An elderly patient attends with an unexplained bruise on the lip. What should the dentist do FIRST?

Correct answer: D. Ask the patient directly, in private and without the accompanying person

• A. Documenting without inquiry fails the patient. Dentists are mandated reporters of suspected elder abuse in most jurisdictions, and the head and neck are among the most common sites of injury.
• B. Calling the police is premature before any history has been taken, and in most jurisdictions the reporting pathway for elder abuse is ADULT PROTECTIVE SERVICES rather than law enforcement — except where there is immediate danger.
• C. Asking the accompanying family member first is exactly wrong if that person is the source of harm. It also signals to the patient that they are being talked about rather than talked to, which undermines their autonomy.
• D. CORRECT. The first step is to speak with the PATIENT ALONE. A competent adult is entitled to be asked about their own body, and a suspected abuse history will not be disclosed in front of a possible perpetrator. Separating the patient from the companion — 'I always take a few minutes alone with every patient' — is standard practice and creates the only conditions in which honest disclosure is possible. Document the findings objectively with measurements and, with consent, photographs.

Note: The important contrast with child abuse: with a CHILD, suspicion alone triggers a mandated report to child protective services, and the child cannot consent or decline. With a COMPETENT ADULT, autonomy carries much greater weight — you interview privately, offer resources and support, and follow your jurisdiction's reporting statute, which may or may not require a report over the patient's objection. If the adult lacks capacity, reporting duties are generally triggered as for a child.