing IPVA. We could identify it. And it's a really good place for somebody to be able to go and open up. And because obviously, they can come alone quite often – D15, interview, female. Dental students talked about the consistency in the patient-dentist relationship. Benefits included noticing changes in behaviour over time, and developing a trusting environment where patients feel comfortable ‘opening up’. You might see a different GP every time, but with a dentist you're in like, a position to be able to sort of spot patterns in behaviour if you’ve seen someone for a prolonged period of time – DS6, focus group, male Preparedness Perceptions of training Both groups indicated that the undergraduate education they received did not prepare them to assist patients affected by IPVA. Some stated that they had received no training. There was nothing, absolutely nothing. This wasn't even on the teaching radar, I would say. The whole idea of safeguarding in general wasn't really on the radar – D6, male, interview. Like education on the signs of domestic abuse, what to do If you suspect someone's suffering domestic abuse... I'd say we've had very little to no education on that – DS1, female, interview. Whilst some did remember receiving training there was a general feeling that this did not sufficiently bolster their confidence or preparedness in any meaningful way. I don't know how you guys felt, but what I learned wouldn’t have helped me – D8, focus group, female. Although government guidelines ‘Safeguarding in General Practice – a toolkit for the dental team’ 17 are available, the majority of participants were not familiar with this guidance. This suggests a need for more effective dissemination and awareness. Confidence All of the dental students stated they felt uncomfortable thinking about acting on their suspicions. All but one dentist indicated a lack of confidence when it came to speaking to patients about challenging and sensitive topics. I think I’d be able to detect if something was off…But I don’t know if I’d be able to like put my finger on what was going on. And I don’t know if that would…if I would have enough confidence to take that further on just a feeling – DS5, focus group, female. Participants noted that bringing up IPVA with a patient is more challenging when they are uncertain of what to do next to safeguard the patient. Many indicated this would discourage them from enquiring despite their suspicions, potentially resulting in missed opportunities to provide support to affected patients. But yeah, we’ve all kind of said like having the conviction in bringing something up when you don’t know what to do next [is difficult]– DS7, focus group, female. Both groups expressed hesitations about assuming the responsibility of reporting. Many assumed that GPs would be better trained in this area and therefore would likely delegate responsibility. I think...I kind of a lot of the time already assume, wrongly, that somebody else is taking care of it when that might not be the case at all. […] I think it comes back to like lack of training and understanding -D3, focus group, female. Desire for more training/resources All participants felt they could benefit from further training, and accessible, specific resources. It has to be something part of curriculum. It has to be a part of post-graduate training. and it has to be updated as we explore different worlds. Emotional abuse have to be taken seriously. And controlling abuse has to be taken seriously. So don't look just for bruises in your patient's face…Typical dental attributes we have. But look at the body language when she comes in with a partner – D17, interview, female. A few dental students did recall some training on IPVA – but unanimously stated that the teaching hadn’t been useful. I've just like done the quizzes got the training done like been to the lecture, ticked the box, but like we have so much stuff to learn, and that it's not really stuck in my head – DS11, focus group, female. Both cohorts brought up the complex role that cultural differences (e.g. nationality, religious beliefs) play in how certain behaviours might present, and how this can be challenging. There seemed to be a specific desire for training to include cultural nuances. I think also an awareness of what is culturally acceptable in like different areas and what is deemed normal. Because I think that is a range and I don’t think it is a one size fits all approach, so I think we need to have more teaching on where that line lies really – DS4, focus group, female. Barriers to care Worry Many participants expressed reluctance in trying to help patients over fear of doing the wrong thing. There was a worry that despite good intentions their lack of training, and confidence in their abilities may inadvertently heighten risk and worsen their patient’s situation. I think you only get one chance to be there with them and have that conversation, that difficult conversation. And if you get it wrong that could change their trajectory as to how they end up, where they end up – D16, interview, female. There was also an apprehension about making a patient feel rushed. Participants expressed concern that time pressures within dental appointments might impact their ability to identify and help patients. I'm worried that I wouldn't notice in such a short amount of time, or they wouldn't feel that comfortable with me at that sort of time to start to then approach me – DS11, focus group, female. Participants also worried that a patient might react negatively should they attempt to communicate their concerns. I think it’s a very difficult situation to be in. Just…you don’t know what way they’re going to take it. Some people might be like ‘oh, who’s this?’ like they, they might just react in anger, but they like might just break