Dentists see domestic violence more intimately than most people.
To them, domestic violence can be loosened, fractured teeth, ripped flesh in the mouth, fingertip-shaped bruising and blood vessel damage on the neck caused by strangulation.
Dentists see these details from centimetres away and a Vancouver prosecutor and anti-domestic violence campaigner says that could potentially save a victim.
"Dentists are really in a superb position," said Jocelyn Coupal, a 59-year-old prosecutor who lives and works in Vancouver.
"A dentist is already examining their patients' head and mouth and face. They know what they're looking at if you train them to understand that those are injuries caused by intimate partner violence."
In addition to her work as a Crown counsel, Coupal has spent decades speaking to packed conferences and seminars, describing to dentists and other health professionals what domestic violence looks like and how they can stop it.
She believes dentists have the best chance of spotting and perhaps ending abuse, and wants them to adjust their practices and improve professional education to make that happen.
"It could result in earlier identification," she said.
Victims don't avoid dentists
In the early 2000s, Coupal was a prosecutor in New Westminster, B.C., working with a special domestic violence unit.
Sometimes she would discuss her clients' suffering with her husband, who is a periodontist — a dentist specializing in the gums among other things. He was seeing symptoms consistent with abuse in some of his patients when they got in his chair.
Coupal said it's not uncommon for abuse victims to avoid seeing family physicians, yet still keep their dentist appointments. That may be because people don't expect dentists to be on the lookout for such problems.
"Dentists are often the only health-care provider a [victimized] woman will see," Coupal said.
"She will go for a regular cleaning, for example, where she might avoid going to her own physician if she has fresh injuries."
When her husband became an instructor at a U.S. medical school, Coupal would also give presentations to his students, explaining the abuse injuries to look out for, and how they could help their patients.
Need professional development
Coupal says while dentists are medical professionals most likely to see domestic violence, they are also the least equipped to deal with it.
One reason is because few schools make domestic violence awareness part of a dentist's education. She wants dental schools to add abuse education into their curriculum.
Right now, many dental schools do cover the subject of domestic violence in classes, but Canadian Dental Association president Dr. Larry Levin said lessons learned in the classroom should be reinforced in professional development.
"Dentists want to be as involved in helping in this area as much as possible," Levin said.
"I know from my own personal experience that it can be difficult in that moment of discussing it with a client."
'Afraid of the unknown'
Another stumbling block is fear.
"They're afraid of the unknown," Coupal said. "They're afraid if they ask the wrong question or interview the person in the wrong way or even bring it up that it's going to be embarrassing, or the patient is going to be upset or offended."
Levin agrees dentists need more training to deal with abuse victims.
"Dentists want to be as involved in helping in this area as much as possible," he said. "I know from my own personal experience that it can be difficult in that moment of discussing it with a client."
Make small changes
Coupal says dentists who want to look out for abused clients can start with small changes, starting with modifying intake screening for new patients.
For example, when they ask clients if they smoke, they should also ask if they are suffering violence at home.
She says research shows patients will respond accurately.
"You're encouraging your patients to think that it's okay to disclose because clearly this is an issue that's common enough that it's on a patient intake form," she said.