Authors

Dimitrios Malamos

DDS, MSc, PhD, DipOM

Oral Medicine Clinic, National Organization for the Provision of Health Services (IKA), Athens, Greece

Articles by Dimitrios Malamos

Crispian Scully

CBE, DSc, DChD, DMed (HC), Dhc(multi), MD, PhD, PhD (HC), FMedSci, MDS, MRCS, BSc, FDS RCS, FDS RCPS, FFD RCSI, FDS RCSEd, FRCPath, FHEA

Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK

Articles by Crispian Scully

Article

Dimitrios Malamos
Crispian Scully

A 65-year-old woman presented for dental care with an obvious brown-black discoloration of her peri-ocular skin on one side, first noticed on awakening 5 days earlier. Extra-oral examination revealed a unilateral diffuse brushing, restricted to the upper and lower eyelid and malar skin (Figure 1), but with no serious eye involvement. No similar lesions were found in the skin of the face or in other parts of her body. Intra-oral examination revealed no tooth, bony or soft tissue abnormalities. The patient had no serious medical problems apart from a mild hypertension and a chronic depression, often exacerbated by domestic violence.

Figure 1. Periocular bruises.

Q1. What is the diagnosis?

  • Leukaemia;
  • Traumatic haematoma;
  • Thrombocytopenic purpura;
  • Anticoagulants side-effects;
  • Ageing.
  • A1. The answer to what is the diagnosis?

    Traumatic haematoma inflicted by her alcoholic husband is the likely diagnosis. Older patients have fragile skin vessels which bleed easily with minor trauma and form petechiae or large ecchymoses on their hands, legs, or other traumatized sites. Patients on anticoagulant drugs or with blood diseases, such as leukaemia or thrombocytopenic purpura, often have a plethora of clinical or laboratory characteristics which were not seen in this patient.

    Q2. Which of these factors may be indicators of domestic violence or abuse?

  • Physical evidence of previous or recent violence;
  • Injuries inconsistent with the patient's life style or history;
  • Patient's psychological status;
  • Financial status;
  • Poor relations with partners or close relatives.
  • A2. The answer to which of these factors may be indicators of domestic violence or abuse?

    Dentists must carefully examine the victim of a suspected domestic abuse for any clinical indications of violence, such as bruises, cuts or burns in the skin of the face or body, broken teeth or bones and scars. These lesions are usually inconsistent with the patient's work, habits or sport activities. Dentists must also assess the patient's mental and psychological status. Abused patients often have a low self-esteem, feel responsible for their punishment and are isolated from friends and relatives. Socially deprived patients may have tension among their family members but this does not necessarily give rise to domestic violence.