Integrating firearm secure storage counseling into dental practice

Firearm violence inflicts considerable harm in the United States. In 2022 alone, firearms were responsible for nearly 48,000 deaths,¹ with tens of thousands more people experiencing nonfatal injuries each year.² Moreover, firearms have been the leading cause of death among children aged 0 through 17 years every year from 2020 through 2022.^3–5 Recognizing the widespread impact of firearm violence, US surgeon general Dr. Vivek Murthy issued a landmark advisory in 2024, officially designating firearm violence as a public health crisis in America.⁶

To reduce firearm-related mortality and morbidity,^7–10 health care providers have become a pivotal group in firearm harm reduction efforts, particularly by means of counseling patients on firearm secure storage practices^11,12; that is, storing firearms unloaded, locked, and separated from ammunition.¹³ Although physicians, particularly in adult primary care and pediatric settings, have increasingly become focal points for counseling firearm-owning patients on secure storage,^14–16 dental clinics have been overlooked in these efforts.¹⁷ Indeed, although dozens of medical professional societies have adopted guidelines recommending counseling of patients on firearm safety and secure firearm storage,¹¹ guidance from professional dental organizations, such as the American Dental Association and American Association of Public Health Dentistry, remains absent.

This is an oversight, given that oral health care serves a broad and diverse population, with nearly 4 in 5 children aged 1 through 17 years¹⁸ and two-thirds of US adults 18 years and older reporting a dental visit within the past 12 months.^19,20 The routine and recurring nature of dental appointments, typically recommended every 6 months,²¹ provides a framework for continuous monitoring and follow-up, facilitating firearm secure storage counseling to a broad population. Moreover, incorporating firearm safety counseling aligns with calls for dentistry to increase its focus on screening and counseling within the professional dental practice to address broader social determinants of health.²²

We explore the potential for firearm secure storage guidance in dental practice, discuss potential challenges, and call for research to identify the feasibility and best practices of integrating firearm safety within oral health care environments.

FIREARM SECURE STORAGE AS A HARM REDUCTION TOOL

There are an estimated 400 million firearms in circulation in the United States,²³ and approximately one-third of US adults live in a household with a firearm,²⁴ including an estimated 30 million children.²⁵ Household firearm ownership has been linked to a heightened risk of firearm-related homicide, suicide, and accidental injury.^26–32 However, storing firearms unloaded and locked in a storage device is associated with reduced risk of both intentional and unintentional firearm injury.^7–10 Even so, nearly 30% of firearm owners report storing at least 1 firearm loaded and unlocked,³³ and estimates suggest that 4.6 million children live in a household where a loaded firearm is stored unsecured.²⁵

For firearm owners, knowing how to store a firearm safely may be a critical step in promoting secure storage practices.^9,34 Health care providers offer a potential opportunity to counsel patients on firearm secure storage behaviors, thereby contributing to harm reduction. For instance, scholars have remarked that “clinician-delivered counseling to promote locked storage has support in population-based studies, has been shown to be acceptable across patient populations, has efficacy in improving locked storage practices, and is consistent with messaging from advocacy organizations about responsible firearm ownership.”¹²

Firearm secure storage counseling in clinical settings typically involves health care providers engaging patients in discussions about the storage of firearms to prevent accidental injuries, suicides, and unauthorized access. This counseling is integrated into routine care, often as part of broader injury prevention or safety assessments. Providers may initiate discussions during routine visits by means of asking patients about the presence of firearms in the household and how they are stored; exploring risk, safety behaviors, and motivations around storage practices, including the potential consequences of storing firearms loaded or unlocked; and guiding safety options, such as using gun safes, lockboxes, or trigger locks and storing ammunition separately.¹² The goal is to raise firearm safety awareness while respecting the patient’s rights and preferences.

POTENTIAL CHALLENGES

Despite the potential benefits of integrating firearm secure storage counseling into dental practice, there are challenges. First, providers must navigate limited appointment times that typically focus on dental procedures, leaving minimal room for additional screenings.²² Second, discussions about firearms can be emotional, raising concerns that patients might view inquiries regarding gun ownership as invasive or judgmental.¹² Third, dental care professionals may lack training or confidence in discussing firearm safety, given its limited inclusion in dental school or continuing education curricula.^35,36 In some regions, legal uncertainties may further complicate such conversations.³⁵

