Dentists Are Integral to the Fight Against Human Trafficking

Victims of human trafficking are often invisible. Surprisingly, dentists and other oral health providers may present a missing link. Hidden from the public eye, victims rarely interact with the outside world. While many go unrecognized, research shows that select healthcare professionals have an opportunity to identify victims and connect them with help.

Despite the risk of discovery, traffickers occasionally seek services for victims who suffer from serious health conditions. Studies of human trafficking studies on human trafficking demonstrate that a significant proportion of victims see health providers during their periods of victimization.

For example, Lederer and Wetzel (2014) found in their study of 106 sex trafficking survivors that 87.8% reported interacting with healthcare professionals while being trafficked, including dentists. More than one-half of the survivors (54.3%) reported dental problems, with tooth loss the most common problem (42.9%). Chisolm-Straker et al. (2012) found in their study of 173 US-based human trafficking survivors that 68% had seen a healthcare provider while being trafficked, and more than one-quarter (26.5%) had seen a dentist.

Oral health often tells a story that trafficking victims cannot. Tooth decay is common, due to poor dental hygiene and a high rate of malnutrition. Other issues that may cause victims to seek dental care include general injuries such as burns, lacerations (especially around lips), bruises, displaced teeth, and tooth or bone-related trauma when victims are force-fed or gagged. Victims may also display signs of sexually-transmitted infections in the mouth, including HPV, gonorrhea, chlamydia, and syphilis.

Dental professionals have a rare opportunity to recognize and respond to cases of human trafficking. But many lack training on the signs and measures required to safely respond. Too often, these pivotal moments become wasted chances.

Dental professionals can learn to spot signs that may indicate human trafficking, such as:

• Controlling dynamics: Victims of human trafficking may seem to be in fear or under the control of the persons who bring them to the visit. Victims may look to their traffickers for guidance on what to do or say. They may not be allowed to speak for themselves.
• Age: The patient’s age may be inaccurate or falsified. There is often a large age difference between the patient and the person accompanying him/her.
• Inconsistent or vague details: Victims may be reluctant to share personal information and have vague or conflicting stories. They may not be aware of the city they are in. They may appear to have lost a sense of time. Or, they may have stories that sound very scripted.
• Malnutrition/dehydration: Long-term consequences of malnutrition are especially common among labor trafficking victims.
• Tattoos or branding: Victims may display markings on their bodies, especially on the face or neck, often with the name or sign of the trafficker.
• Signs of neglect or abuse: Signs of neglect or violence may be indicators of an abusive relationship between traffickers and victims. Victims may lack preventative care over a long period of time, such as access to oral care products.
• Serial sexually-transmitted infections: Serial STIs of the mouth may suggest sex trafficking.
• Extreme discomfort with the dental exam: Due to trauma, trafficking survivors may have difficulty with certain exam positions, items in their mouth, or feeling a lack of control.
• Lack of personal identification: If a patient is unable to produce personal identification, it may be because the trafficker has taken it away from them to ensure that they don’t escape.
• Constant supervision: Traffickers usually insist on being with victims at all times, blocking them from the opportunity to ask for help.
• Communication issues: The refusal of interpreter services may be another red flag indicating victimization. They may lie about their victims’ English-speaking abilities and translate on their behalf. If translating, they may alter victims’ responses to fit their narrative to avoid exposure.
• Only interested in appearance: Traffickers may seek cosmetic dental work to improve the victims’ appearance. They are usually not interested in long-term preventative care.
• Payment in cash: Bill is paid in cash by the trafficker.

Dental professionals must be well educated about what to do if they suspect a patient being trafficked. Separating the patient from the suspected trafficker is a crucial first step in conducting a screening. Traffickers may not be cooperative for fear of repercussions. Clinicians should not inquire about trafficking-specific details but should attend to the immediate health and safety needs of the patient.

There are many legal requirements around reporting. Clinicians should know their state-mandated reporting laws for children and adults, as well as vulnerable adults, and when weapons are involved. Reporting suspicions of abuse or neglect of minors is mandatory, regardless of consent. But unless legally mandated, providers should not contact authorities without the consent of an adult trafficking victim; instead, they are advised to encourage self-reporting and refer the patient to the appropriate support services. To encourage future disclosure, it may help to establish trust and rapport and express that help is available.

In addition to identifying and helping trafficking victims, oral health professionals such as dental hygienists can support forensic services by documenting detailed evidence of signs of abuse or injuries. They may also be called upon to help by providing a patient medical history or estimating the age of patients with no birth certificate.

Clearly more education is needed for oral health and the broader health care industry to assist victims of human trafficking. Raising awareness is the first step to ensuring providers can seize upon these rare chances. Lawmakers, advocates, authorities and health care professionals must come together to protect these vulnerable individuals.

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This post was co-written by Mellissa Withers and Trinity Yang.

Mellissa Withers is an associate professor of global health at the University of Southern California's Online Master of Public Health program.

Trinity Yang is an undergraduate student at the University of Southern California majoring in global health.