down – DS3, focus group, female. Dentists identified additional barriers such as the presence of a partner and gender dynamics. Providing succinct, easy to follow protocols may help to alleviate this. I think that. Okay, I’m a 6-foot-tall man with a beard and most people that experience domestic violence are going to be women who are potentially going to be quite intimidated by 6 foot tall me – D6, interview, male. Resilience Around half of all participants identified lack of resilience training as a barrier to engaging with patients. This highlights the complexity of the link between professional responsibilities and the mental well-being of practitioners. I find it sort of boundaries and things quite difficult. you know, going home. If someone, when well, when people have sort of disclosed things. You can't help but go home and think about it, and that's where you think let's have a lot better training… Switching off to that isn’t the easiest – D16, interview, female. Discussion This study aimed to explore the views of practicing dentists and dental students on their preparedness to help patients with lived experience of IPVA. The results of this study show that most dentists and dental students felt that their knowledge of IPVA and their confidence of how to help patients was inadequate, and that most would like to expand their knowledge on the subject. Appropriateness All participants felt that they were in a good position to be able to identify and help patients experiencing IPVA. The reasons for this were a perceived good continuity of care thereby being able to notice behavioural or physical changes in patients, accessibility – due to biannual appointments, and the opportunities dentists have to build patient rapport over time. These factors were thought to make an individual feel more comfortable disclosing their experience of abuse to a dentist over other health care professionals. This aligns to evidence suggesting that women with lived experience of IPVA would trust their dentist to act appropriately after disclosure of violence 18 . This appropriateness is also reflected in the General Dental Council (GDC) document Standards for the Dental Team which states that; ‘You must raise any concerns you may have about the possible abuse or neglect of children or vulnerable adults. You must know who to contact for further advice and how to refer concerns to an appropriate authority such as your local social services department.’ 19 Training Many dentists felt that they had received little to no training on IPVA before graduating. Whilst this could be explained by a longitudinal decline of knowledge, dental students felt similarly about their levels of preparedness. This would seem to suggest a need for improved undergraduate training, perhaps alongside enhanced postgraduate continuing professional development requirements. This raises questions about the efficacy of the current education model regarding safeguarding IPVA patients and its fitness for purpose. Several studies have praised the benefits of additional training by one-off teaching seminars and online content and perhaps this needs to be explored further within the safeguarding framework 20 . However, there is no literature to confirm the most effective way of teaching this subject that translates into the practical demands of safeguarding in practice. Many participants assumed that GPs would have more extensive training in comparison to dentists. However, studies demonstrate that GPs also feel that they lack support, training, and guidance 21 , 22 . As the long-term management of patients who have experienced IPVA is likely to be multidisciplinary it might be beneficial to look towards an interprofessional learning model including interdisciplinary curriculum integration to ensure that all students receive consistent and comprehensive teaching. Barriers Both cohorts expressed concerns that despite their best intentions their perceived lack of adequate training, guidance, and resources might worsen their patients' situations by re-traumatisation or escalation of abuse. This indicates the need for improved training to give dentists the skills to navigate these sensitive situations. Communicating with patients who have experienced trauma is complex and necessitates careful navigation. Trauma informed practice is an approach to healthcare that acknowledges that exposure to trauma can affect a person’s neurological, biological, psychological and social development 23 . This includes an individual’s ability to develop relationships with healthcare staff and access treatment. This is supported by studies that show that women are more likely to disclose IPVA to health professionals who enquire in a validating, supportive, non-judgemental way 21 , 24 . A systematic analysis showed that trauma informed organisational interventions may improve the readiness of practitioners and improve patient outcomes 25 . Additionally studies show that ineffective communication with dental patients can lead to adverse outcomes such as anxiety in the clinician and patient, and breakdown in the patient-clinical relationship 26 . Moving Forwards Currently all programmes are working to the learning outcomes in 'Preparing for practice'. This states practitioner must be able to; 'Identify the signs of abuse or neglect, explain local and national systems that safeguard welfare and understand how to raise concerns and act accordingly'. 27 As of September 2025 students entering dental programmes will have to deliver the following learning outcome which is subtlety different; 'Identify the signs of abuse, neglect or emotional trauma, explain local and national systems that safeguard the welfare of children and adults and understand how to raise concerns and act accordingly '. 