The literature contains numerous accounts of the frequent history of physical and sexual abuse in patients with chronic TMD pain.:" The prevalence of such domestic violence is estimated to be about 16"'/o of the American population. Although women are the most common target of such abuse, the very young and the elderly are also targets. Moreover, the epidemiologic studies increasingly show a trend for more men to be self-reported victims of domes• tic violence.
The consequences of abuse can be grave, and the over whelming tendency is for victims to hide or deny any experience of abuse. Therefore, it is appropriate, after a secure doctor-patient relationship has been established, to recommend that dentists undertake sensitive screening for issues of physical and sexual abuse with patients in whom persistent pain is a dependable part of the clinical picture. The recommended assessment process in the so-called AVDR model: ask about abuse; provide validating messages; document presenting signs and symptoms; and refer victims to specialists who treat victims of domestic violence.