Adopting a trauma-informed approach to care is not accomplished through a particular technique or following a checklist. It requires constant attention, compassion, sensitivity, andperhaps a shift in the cultureof apractice. While the ideal patient would be able to advocate for themselves and express how challenging certain situations are for them, someone who has experienced trauma may not have the confidence to express their feelings to help avoid difficult situations. These patients may only go to the dental office when they are in extreme pain, but they may also be extremely nervous. It’s important to have empathy for patients for whom going to the dentist may be a triggering experience. The biggest challenge for dentists is learning to recognize, observe and be aware when these situations might be happening. When a patient’s emotions are triggered and the patient moves into a flight response, it is important to recognize this and try to create a safe space for your patient. Dentists should remember that engaging in traumainformed care does not necessarily require the patient to disclose the trauma, if they are not comfortable sharing. Practitioners don’t need all the minute details; they can still take care of their patients’ emotional needs; it comes down to their approach. to handle stress) fluctuates depending on the person and impacts their ability to cope with trauma. What is highly distressing to one person may not cause the same emotional response in someone else. Trauma is more than just an event that took place in the past. It can also be an imprint left by that experience on the mind, brain and body. Dentists are going to see patients who have experienced different levels of trauma. “We must consider instances of emotional, physical, and sexual abuse when we consider psychological trauma, because frequently the face and mouth are involved,” explains Dr. Ruth Lanius, professor of psychiatry at Western University, where she is also director of the clinical research program for post‑traumatic stress disorder. “For example, if somebody has had physical abuse in the face or oral area, they may have lost some teeth. Any touch or engagement with that area could bring back these traumatic memories,” she says. One aspect of traumatic memories is that they are not remembered by the person, but rather they are re-lived. So, if a dentist touches their patient’s oral region or asks them to open their mouth, this could serve as triggers sending the patient back in time, where they would be re-living those experiences. These patients would be experiencing acute hyperarousal, which includes anxiety and fear, or hypoarousal, which causes them to shut down, as if they are returning to the scene of the trauma. A dentist might notice signs when a patient is becoming fearful and anxious sitting in the dentist chair, but the opposite effect can also occur, where a patient may shut down and become passive. They might become numb, docile, and have trouble communicating with the dentist or dental hygienist or assistant. These instances are more difficult to detect and require a better understanding of how trauma is relived. Adopting a trauma-informed approach to care is not accomplished through a particular technique or following a checklist. It requires constant attention, compassion, sensitivity, and perhaps a shift in the culture of a practice. “As dentists, we are very familiar with the term ‘universal precautions’ when it comes to infection control,” says Dr. Clive Friedman, a pediatric dentist practising in London, Ontario, and assistant clinical professor at Western University and the University of Toronto. “We could apply the term universal precautions to trauma and make the assumption that anyone walking into our office with any sign of anxiety, has had some form of trauma in their world or in their lives,” he says. 31 Issue 1 | 2024 | SupportingYour Practice
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