A few patient screening questions are a good way to check in with the person, especially if they feel or look a bit off. ’What’s it like for you to be here today? Have you experienced anything about seeing a dentist that’s scary for you? Is there anything we can do to make you feel more comfortable or safer?” And if that hasn’t helped the problem and the patient still becomes hyperaroused or shuts down, it’s important to stop, take a step back, identify that there is some distress and try to bring the person back to the present. “As part of a process in the same way we ask people about their medical issues of asthma or allergies, the first question we could be asking every individual what they do to self-regulate,” says Dr. Friedman. “Our role as dentists is to create a safe space for the patient. Encouraging self-regulation and re-engaging the parasympathetic nervous system are the best ways to respond to a hyper or hypo arousal state.” “And this process is not confined to the dentist. When a patient comes into the office, the receptionist can identify if a person is in that hyper aroused state, or the dental assistants can likely identify if a child is in that state. As dentists, we cannot intervene as needed if the patient is not able to connect,” says Dr. Friedman. Related Resources: z CDA Oasis Website: Trauma-Informed Care in the Dental Office — bit.ly/3SoUBEg z CDA Oasis Website: Trauma-Informed Care: a CSDHAboutFace Panel Discussion — bit.ly/36IbRij z Maté G, Maté D. The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture, Toronto (A.A. Knopf Canada) 2022. z Porges S. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-regulation. NewYork (W.W. Norton&Co) 2011. Dr. Ruth Lanius is professor of psychiatry atWesternUniversity anddirector of the clinical researchprogram for post‑traumatic stress disorder (PTSD). Dr. Clive Friedman is a pediatric dentist practising in London, Ontario, and assistant clinical professor at Western University and University of Toronto. How Trauma Can Affect Your Window of Tolerance Hyperarousal: Anxious,Angry,Out of Control,Overwhelmed. Your body wants to fight or run away. It’s not something you choose–these reactions just take over. Window of Tolerance: When you are in your window of tolerance, you feel like you can deal with whatever’s happening in your life.You might feel stress or pressure, but it doesn’t bother you too much.This is the ideal place to be. When stress and trauma shrinks your window of tolerance, it doesn’t take much to throw you off balance.Working with a practitioner can help expand your window of tolerance so that you are able to cope with challenges. Hypoarousal: Spacy, Zoned Out, Numb, Frozen. Your body wants to shut down. It’s not something you choose–these reactions just take over. © 2019 The National Institute for the Clinical Application of Behavioral Medicine (nicabm.com) 32 | 2024 | Issue 1
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