Embracing Trauma: Informed Dental Care for Patient Well-being
By: Adriana Zuniga
Patients come in and out of our dental offices from many walks of life. They are diverse in many ways and carry a large set of life experiences. Unfortunately, some of those patients come in with a history of negative life experiences also known as trauma. The Trauma-Informed Care Implementation Resource Center defines trauma as, “resulting from exposure to an incident or series of events that are emotionally disturbing or life-threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional and/or spiritual well-being.”,1 In fact, it is estimated that roughly 62% of adults have at least one adverse childhood experience (ACE) that can result in some form of trauma.1 Some patients claim to have “White Coat Syndrome” when told they have an elevated blood pressure reading. Other patients display their anxiety with beads of sweat on their forehead and an elevated heart rate. Trauma-informed dental care is dental care with an understanding your patient may have had previous trauma which can negatively impact their emotions during the dental appointment. Much like universal precautions in infection control, trauma-informed care assumes that every patient has some form of previous trauma.
The goal of trauma-informed care is not to initiate trauma therapy or to inquire about the specifics of what caused the trauma. The goal is to understand patients have different reactions to dental care based on their previous life experiences and help the patient feel less vulnerable and regulate their emotions during a dental visit. This approach to care is focused on creating a supportive and safe environment for the patient.
What does it mean to create a safe environment for the patient? When a patient comes into your office stressed and emotionally dysregulated, as a provider, it is important to maintain a calm and confident demeanor including eye contact and open body language. The patient’s sympathetic nervous system may be activated triggering the body’s flight or fight response, but your confidence and caring words let them know they are in a safe space. Clear communication, frequent check-ins as well as validation and positive reinforcing statements during the procedure can ease the patient’s mind and increase the likelihood of a successful dental appointment. As providers, we can validate the patient by letting them know we understand they are having difficulties. Next, redirect the patient’s thoughts by suggesting deep breathing or visualization exercises. Finally, provide the patient with consistent positive reinforcement by letting them know they are doing great and providing care updates. Other strategies to help emotionally regulate patients include playing calming music and diffusing essential oils. Weighted blankets and fidget pieces can also be used to calm an especially anxious patient.
For the patients who choose to disclose details about their trauma or emotional state, as providers, we have a requirement for mandatory state reporting. As dental professionals, it is important to remember we should not try to diagnose a patient’s behavioral health or initiate therapy.
However, we can and should refer these patients to get assistance by having brochures available for local crisis hotlines and mental health resources. The National Institute of Mental Health has a variety of free printable fact sheets and brochures .
For more information about trauma-informed care, visit the Trauma-Informed Care Implementation Resource Center at traumainformedcare.chcs.org.
Dr. Adriana Zuniga is the Director of Dentistry at Denver Indian Health and Family Services. She has an interest in integrated health care, particularly behavioral health screening of patients during their dental visit. In her spare time, she enjoys traveling, spending time with her family, reading and scuba diving. She is also the Chair of the MDDS Community Outreach & Public Relations Committee.