28 In neither version of the learning outcomes are students expected to be able to apply their knowledge. This is likely because it would be impossible to give every dental student the opportunity to see a 'real world' patient in this situation - nonetheless simulated teaching and assessment could be beneficial. Currently dental educators are limited by the capacity of their curriculum and there may not be the resources to have a significant portion of training directed at a new topic. Enhancing the pre-existing safeguarding training may be the most appropriate way forwards. Improving awareness that dentists will encounter IPVA patients in practice may be a logical place to start, as well as introducing the concept that adult patients experiencing violence can be considered vulnerable adults. This would allow the introduction into the curriculum for evidence-based trauma informed interviewing techniques and would support GDC communication learning outcomes 19 . Examples of good practice do exist. The Identification and Referral to Improve Safety system (IRIS) is a specialist domestic violence and abuse training, support and referral program for general medical practices that encourages ongoing education and consultancy. This system has been shown to improve GP response to IPVA and thereby improve the safety, quality of life and wellbeing of survivors 29 , 30 . This improved understanding led to better usage of specialist services. A recent study showed that dentists who experienced an IPVA disclosure felt IRIS was a valuable resource. This shows that interventional strategies could be welcomed by GDPs, but increasing knowledge, confidence, and training would be key to increase willingness to use it. Future research could focus on the type of training required in dental schools to be able to make this feasible. Conclusion This study found that both the undergraduate and qualified participants did not feel they were adequately prepared to help manage patients who have lived experience of IPVA, especially in terms of the training they had received through their formal education. There was little difference between the perceptions of the two cohorts, meaning that experience in primary care does not make up for inadequate preparation at undergraduate level. Declarations Acknowledgements We thank all participants for giving their time to participate in interviews and focus groups. Funding No external funding was received for this study. Conflict of Interest The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. Institutional Review Board Statement This study was approved by the Faculty of Medical Sciences Research Ethics Committee, part of Newcastle University's Research Ethics Committee. Ref 2363/24445 References WHO (2013). Responding to inimate partner violence and sexual violence against women. WHO clinical and policy guidelines. In W.H. Organisation, ed. WHO (2021). Violence Against Women Prevalence Estimates, 2018. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4293306","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":297663993,"identity":"b0f79af0-fbd5-45fb-9e25-1e4bf1a68b45","order_by":0,"name":"Sarah Farmer","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABJElEQVRIie2RMUvEMBTHXwh0CnQtFOxXSMkg4tX7KgmF3tKi4HKDYEBIJ+kmAf0QBRfHQuFc6l64pYdwtzgUbhJFPT11Mac3OuQ3Pd7jx/snD8Bi+adggJ111X+1uu/JRoV9FEivG0jybRVMtlGC/G62PAIa7F7Uk2V0MxBFfrvo+BgCVxJGDQptRszXQMOraRJfZk0idJOGkjcQ6oowblIgAZ/AM9J+ynCm6qyEFEmhAJVAWGUKVszxEwE61P7hEu+p16x0FzMpXmC4SYE2cVZbqFhtwRipKis9HkohQbwrxmDt3NknlMbaTxg6V/Gpbh9CzSderGvn2PT8oEjwlIxppP34Hh7VAXOLUdf3J4OoyM+uPVOwz0/4gffLIS0Wi8XyF28oDVwtNdoBFgAAAABJRU5ErkJggg==","orcid":"","institution":"Newcastle University","correspondingAuthor":true,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Farmer","suffix":""},{"id":297663995,"identity":"4592ad3e-da9c-425b-8385-7d1d6fd61b26","order_by":1,"name":"Janice Ellis","email":"","orcid":"","institution":"Newcastle University","correspondingAuthor":false,"prefix":"","firstName":"Janice","middleName":"","lastName":"Ellis","suffix":""},{"id":297663997,"identity":"7f37382b-0ef2-4c58-8211-3d2d7d8e37ab","order_by":2,"name":"Hayley Alderson","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Hayley","middleName":"","lastName":"Alderson","suffix":""}],"badges":[],"createdAt":"2024-04-19 13:00:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4293306/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4293306/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55995814,"identity":"874b8210-edee-4cb5-8b5c-c7a026e990ea","added_by":"auto","created_at":"2024-05-07 10:27:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":311715,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4293306/v1/8519847d-9e02-4d29-9345-bf2acde5ab52.pdf"}],"financialInterests":"There is no duality of interest","formattedTitle":"Why aren’t we doing better? Are dentists and dental students prepared to support patients with lived experience of intimate partner violence and abuse?","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIntimate partner violence and abuse (IPVA) is defined as psychological harm with physical or sexual violence including controlling behaviour, acts of aggression, sexual coercion and psychological abuse \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. The impact of IPVA is substantial, with an estimated 30% of UK women expected to be affected within their lifetime \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. The Crime Survey for England and Wales has reported a 14.4% increase in domestic abuse related crimes since March 2020, affecting an estimated 2.1\u0026nbsp;million people \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe vast majority of IPVA related physical trauma results in head and neck injuries \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. This makes dentists