A cross-sectional, questionnaire study was conducted during the state dental conference in the month of September 2013 to involve the dentists from all over Karnataka state. Out of 782 participants, people who were voluntarily willing (536) to participate were included in the study.

An anonymous, self-administrated, structured questionnaire was used to assess the knowledge about Domestic violence & dentistry. The questionnaire consisted of eight close ended & one open ended question & it included the demographic characteristics of the dentists like age, gender, and year of experience. The close ended questions were to know the knowledge about DV & their awareness about its relation to dentistry. Regarding their role in bringing down its prevalence an open ended question was included based on expert opinion. The questionnaire was checked for validity by using kappa statistics. The data was analysed using SPSS (Version 17.0) statistical computer software.

Total number of participant for the conference program was 782, out of them only 536 participated voluntarily by filling the questionnaire making a response rate of 68.54%. [Table/Fig-1] shows agreement of dentists towards domestic violence in which out of 68.5% of respondents, 84% answered they heard about domestic violence & only 30% of them reported that they had come across the domestic violence victims. But out of 30%, only 42% has asked the reason for the injury but didn’t took any measures to reduce showing overall attitude towards approach for DV victims among dentists is very low.

The four common barriers to ask the reason for the injury were in the order - Lack of training in identifying domestic violence (21%), Patient was accompanied by partner or children (15%), Do not have a list of referral agencies (13%), Believe domestic violence is not my business (11%). Eighty two percent accepted they are aware that 75% of physical injuries in domestic injuries are to head, neck &/or mouth & 64% of them accepted that dentist has a role in bringing down the prevalence of domestic violence. And for the open question to specify how, many answers were given. Answer with similar meaning are grouped into five categories based on AVDR technique [2] as,

In present study out of 64% who said the dentist has a role in bringing down the prevalence, 16% reported it by Asking, 28% by Counselling, 19% by Awareness/ Educate, 9% by Reporting & 28% by Training; highlighting Counselling as the method and mentioned need for training for the same.

The initial response rate towards the study among dentists gathered itself was low (68.5%) & out of them 30% had seen DV victims and out of that 30% only 42% has asked the reason for the injury showing a wide gap among dentists knowledge & attitude towards DV. This was similar to a study conducted in Texas, where 50% of the DV victims had seen a dentist when signs of abuse were present, yet 88.6% were not asked about their injuries [6]. Although victims want the abuse to be recognized, dental health care providers face barriers when it comes to domestic violence recognition. The common barrier to ask the reason for the injury was lack of training in identifying domestic violence. This was also similar to a studies reported Skelton et al., Nahla et al., & Love et al., [7–9].

Education is a key factor in overcoming some of these barriers. Lack of training in identifying suspected, dental professionals didn’t know the appropriate actions to take to prevent further abuse. 82% accepted in the present study that 75% of physical injuries in domestic injuries are to head, neck &/or mouth & 64% of them accepted that dentist has a role in bringing down the prevalence of domestic violence but they were not clear what are their roles. This was similar to studies by Skelton et al., & Nahla et al., [7,8]. As none of the dentists were aware what were their role in bringing down the prevalence Hence, an answers of an open question were categorized into groups Ask, Counsel, Awareness, Report & Training.

There were no studies to determine what services DV victims want or need from the dental profession [10]. But, the authors in an article titled “Changing Dentists’ Knowledge, Attitudes, and Behaviours Regarding Domestic Violence through an Interactive Multimedia Tutorial” mentioned regarding a tool called “AVDR,” an acronym for “asking, validating, documenting, and referring.” AVDR means: 1) asking the patient about the injury or incident; 2) providing validating messages that battering is wrong and it is not the victim’s fault in any circumstance; 3) documenting signs, symptoms, or any verbal disclosures that the patient has shown or given in the patient’s records in writing and with any pictures; and 4) referring victims to a DV specialist, which may include counselors, authorities, or shelters [2,10]. This was developed to explain and simplify the dentist’s role in addressing DV. This intervention can be used when abuse is suspected but not disclosed, and it allows dentists to help their patients. Hence, AVDR tutorial is a quick & simple way to educate oral health professionals about the importance of recognizing DV among their patients and learning how to help them by providing strategies for assessment and intervention [10,11].

Even though in present study few mentioned about asking, validating (counseling+ creating awareness) and reporting, documenting was not mentioned. This was similar to the report by Hendler et al., & Tilden et al., [6,12]. Similar to the findings of these studies, a study conducted by Mc Dowell et al., showed out of 30% suspected cases only 3% reported to higher authorities [13]. Identification, intervention and quick action to refer the patient for medical evaluation and treatment can save a life. Hence, dentists have a moral & legal obligation to recognize and report the abuse [14].

Few studies [6,7,11,15,16] have shown brief domestic violence intervention training can be effective in improving knowledge and attitudes among dentists but could lead to a false confidence in staff and should be followed by in-depth practical training and the development of appropriate processes for dealing with abuse victims.

Convenience sampling method to collect the information from dentists of Karnataka making a small sample size is one of the limitations of the study and as we have included people who are willing to participate in a survey has still reduced the number of samples. Hence, further in depth studies are recommended.

Knowledge about Domestic Violence and their role in bringing down its prevalence was very low among dentists. The research findings suggest several potential directions for change indicating the providers’ barriers and emphasizing the importance of establishing systematic evidence based multidisciplinary and interagency approach to teaching and learning on the topic of DV for dentists. In addition, regular continual developmental updates should be empowered with a joined approach and a clear knowledge of support agencies and interagency networks to enhance the dental professional’s response to support the DV victims.

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Enhancing Dental Professionals Responsiveness Towards Domestic Violence