The links between trauma and dental phobias

As a dentist, it’s your duty to make sure each patient feels comfortable when receiving a check-up or treatment.

As a dentist, it’s your duty to make sure each patient feels comfortable when receiving a check-up or treatment. Many survivors of sexual abuse feel extreme fear and avoid dental appointments due to the similarities between the abuse they suffered when they were younger, and the feeling of being powerless in the dental chair: You are lying horizontally with your personal space invaded, possibly being sedated for a procedure, the fear of gagging or not being able to breathe consuming you, not able to really move during treatment – it can be very triggering and traumatic for trauma survivors.

These individuals often feel extremely embarrassed of their past abuse and ashamed for leaving dental issues too long, which then creates an unhealthy cycle of avoiding regular check-ups. Dr Sharonne Zaks, from Sharonne Zaks Dental in Melbourne, is working hard to raise awareness of this issue.

Giving power back to the individual

Abuse usually stems from a power imbalance, in most cases a person of authority or a “trustworthy” adult takes advantage of a younger, more naïve individual. “I listen to what the patient has to say and then let them set the agenda,” says Dr Zaks. “It’s really important to give power back to the individual and get consent for everything that you do. Communication is the key to ensuring they feel their anxieties are valid and that as a person they feel fully accepted and not judged. When you really listen to people with empathy, they feel they can trust you fully and this allows them to feel comfortable to open up. This is the key to building a deeper connection, which allows you to give them the best quality of care.”

What can you do to make abuse survivors feel more comfortable at the dentist?

Over the past 20 years, Dr Zaks has been creating and perfecting practical strategies for patients who are anxious, phobic or who have a history of abuse to feel more comfortable at the dentist. “Personally greeting them in the waiting room, opening the communication up and building rapport and trust so patients know that they’re in full control over what happens to them in the appointment, giving power back in many small ways like making sure you stay at a similar height to the patient when you talk together, keeping the door open, playing music and using humour to make them feel more comfortable. These are all ways to help this process of rebuilding their confidence”, says Dr Zaks. However, she believes that this should be a universal precaution for all dentists to use whether the person is an abuse survivor or not. “We’re all vulnerable in many ways during dental appointments, just to allow it all to happen”, says Dr Zaks. “This mindset and these strategies make us better dentists for everyone.”

The importance of responding sensitively to trauma survivors

With 1 in 3 women and 1 in 6 men suffering from sexual abuse by the age of 18 globally, we are seeing these survivors as our regular patients without any awareness of their history and triggering memories without realising it. “I’ve always enjoyed helping patients who are anxious and found more and more people reaching out who are dentophobic”, says Dr Zaks. “In 2012, I began to treat a trauma survivor who works at CASA (The Victorian Centres against Sexual Assault). It was through working with her that I realised the many parallels between being in the dentist chair and suffering abuse,” states Dr Zaks. “In 2017 I collaborated with CASA to create free educational videos for dentists and survivors.”

The unique opportunity we have as dentists to help heal trauma in patients

Dr Zaks hopes that future students will be taught how best to provide dental treatments to abuse survivors. “There are so many easy ways for practitioners to help people feel more relaxed and comfortable in the dental chair, it’s just that they’re usually not aware of them,” says Dr Zaks. “Trauma manifests in the mouth so it’s also important for dentists to look out for the characteristic fears, behaviours and coping strategies which all damage the mouth, such as smoking, eating copious amounts of junk food and sugar, and doing recreational drugs.”

There have been studies showing that when a trauma informed approach is used, there has been a much faster wound healing process and less burnout for the clinician. Dentists are in a unique position to be able to help heal trauma – not just in restoring function and aesthetics for patients, but also the relationship we have can lead to profound emotional healing in our patients.”

“It’s important as dentists to look after ourselves, take breaks and recognise when we need to get help debriefing emotionally”, suggests Dr Zaks, “it can be draining to be around anxiety and hear these devastating stories all the time.  Having said this, the work is incredibly rewarding.”

Image from 'TEDx Sydney 2019 Visionair media'

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