Nevertheless, feasible solutions exist. Brief screenings at patient check-in can be optional for patients to respond to and include language that makes it clear that questions are only being asked to promote safety.¹² Brief screening that identifies potential patients for follow-up counseling while minimizing workflow disruptions can be achieved via a few simple questions such as “Are any firearms kept in or around your home?” and, if yes, “Are any of these firearms stored loaded and not locked away?” Printed materials or short digital messages can be provided to reinforce the secure storage of information after a patient’s visit.¹² Training on firearm secure storage counseling supported by professional dental societies, as has been the case for many professional medical societies,¹¹ could be integrated to provide dental care providers with the necessary knowledge to deliver such counseling.¹² Finally, reimbursement structures, such as those established by the Centers for Medicare & Medicaid Services to compensate providers for injury prevention counseling, may encourage dental practices to invest the necessary time and resources.³⁷

AREAS OF FUTURE RESEARCH

Given the absence of research on the best practices for conducting firearm secure storage counseling in the professional dental practice setting, it remains unclear what the best approaches are. Nonetheless, these conversations may be best when they are patient-centered and nonjudgmental. Such counseling may occur universally or on the basis of risk assessments, such as whether there are children or people with mental health conditions in the home.¹²

Numerous models exist for addressing firearm secure storage.^9,12 Determining which models are best suited for the dental care setting must be subject to future research. An example of clinical firearm secure storage counseling methodology that can be adapted to the dental clinical setting is the 5 A’s (Ask, Advise, Assess, Assist, and Arrange) model, which offers a brief and efficient approach to counseling that integrates counseling from a dentist or dental hygienist into a chairside dental visit, ensuring minimal disruption to the provider’s workflow.³⁸ An example of the 5 A’s model adapted to secure firearm storage³⁹ is provided in the box.

Box. 5 A’s of firearm secure storage counseling.^*.

Ask	Obtain patient’s firearm storage behavior Do you have firearms in your home? yes, no How are your firearms currently stored? locked, unlocked Are firearms stored separately from ammunition? yes, no Do you use any safety devices like trigger locks or gun safes? yes, no
Advise	Counsel on the importance of secure firearm storage in a clear, strong, and personalized manner. Emphasize that securely storing firearms can prevent accidental injuries or misuse, particularly by children and unauthorized users
Assess	Evaluate the patient’s readiness to implement secure firearm storage practices Are you interested in improving the security of your firearm storage? Are you open to learning about additional safety measures?
Assist	Suggest resources for secure firearm storage Access to gun safes or lockboxes Information on local programs that provide free or discounted safety devices Guidance on best practices for separating firearms from ammunition
Arrange	For support, discuss a plan to enhance firearm storage security Set a date to implement secure storage practices. Schedule a follow-up to assess progress and address challenges. Encourage the patient to share secure storage practices with family members and friends.

^*Source: Hoops and colleagues.³⁹

Although the evidence from clinician counseling on firearm storage offers potential promise, there is a need for dental practice-based research to understand how best to incorporate firearm secure storage counseling into routine dental visits. Future studies are needed to explore several key questions.

Are dental practitioners comfortable discussing firearm secure storage with their patients?

Research should assess the comfort level of dental care professionals in initiating firearm secure storage conversations and identify any barriers, such as lack of training or perceived role limitations, that may affect their willingness or ability to provide counseling on firearm safety.

How do dental patients perceive firearm safety discussions with dental care providers?

Understanding patients’ attitudes and receptiveness to firearm-related counseling in dental settings is crucial for designing interventions and counseling language that respect privacy and patient autonomy while promoting firearm secure storage behavior.

What are the most effective methods for dental practitioners to ask about firearm access and counsel on secure storage?

Research is needed to address the best practices for initiating discussions regarding firearm storage and safety, the most effective messaging to use to promote firearm secure storage, and whether messaging must be tailored to different populations (eg, households with children and rural populations). In addition, identifying best practices for integrating secure storage counseling into the dental clinical workflow without causing disruptions in patient care is critical.

What are the potential public health impacts of integrating firearm secure storage counseling into oral health care?

Rigorous studies, including randomized controlled trials, are needed to determine whether and which types of dental firearm secure storage interventions result in changes in secure storage practices and reductions in firearm-related injuries.

CONCLUSIONS

Considering the US surgeon general’s declaration of firearm violence as a public health crisis,⁶ the time is ripe for dental care professionals to prioritize firearm secure storage research and practice. As a profession, dentistry has the potential to be at the forefront of an expanded, interdisciplinary approach to firearm harm reduction that can contribute to public health efforts aimed at reducing firearm-related injuries and deaths.