well placed to identify vulnerable patients. National Institute for Clinical Excellence (NICE) and General Dental Council (GDC) guidance states that dentists have an obligation to make sure they can recognise, assess, and signpost these patients to appropriate services to the best of their abilities \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThere is however a wealth of evidence that suggests this is not happening. The majority (87%) of dentists surveyed in the US did not screen for IPVA, even when tell-tale head and neck related injuries were present \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, whilst only 5.7% of French primary care dentists systematically looked for signs of abuse or neglect \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Similar issues have been found in Saudi Arabia and India \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEarly identification of vulnerable patients and signposting are key to improving this public health crisis alongside its associated health and social consequences, and it is therefore important to understand barriers that dentists experience when supporting IPVA patients.\u003c/p\u003e \u003cp\u003eAim\u003c/p\u003e \u003cp\u003eThe aim of this study is to explore whether dentists and dental students are prepared to support patients with lived experience of IPVA.\u003c/p\u003e \u003cp\u003eObjectives:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eExplore dental undergraduates\u0026rsquo; perceptions of their preparedness to treat patients who have experienced IPVA.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eExplore dentists\u0026rsquo; views and experiences of treating patients who have experienced IPVA.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eExplore dentists\u0026rsquo; and dental students\u0026rsquo; perceptions of their training opportunities\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIdentify facilitators and barriers to provision of care\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCompare and contrast the views of undergraduates and dentists.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Design\u003c/p\u003e \u003cp\u003eThis study adopted a qualitative cross-sectional research design; focus groups and interviews were conducted between November 2022 and April 2023\u003c/p\u003e \u003cp\u003eSample and Recruitment\u003c/p\u003e \u003cp\u003eParticipants were recruited using the following inclusion criteria;\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e3rd -5th year dental students studying at Newcastle university.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDental practitioners currently working in primary care.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eDental students at Newcastle University were recruited through university email. Dentists were recruited via email through Local Dental Committees.\u003c/p\u003e \u003cp\u003eInterested participants were sent a participant information leaflet, consent form, and a screening questionnaire. Participants were able to withdraw their consent to participate at any time.\u003c/p\u003e \u003cp\u003e A favourable ethical opinion was gained from the Newcastle University ethics committee.\u003c/p\u003e \u003cp\u003eData Collection\u003c/p\u003e \u003cp\u003eData generation followed the principals of grounded theory \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. A combination of in person and online focus groups were offered to accommodate participant preferences. Due to the sensitive nature of the subject participants were offered the opportunity to request a one-to-one interview.\u003c/p\u003e \u003cp\u003eA semi-structured topic guide informed questions to ensure that the data was reflexive.\u003c/p\u003e \u003cp\u003eThe focus groups were digitally recorded and transcribed with consent. Participants were assigned a code to maintain anonymity (either \u0026lsquo;D\u0026rsquo; for dentist or \u0026lsquo;DS\u0026rsquo; for dental student). Thematic analysis was used to analyse the data and identify recurrent themes using the model proposed by Braun and Clarke\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn total 14 dentists (6 interviews, 3 focus groups), and 22 dental students (4 interviews, 4 focus groups) participated. The main themes are discussed below.\u003c/p\u003e \u003cp\u003eAwareness of IPVA issues\u003c/p\u003e \u003cp\u003eAll participants indicated an awareness of physical abuse as an aspect of IPVA. Most participants understood that abuse is complex and often multifaceted with emotional, financial and psychological abuse being highlighted as characteristics of IPVA.\u003c/p\u003e \u003cp\u003e \u003cem\u003eThis is such an important subject in everybody's day to day life. that unless we have more knowledge. We don't know there is a problem. If you don't understand the definition of the abuse. \u0026ndash; D17, interview, female\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIPVA also shares risk factors with child abuse \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, and the presence of either form of violence increases the risk of the other, meaning that early identification of patients experiencing IPVA may benefit family issues \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. The majority of dentists were not aware of this link. Being aware of population risk factors could help dentists identify high risk patients.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI didn't really think about the link between domestic violence and child abuse in the same home. That's quite bad, but it's pretty obvious isn't it, I guess [\u0026hellip;] if they've got kids. So, then it would maybe make me think about reporting it more \u0026ndash; D15, interview, female.