A young woman attends with her boyfriend for treatment of an oral injury. The history she gives does not match the clinical findings. What is the most appropriate consideration?

Correct answer: B. Suspect intimate partner violence and arrange to interview her privately

• A. Dementia is not a plausible consideration in a young adult and would not explain an injury-history mismatch of this kind.
• B. CORRECT. A history that does not fit the injury is the single most reliable red flag for interpersonal violence. The essential step is to create an opportunity to speak with her ALONE — separate her from the accompanying person on a neutral pretext such as taking a radiograph — and to ask directly and non-judgementally.
• C. Contacting authorities without first speaking to her removes her agency and can escalate the danger. Adult IPV reporting requirements vary considerably by jurisdiction, and most states do not mandate reporting of competent adults without consent.
• D. Documenting an implausible history without exploring it misses the only realistic opportunity to offer help.

Note: Between 50 and 80% of intimate partner violence injuries involve the head, neck or face, which puts dentists in an unusually good position to detect it. Document objectively with photographs and diagrams, record her words in quotation marks, avoid conclusions in the chart, and have the local domestic violence hotline number available. Note that child abuse and elder abuse ARE mandatory reports in every state — competent adult IPV usually is not.