Forensic Dentistry, Second Edition

376 Forensic dentistry

•    In the year 1996, nearly one-half million adults age sixty and over

were abused or neglected in a domestic setting.

Like other forms of abuse, physical abuse of an elderly individual can

appear in many different patterns. Some of the common signs can present

in the head and neck complex. Other signs are traumatic hair and tooth

loss, rope or strap marks indicating physical restraint, multicolored bruises

indicating injuries at various stages of healing, and injuries suggesting heal-

ing “by secondary intention” (possibly indicating inappropriate or delayed

presentation for care). The National Committee for the Prevention of Elder

Abuse also reports that some of the indicators of elder abuse can include:

•   Injuries that are unexplained or are implausible

•   Family members providing different explanations of how injuries

were sustained

•   A history of similar injuries or numerous hospitalizations, or both

•   Victims brought to different medical facilities for treatment to pre-

vent medical practitioners from observing a pattern of abuse

•   Delay between onset of injury and seeking medical care

Many of these indicators are very similar to those signs and symptoms of
abuse/neglect seen in younger populations.
Injuries to the head and neck area are not uncommon in elder abuse.
Zeitler reported that approximately 30% of known elder abuse cases presented
with neck and facial injuries.^17 Injuries to the oral soft tissues, jaw fractures,
and fractured or avulsed teeth have been reported to be indicators of elder
abuse.^18 Oral health care providers must be aware that signs of intentional
trauma are often seen in the orofacial structures (Figures 15.6 to 15.8).

15.7 Conclusion

Violence is a widespread problem in the United States. Many of the inju-

ries associated with inflicted trauma are seen in the maxillofacial complex.

Because of the injury locations, oral health care providers may be the first

to have the opportunity to diagnose and treat the victims of nonaccidental

(inflicted) trauma. This is valid for victims of all ages. Plans should be in

place in each oral health care facility whereby intervention can appropri-

ately begin on behalf of the suspected victim of violent behavior. Without

intervention, the assaults may increase, leading to serious sequelae, including

death by homicide.^19