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eWillingness to help\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eAppropriateness\u003c/h2\u003e \u003cp\u003e All participants felt that dentists could play a role in helping patients who have experienced or were experiencing IPVA.\u003c/p\u003e \u003cp\u003e \u003cem\u003eWe could identify it. And it's a really good place for somebody to be able to go and open up. And because obviously, they can come alone quite often \u0026ndash; D15, interview, female.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eDental students talked about the consistency in the patient-dentist relationship. Benefits included noticing changes in behaviour over time, and developing a trusting environment where patients feel comfortable \u0026lsquo;opening up\u0026rsquo;.\u003c/p\u003e \u003cp\u003e \u003cem\u003eYou might see a different GP every time, but with a dentist you're in like, a position to be able to sort of spot patterns in behaviour if you\u0026rsquo;ve seen someone for a prolonged period of time \u0026ndash; DS6, focus group, male\u003c/em\u003e \u003c/p\u003e \u003cp\u003ePreparedness\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePerceptions of training\u003c/h2\u003e \u003cp\u003eBoth groups indicated that the undergraduate education they received did not prepare them to assist patients affected by IPVA. Some stated that they had received no training.\u003c/p\u003e \u003cp\u003e \u003cem\u003eThere was nothing, absolutely nothing. This wasn't even on the teaching radar, I would say. The whole idea of safeguarding in general wasn't really on the radar \u0026ndash; D6, male, interview.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eLike education on the signs of domestic abuse, what to do If you suspect someone's suffering domestic abuse... I'd say we've had very little to no education on that \u0026ndash; DS1, female, interview.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eWhilst some did remember receiving training there was a general feeling that this did not sufficiently bolster their confidence or preparedness in any meaningful way.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI don't know how you guys felt, but what I learned wouldn\u0026rsquo;t have helped me \u0026ndash; D8, focus group, female.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAlthough government guidelines \u0026lsquo;Safeguarding in General Practice \u0026ndash; a toolkit for the dental team\u0026rsquo; \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e are available, the majority of participants were not familiar with this guidance. This suggests a need for more effective dissemination and awareness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eConfidence\u003c/h2\u003e \u003cp\u003eAll of the dental students stated they felt uncomfortable thinking about acting on their suspicions. All but one dentist indicated a lack of confidence when it came to speaking to patients about challenging and sensitive topics.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI think I\u0026rsquo;d be able to detect if something was off\u0026hellip;But I don\u0026rsquo;t know if I\u0026rsquo;d be able to like put my finger on what was going on. And I don\u0026rsquo;t know if that would\u0026hellip;if I would have enough confidence to take that further on just a feeling \u0026ndash; DS5, focus group, female.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e Participants noted that bringing up IPVA with a patient is more challenging when they are uncertain of what to do next to safeguard the patient. Many indicated this would discourage them from enquiring despite their suspicions, potentially resulting in missed opportunities to provide support to affected patients.\u003c/p\u003e \u003cp\u003e \u003cem\u003eBut yeah, we\u0026rsquo;ve all kind of said like having the conviction in bringing something up when you don\u0026rsquo;t know what to do next [is difficult]\u0026ndash; DS7, focus group, female.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eBoth groups expressed hesitations about assuming the responsibility of reporting. Many assumed that GPs would be better trained in this area and therefore would likely delegate responsibility.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI think...I kind of a lot of the time already assume, wrongly, that somebody else is taking care of it when that might not be the case at all. [\u0026hellip;] I think it comes back to like lack of training and understanding -D3, focus group, female.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eDesire for more training/resources\u003c/h2\u003e \u003cp\u003eAll participants felt they could benefit from further training, and accessible, specific resources.\u003c/p\u003e \u003cp\u003e \u003cem\u003eIt has to be something part of curriculum. It has to be a part of post-graduate training. and it has to be updated as we explore different worlds. Emotional abuse have to be taken seriously. And controlling abuse has to be taken seriously. So don't look just for bruises in your patient's face\u0026hellip;Typical dental attributes we have. But look at the body language when she comes in with a partner \u0026ndash; D17, interview, female.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eA few dental students did recall some training on IPVA \u0026ndash; but unanimously stated that the teaching hadn\u0026rsquo;t been useful.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI've just like done the quizzes got the training done like been to the lecture, ticked the box, but like we have so much stuff to learn, and that it's not really stuck in my head \u0026ndash; DS11, focus group, female.