370 Forensic dentistry
When presented with injuries such that the history and physical exami-
nation suggest the trauma might not be accidental in origin, the oral health
care provider should always include inflicted trauma in the differential diag-
nosis. Health care providers must remember that all forms of familial and
intimate partner violence are interrelated. Since the sequelae of violence
affects all age groups—especially those living together—one form of violent
behavior cannot be separated from another.
Domestic violence and violence within the family—child abuse, spouse
abuse, abuse/neglect of the disabled, and elder abuse—are common in Western
society. Violent assaults can result in injuries to the developing fetus, children,
adolescents, adults, and the elderly; in fact, no age group is free of the potential
for violent acts. The most recent estimates from the Centers for Disease Control
and Prevention indicate that approximately 25% of women have been raped
or physically assaulted by an intimate partner.^1 Although most researchers in
the field of domestic violence report that men and women are nearly equally
involved in assaults, women experience more chronic injuries and assaults
from men than men do from their female intimate partner. More than 40% of
women who experience partner rapes and physica l assault suffer some form of
physical injury.^1 These soft and hard tissue physical injuries can take the form
of bruises, lacerations, contusions, gunshot wounds, avulsion tissue injuries,
broken bones (including the alveolar bone, jaws, and other bones of the max-
illofacial complex), bitemarks, and fractured, subluxated, or avulsed teeth.
Intimate partner violence can take many forms, to include psychological/
emotional, physical, and sexual abuse. Intimate partner violence can begin
in the dating relationship, while cohabitating, while married, when separated
or divorced, and can continue into the later years of life. Unfortunately, the
violence can often result in death, serious physical injury, disfigurement, and
emotional injuries.
15.2 Child Maltreatment
Most legal definitions of child abuse/maltreatment and neglect generally uti-
lize the same or very similar criteria for classifying physical or emotionally
injurious actions directed against children. One of the most useful defini-
tions comes from the Child Abuse Prevention and Treatment Act (CAPTA),
Public Law 104-235. CAPTA defines child maltreatment (abuse) as any act or
failure to act resulting in imminent risk of death, serious physical or emo-
tional harm, sexual abuse, or exploitation of a child by a parent or caretaker
who is responsible for the child’s welfare.^2 CAPTA more specifically defines
child abuse as any physical act (i.e., burns, broken bones, etc.), sexual act
(i.e., touching, fondling, sexual assault, or incest), or emotional insult (i.e.,
isolation , belittling, or calling names).^2 CAPTA defines neglect as happening