Oral Health

Oral Health Exam

Introduction, by Dr. Michael Grodin
Click for the Video

What you are about to see is an oral screening involving a dental hygienist and survivor of torture. The corresponding bullet points explain and supplement the material shown in the film clips. For convenience, only male pronouns will be used in the following text corresponding to the male patient in the film. Above all, you want to avoid re-traumatization via interrogation-like techniques—as well as physical contact and use of routine oral instruments—that simulate your client’s torture experience. It is best to proceed slowly and to use interpreters who are culturally sensitive and medically trained.

Interview Content, by Harpreet Singh, RDH, MS

Beginning the Exam

A dental screening can be conducted in a dental or non-dental setting. The examination environment should be welcoming, non-traumatizing, and un-cell-like, with all examination implements and instruments in view.
Start by introducing yourself. Inform the client how he was referred to you and then tell him what you will be doing today.

Explain to your client that you will look into his mouth to examine his oral health status and then will help him find a dentist that will be able to treat him.

Clarify your patient’s demographic information.
How does your patient spell and pronounce his name? How would he like to be addressed?

Obtain his contact information

Is he experiencing any pain in his mouth today?
How would he describe the health of his teeth and gums?
Has he ever been to the dentist, and if so, when was his last visit?
Ask about his brushing habits. What does he use to clean his teeth and how often does he do so?
Has he experienced any trauma or torture in his face or mouth. If he was imprisoned in the past, was he able to clean his teeth during that time? What were his eating habits while imprisoned?
Inform him that you will now perform a brief examination of his neck, mouth, and teeth.

Click for the Video

Assessing Oral Health Status

Begin by doing an extra-oral exam, looking at the lips, neck, and jaw for any abnormalities.
I nspect the entire dentition systematically, proceeding from tooth to tooth. Begin with the teeth in the right upper jaw and continue towards the left upper jaw. Then examine the teeth in the lower jaw from left to right.
Examine the mouth for:

Loose teeth, missing teeth, broken teeth and root tips
Presence of restorations (fillings) and broken or missing fillings
Signs of poor oral hygiene and oral malodor
Tooth pain, sensitivity to temperature change and pressure, and inability to chew in comfort

Click for the Video

Patient Education and Referral

Discuss your findings with the patient in simple terms and inform him of his treatment options.
Educate your patient about oral hygiene and do a demonstration of proper brushing and flossing.
Tell him to where you will be referring him for dental services and help him set up an appointment.
Ensure that you have answered all of his questions.

Click for the Video

References:

1. Shrestha NM and Sharma B. Torture and Torture Victims – A Manual for Medical Professionals. Center for Victims of Torture, Katmandu, Nepal, 1995.

2. Mcivor RJ and Turner SW. Assessment and Treatment Approaches for Survivors of Torture. British J. Psychiatry 1995;166: 705 – 711.

3. Forrest D. The Physical After-Effects of Torture. Forensic Science International 1995; 76: 77 – 84.

4. Petersen HD and Rasmussen OV. Medical Appraisal of Allegations of Torture and the Involvement of Doctors in Torture. Forensic Science International 1992; 53: 97 – 116.

5. Rasmussen OV. Medical Aspects of Torture. Danish Medical Bulletin 1990; 37(Supplement 1): 1 – 88.

6. Goldfeld AE, Mollica RF, Pesavento BH, Stephen VF. The Physical and Psychological Sequelae of Torture – Symptomatology and Diagnosis. JAMA 1988; 259(18): 2725 – 2729).

7. Skylv G. Physical Sequelae of Torture. In: Basoglu M (Ed.). Torture and Its Consequences – Current Treatment Approaches. Cambridge University Press: Cambridge, UK, 1992. p 39 – 53.

8. Sommier F, Vesti P, Kastup M and Genefke IK. Psychosocial Consequences of Torture: Current Knowledge and Evidence. In: Basoglu M (Ed.). Torture and Its Consequences – Current Treatment Approaches. Cambridge University Press: Cambridge, UK, 1992. p 56 – 68.

9. Weinstein HM, Dansky L, and Iacopino V. Torture and War Trauma Survivors in Primary Care Practice. West J Med 1996; 165: 112 – 118.
10.Iacopino V, Ozkalipci O, Schlar C. Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (The Istanbul Protocol). Available at: http://www.phrusa.org/research/torture/index.html [Accessed 05/11/01].

11. American College of Physicians. The Role of the Physician and the Medical Profession in the Prevention of International Torture and in the Treatment of its Survivors. Ann Int Med 1995;122: 607 – 613.

12. Annas GJ and Grodin MA. The Nazi Doctors and the Nuremberg Code - Human Rights and Human Experimentation. Oxford University Press, New York, NY; 1992.