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eBoth cohorts brought up the complex role that cultural differences (e.g. nationality, religious beliefs) play in how certain behaviours might present, and how this can be challenging. There seemed to be a specific desire for training to include cultural nuances.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI think also an awareness of what is culturally acceptable in like different areas and what is deemed normal. Because I think that is a range and I don\u0026rsquo;t think it is a one size fits all approach, so I think we need to have more teaching on where that line lies really \u0026ndash; DS4, focus group, female.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eBarriers to care\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eWorry\u003c/h2\u003e \u003cp\u003eMany participants expressed reluctance in trying to help patients over fear of doing the wrong thing. There was a worry that despite good intentions their lack of training, and confidence in their abilities may inadvertently heighten risk and worsen their patient\u0026rsquo;s situation.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI think you only get one chance to be there with them and have that conversation, that difficult conversation. And if you get it wrong that could change their trajectory as to how they end up, where they end up \u0026ndash; D16, interview, female.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThere was also an apprehension about making a patient feel rushed. Participants expressed concern that time pressures within dental appointments might impact their ability to identify and help patients.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI'm worried that I wouldn't notice in such a short amount of time, or they wouldn't feel that comfortable with me at that sort of time to start to then approach me \u0026ndash; DS11, focus group, female.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipants also worried that a patient might react negatively should they attempt to communicate their concerns.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI think it\u0026rsquo;s a very difficult situation to be in. Just\u0026hellip;you don\u0026rsquo;t know what way they\u0026rsquo;re going to take it. Some people might be like \u0026lsquo;oh, who\u0026rsquo;s this?\u0026rsquo; like they, they might just react in anger, but they like might just break down \u0026ndash; DS3, focus group, female.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eDentists identified additional barriers such as the presence of a partner and gender dynamics. Providing succinct, easy to follow protocols may help to alleviate this.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI think that. Okay, I\u0026rsquo;m a 6-foot-tall man with a beard and most people that experience domestic violence are going to be women who are potentially going to be quite intimidated by 6 foot tall me \u0026ndash; D6, interview, male.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eResilience\u003c/h2\u003e \u003cp\u003eAround half of all participants identified lack of resilience training as a barrier to engaging with patients. This highlights the complexity of the link between professional responsibilities and the mental well-being of practitioners.\u003c/p\u003e \u003cp\u003e \u003cem\u003eI find it sort of boundaries and things quite difficult. you know, going home. If someone, when well, when people have sort of disclosed things. You can't help but go home and think about it, and that's where you think let's have a lot better training\u0026hellip; Switching off to that isn\u0026rsquo;t the easiest \u0026ndash; D16, interview, female.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to explore the views of practicing dentists and dental students on their preparedness to help patients with lived experience of IPVA. The results of this study show that most dentists and dental students felt that their knowledge of IPVA and their confidence of how to help patients was inadequate, and that most would like to expand their knowledge on the subject.\u003c/p\u003e \u003cp\u003eAppropriateness\u003c/p\u003e \u003cp\u003eAll participants felt that they were in a good position to be able to identify and help patients experiencing IPVA. The reasons for this were a perceived good continuity of care thereby being able to notice behavioural or physical changes in patients, accessibility \u0026ndash; due to biannual appointments, and the opportunities dentists have to build patient rapport over time. These factors were thought to make an individual feel more comfortable disclosing their experience of abuse to a dentist over other health care professionals.\u003c/p\u003e \u003cp\u003eThis aligns to evidence suggesting that women with lived experience of IPVA would trust their dentist to act appropriately after disclosure of violence \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. This appropriateness is also reflected in the General Dental Council (GDC) document Standards for the Dental Team which states that;\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026lsquo;You must raise any concerns you may have about the possible abuse or neglect of children or vulnerable adults. You must know who to contact for further advice and how to refer concerns to an appropriate authority such as your local social services department.\u0026rsquo;\u003c/em\u003e \u003csup\u003e\u003cem\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTraining\u003c/p\u003e \u003cp\u003eMany dentists felt that they had received little to no training on IPVA before graduating. Whilst this could be explained by a longitudinal decline of knowledge, dental students felt similarly about their levels of preparedness. This would seem to suggest a need for improved undergraduate training, perhaps alongside enhanced postgraduate continuing professional development requirements.