Bringing trauma-informed care to the dental chair

Dental health professionals can use simple strategies in their offices to create a trauma-informed practice, improve oral health care, and provide comfort and support to their patients.

However, most dental health professionals aren’t familiar with trauma-informed practice, said Madison Hammett during a Wednesday morning APHA Annual Meeting session on addressing the oral health needs of unique populations. Hammett works as a policy analyst for the Illinois ACEs Response Collaborative at the Chicago-based Health and Medicine Policy Research Group in Chicago, which has committed to being a trauma-informed city.

Studies have shown that a history of childhood trauma can lead to poor oral health, tooth decay and higher rates of gum disease. In turn, trauma-informed care recognizes that the majority of U.S. adults have experienced one or more adverse childhood experiences, or ACEs, Hammett told session attendees. ACEs are traumatic events such as physical, emotional or sexual abuse; physical or emotional neglect; parent separation or divorce; and separation from a parent.

Through stakeholder meetings, the Illinois collaborative found that knowledge of ACEs was low among dental health professionals and that they were uncomfortable talking about trauma with patients — many considered it “a doctor’s job” instead. On the flip side, patients questioned why they would talk to a dentist about their childhood traumas. Researchers also learned there were very few resources related to trauma care in oral health, and much of it was related specifically to domestic violence awareness.

In fact, even after the collaborative held an ACEs educational event for dental students at the University of Illinois at Chicago College of Dentistry, the question remained: “But what can I do with this information in my dental practice?” So, the collaborative held a second event featuring a pediatrician who implements trauma-informed practices in her office.

“We wanted to give the students an example of ‘this is a way you can talk about trauma without it becoming about trauma,’” Hammett said.

However, the collaborative doesn’t recommend dental health professionals screen their patients for trauma history.

“You should just assume that the patient in front of you is likely to have had an (ACE) and that is how you should operate,” Hammett said. “It doesn’t mean you have to ask your patients difficult questions about abuse, etc.”

Dentists can then use strategies in their practice that are beneficial to all patients. For example, start by asking patients if there’s anything you should know before you start treatment. Ask patients how you can help make them feel more comfortable. Tell patients that if they need to take a break, to simply raise their hand. Explain each procedure and how it will feel before you start. Ask patients for consent throughout the exam, such as “Do I have your permission to put my hand in your mouth now?”

“Asking consent is a very simple step you can take, and it’s actually been proven to be one of the most effective means of trauma-informed care — giving people control back,” Hammett said. “Because part of the fear of the dentist is the huge lack of control.”

After the second event at the dental school that featured the pediatrician, there was a tenfold increase in dental students who said they would provide referrals related to childhood trauma to their patients — that is, if they were aware of local resources, Hammett said.

Based on that, the collaborative created a packet of materials that includes an overview of ACEs and its connection to oral health, as well as an explanation on trauma-informed care. It also provides oral health-specific strategies and shares community resources related to trauma. The collaborative is now working to disseminate the educational materials more widely.

Visit the collaborative’s website to access their ACE resources.

Photo by Dragonimages, courtesy iStockPhoto