\u003c/p\u003e \u003cp\u003eThis raises questions about the efficacy of the current education model regarding safeguarding IPVA patients and its fitness for purpose. Several studies have praised the benefits of additional training by one-off teaching seminars and online content and perhaps this needs to be explored further within the safeguarding framework\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. However, there is no literature to confirm the most effective way of teaching this subject that translates into the practical demands of safeguarding in practice.\u003c/p\u003e \u003cp\u003eMany participants assumed that GPs would have more extensive training in comparison to dentists. However, studies demonstrate that GPs also feel that they lack support, training, and guidance \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. As the long-term management of patients who have experienced IPVA is likely to be multidisciplinary it might be beneficial to look towards an interprofessional learning model including interdisciplinary curriculum integration to ensure that all students receive consistent and comprehensive teaching.\u003c/p\u003e \u003cp\u003eBarriers\u003c/p\u003e \u003cp\u003eBoth cohorts expressed concerns that despite their best intentions their perceived lack of adequate training, guidance, and resources might worsen their patients' situations by re-traumatisation or escalation of abuse. This indicates the need for improved training to give dentists the skills to navigate these sensitive situations.\u003c/p\u003e \u003cp\u003eCommunicating with patients who have experienced trauma is complex and necessitates careful navigation. Trauma informed practice is an approach to healthcare that acknowledges that exposure to trauma can affect a person\u0026rsquo;s neurological, biological, psychological and social development \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. This includes an individual\u0026rsquo;s ability to develop relationships with healthcare staff and access treatment. This is supported by studies that show that women are more likely to disclose IPVA to health professionals who enquire in a validating, supportive, non-judgemental way \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. A systematic analysis showed that trauma informed organisational interventions may improve the readiness of practitioners and improve patient outcomes \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Additionally studies show that ineffective communication with dental patients can lead to adverse outcomes such as anxiety in the clinician and patient, and breakdown in the patient-clinical relationship \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMoving Forwards\u003c/p\u003e \u003cp\u003eCurrently all programmes are working to the learning outcomes in 'Preparing for practice'. This states practitioner must be able to;\u003c/p\u003e \u003cp\u003e \u003cem\u003e'Identify the signs of abuse or neglect, explain local and national systems that safeguard welfare and understand how to raise concerns and act accordingly'.\u003c/em\u003e \u003csup\u003e\u003cem\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAs of September 2025 students entering dental programmes will have to deliver the following learning outcome which is subtlety different;\u003c/p\u003e \u003cp\u003e \u003cem\u003e'Identify the signs of abuse, neglect or emotional trauma, explain local and national systems that safeguard the welfare of children and adults and understand how to raise concerns and act accordingly '.\u003c/em\u003e \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn neither version of the learning outcomes are students expected to be able to apply their knowledge. This is likely because it would be impossible to give every dental student the opportunity to see a 'real world' patient in this situation - nonetheless simulated teaching and assessment could be beneficial.\u003c/p\u003e \u003cp\u003eCurrently dental educators are limited by the capacity of their curriculum and there may not be the resources to have a significant portion of training directed at a new topic. Enhancing the pre-existing safeguarding training may be the most appropriate way forwards. Improving awareness that dentists will encounter IPVA patients in practice may be a logical place to start, as well as introducing the concept that adult patients experiencing violence can be considered vulnerable adults. This would allow the introduction into the curriculum for evidence-based trauma informed interviewing techniques and would support GDC communication learning outcomes\u003csup\u003e\u003cem\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/em\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eExamples of good practice do exist. The Identification and Referral to Improve Safety system (IRIS) is a specialist domestic violence and abuse training, support and referral program for general medical practices that encourages ongoing education and consultancy. This system has been shown to improve GP response to IPVA and thereby improve the safety, quality of life and wellbeing of survivors \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. This improved understanding led to better usage of specialist services. A recent study showed that dentists who experienced an IPVA disclosure felt IRIS was a valuable resource. This shows that interventional strategies could be welcomed by GDPs, but increasing knowledge, confidence, and training would be key to increase willingness to use it. Future research could focus on the type of training required in dental schools to be able to make this feasible.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study found that both the undergraduate and qualified participants did not feel they were adequately prepared to help manage patients who have lived experience of IPVA, especially in terms of the training they had received through their formal education. There was little difference between the perceptions of the two cohorts, meaning that experience in primary care does not make up for inadequate preparation at undergraduate level.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch5\u003eAcknowledgements\u003c/h5\u003e\n\u003cp\u003eWe thank all participants for giving their time to participate in interviews and focus groups.\u003c/p\u003e\n\u003ch5\u003eFunding\u003c/h5\u003e\n\u003cp\u003eNo external funding was received for this study.\u003c/p\u003e\n\u003ch5\u003eConflict of Interest\u003c/h5\u003e\n\u003cp\u003eThe authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.\u003c/p\u003e\n\u003ch5\u003eInstitutional Review Board Statement\u003c/h5\u003e\n\u003cp\u003eThis study was approved by the Faculty of Medical Sciences Research Ethics Committee, part of Newcastle University\u0026apos;s Research Ethics Committee. Ref 2363/24445\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO (2013). Responding to inimate partner violence and sexual violence against women. WHO clinical and policy guidelines. In W.H. Organisation, ed.\u003c/li\u003e\n\u003cli\u003eWHO (2021). Violence Against Women Prevalence Estimates, 2018. Global, regional and national prevalence estimates for intimate partner violence against women and global and regional prevalence estimates for non-partner sexual violence against women. In W.H. Organisation, ed.\u003c/li\u003e\n\u003cli\u003eHavard, T. (2021). Domestic abuse and Covid-19: A year into the pandemic. In H.o.C. Library, ed.\u003c/li\u003e\n\u003cli\u003eHomeOffice (2021). Annual Domestic Abuse Trends Report 2020/21. In H.O. Statistics, ed.\u003c/li\u003e\n\u003cli\u003eOchs, H.A., Neuenschwander, M.C., and Dodson, T.B. (1996). Are head, neck and facial injuries markers of domestic violence? 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Arch Fam Med \u003cem\u003e5\u003c/em\u003e, 153-158. 10.1001/archfami.5.3.153.\u003c/li\u003e\n\u003cli\u003eLewis, N.V., Bierce, A., Feder, G.S., Macleod, J., Turner, K.M., Zammit, S., and Dawson, S. (2023). Trauma-Informed Approaches in Primary Healthcare and Community Mental Healthcare: A Mixed Methods Systematic Review of Organisational Change Interventions. Health \u0026amp; Social Care in the Community \u003cem\u003e2023\u003c/em\u003e, 4475114. 10.1155/2023/4475114.\u003c/li\u003e\n\u003cli\u003eGriffiths, H.S., Wilson, M.A., and Kincey, J.A. (1998). Anxiety levels, patient satisfaction and failed appointment rate in anxious patients referred by general practitioners to a dental hospital unit. Br Dent J \u003cem\u003e185\u003c/em\u003e, 134-136. 10.1038/sj.bdj.4809749.\u003c/li\u003e\n\u003cli\u003eGDC (2015). Preparing for practice. In G.D. Council, ed.\u003c/li\u003e\n\u003cli\u003eGDC (2024). The Safe Practitioner: A framework of behaviours and outcomes for dental professional education.\u003c/li\u003e\n\u003cli\u003eGregory, A., Ramsay, J., Agnew-Davies, R., Baird, K., Devine, A., Dunne, D., Eldridge, S., Howell, A., Johnson, M., Rutterford, C., et al. (2010). Primary care identification and referral to improve safety of women experiencing domestic violence (IRIS): protocol for a pragmatic cluster randomised controlled trial. BMC Public Health \u003cem\u003e10\u003c/em\u003e, 54. 10.1186/1471-2458-10-54.\u003c/li\u003e\n\u003cli\u003eFeder, G., Davies, R.A., Baird, K., Dunne, D., Eldridge, S., Griffiths, C., Gregory, A., Howell, A., Johnson, M., Ramsay, J., et al. (2011). Identification and Referral to Improve Safety (IRIS) of women experiencing domestic violence with a primary care training and support programme: a cluster randomised controlled trial. Lancet \u003cem\u003e378\u003c/em\u003e, 1788-1795. 10.1016/S0140-6736(11)61179-3.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"british-dental-journal","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"bdj","sideBox":"Learn more about [British Dental Journal](http://www.nature.com/bdj/)","snPcode":"41415","submissionUrl":"https://mts-bdj.nature.com/cgi-bin/main.plex","title":"British Dental Journal","twitterHandle":"@the_bdj","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4293306/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4293306/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Introduction\r\nIntimate partner violence and abuse (IPVA) is a public health crisis with long term implications for an individual’s mental and physical health. IPVA can result in head and neck trauma, including oral injuries, placing dentists in a unique position to be able to identify at risk patients. It is therefore important to understand any barriers dentists may experience when supporting IPVA patients. \r\nAims\r\nThe aim of this study was to explore whether dentists and dental students are prepared to support patients with lived experience of IPVA.\r\nMethod\r\nThis study adopted a qualitative cross-sectional research design using focus groups and interviews. Data was collected using the principles of grounded theory and analysed using thematic analysis.\r\nResults\r\nData was collected from 14 dentists and 22 dental students. Results showed that dentists and dental students did not feel confident or prepared identifying and responding to patients they suspected were experiencing IPVA. Barriers included a lack of practical knowledge and fear of ‘getting it wrong’ resulting in professional paralysis. \r\nConclusion\r\nImproving current safeguarding educational frameworks at both undergraduate and postgraduate could be key to improving the confidence and practical knowledge of dental practitioners.","manuscriptTitle":"Why aren’t we doing better? 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