In the last Mental Health Spotlight, I talked about trauma, its neurobiological effects, and how it could potentially influence dental patient management and outcomes. With this article, I want to dive deeper into the practice of trauma-informed care.
Dental professionals often focus on the clinical aspects of patient care, endeavoring to perfect skills. However, what lies beneath the surface for our patients can be a complex web of emotions and experiences. Dental professionals, equipped with both clinical and empathetic skills, are uniquely positioned to recognize and respond to the weighty impact of trauma on oral health and well-being.
Unearthing Dental Trauma
As dental clinicians, we are no strangers to the anxiety and fear that dental visits can evoke. But what if those emotions run deeper than just a distressing past dental experience? Often, trauma unrelated to a dental experience can be buried beneath layers of resignation, silence, and an array of other survival behavior tactics.
The trauma can surface in the dental chair due to a stimulus that resembles the original trauma. The patient is then taken back to that traumatic event by way of rising emotions, images, sounds, and smells. This is called re-traumatization. Look back at my previous article titled, Mental Health Spotlight: What Dental Professionals Should Know about Trauma, to take a deeper dive into the neurobiology of these responses.
What is Trauma-Informed Care?
Trauma-informed care (TIC) is an approach to providing support and services that recognizes and responds to the impact of trauma on individuals. It is when I, as a clinician, use a broad lens that recognizes that many people have had trauma and assume that each person who sits in my chair may be affected.1 It is applied in various health care settings and holds promise of transformation within dentistry.
The core principles of TIC are rooted in understanding the prevalence and effects of trauma on individuals and creating environments that promote healing. The core tenets lie in the idea that a TIC provider can empower the patient so that they may build resilience and overcome dental fear or other trauma-related anxieties.
Creating a safe, non-judgmental environment for patients is the cornerstone of this approach, and it begins with acknowledging that everyone’s journey is unique. The following are a few basics of trauma-informed care.
Understanding Trauma
Trauma refers to experiences or events that are emotionally or psychologically distressing and can have a long-lasting impact on an individual’s mental, emotional, and physical well-being. Trauma can result from various situations, including abuse, neglect, violence, accidents, natural disasters, and more.2
Trauma Prevalence
It is important to understand how prevalent trauma is and that many people have experienced some form of it in their lives. It can affect people of all ages, backgrounds, and socioeconomic statuses.2
Putting Trauma-informed Care into Action
Six core principles of trauma-informed care are discussed below when being evaluated in a dental practice.
Safety
Ensure physical and emotional safety for dental patients by creating environments where they feel secure and can trust the people and systems around them. Trauma-informed care starts with the first contact with the patient. Make eye contact, use the appropriate greeting such as a handshake, tell the patient your name, and let them know that you will be their hygienist and with them for the rest of the appointment.2,3
Trustworthiness and Transparency
Show the patient they can trust you. This can be done with simple steps such as protecting their privacy, using proper infection control, telling them what is next in the process of care, and carrying out the actions you said you would. Maintain nonjudgmental, empathetic, and respectful language when communicating with patients. Patients who struggle with dental fear due to past trauma can build resilience and healing when the clinician sets realistic expectations.4
Choice and Empowerment
Respect the patient’s autonomy and involve them in decision-making by creating collaborative conversations. Consider removing yourself from the role of chairside lecturer or educator and find ways to eliminate power differentials through the use of motivational interviewing. A straightforward way to eliminate the power differential is to sit the patient up for important conversations. Take off your loupes and mask, make eye contact, and raise the patient’s chair slightly higher than yours. This tells the patient you are listening and gives them a sense of being in control.
Collaboration and Peer Support
Promote interprofessional collaboration by being prepared to refer a patient to the proper provider when a patient confides something in us that may require more professional analysis. Even though we often feel like counselors in our chairs, our intimate conversations are supportive and do not replace the therapeutic value of a mental health professional.2,3
Cultural Sensitivity
Recognize and respect cultural, gender, and other individual differences. Remember that groups of people may have suffered systemic abuse due to race, culture, gender, or sexuality. When we recognize how this can affect different groups of people, our empathy increases, and we can better serve the patient without re-traumatization.
Strengths-based
Focus on your patients’ strengths and resilience instead of their deficits or challenges. Praise them for things they have done well, including the bravery it takes to come to the dental office while feeling fearful.
Reclaim Good Mental Health
It is essential to cultivate a haven for our patients. As I recently discovered in an enlightening interview with the founder of Reclaim 611 (a nonprofit organization that equips health care professionals to recognize, respond and report victims of human trafficking), Carrie Schirato, RN, FNP-C, ACNP-C, recognizing signs of trauma or fear within our patients is the first crucial step towards offering them the support they may silently yearn for. Carrie, a beacon of wisdom in TIC, trains medical professionals how to recognize, respond, and report patients who are enslaved so they may reclaim their lives.
As a seasoned emergency department nurse practitioner, Schirato is no stranger to treating traumatized patients. She is well-versed in how to show up for each patient with a trauma-informed mindset, and she shared valuable pieces of guidance during the interview. Schirato talks about trust as a currency in the healthcare environment.
She said, “When we create a safe environment for our patients to feel seen and heard, we can foster a profound connection that goes beyond the medical or dental setting. This can be the first step in the patient’s healing journey.”5
Imagine a patient walking into your office with unspoken fears and past trauma. The resurfacing of the trauma or re-traumatization can be an overwhelming experience. Schirato recommends a few simple but profound gestures that can greatly impact the trust-building process.
“Take a seat and be at eye level with the patient,” she said. “Do not stand over them, especially when they are lying back in the dental chair. This will show them that you are ready to listen.”5
She also reminded me that people who have suffered trauma may have incredible difficulty with eye contact. We should maintain eye contact even when the patient does not. This demonstrates respect and our willingness to connect.5
As our schedules get jam-packed, and we are tempted to rush through an appointment, Schirato encourages taking a minute to gather yourself, breathe, and remember that you may be the first person to show genuine care for this patient.
“Will it run you behind?” she asked. “Most likely, but the genuine connection far outweighs the temporary delay in our schedule.”5
Reclaim 611 created the acronym EMPOWER for ease of remembering the key steps in TIC. Use this simple guide to keep you on track for a trauma-informed mindset:5
- E: Eye contact at eye level. Explain the exam.
- M: Meet immediate physical needs such as water when the patient is outwardly distressed. Monitor for signs of distress.
- P: Provide a professional interpreter when appropriate and a private exam (ask an accompanying person to step out).
- O: Open-ended questions.
- W: Wait for a response.
- E: Equip patients with options and resources. Establish rapport.
- R: Reinforce the patient’s safety and bravery. Respect the patient’s choices.
Mostly, Schirato urges us to honor the patient by meeting them where they are and using curiosity over judgment.5 As dental professionals, we wear the hats of clinicians and empathetic confidants. In this blending of roles, we have the potential to transform lives.
By embracing Schirato’s counsel, we can craft an environment where dental patients can trust us enough to be vulnerable and confide in us, find strength in their stories, and build resilience. In this intimate dance, we can realize the impact we have ‒ one compassionate interaction at a time.
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References
- Gerber, M.R. (2019). Trauma-informed Healthcare Approaches: A Guide to Primary Care. Springer.
- Qualie, H.C. Trauma-informed Care for the Primary Care Provider. Women’s Healthcare. 2020; 8(4): 6-12. https://www.npwomenshealthcare.com/wp-content/uploads/2020/07/CE_Trauma-informed-care-1.pdf
- SAMHSA’s Trauma and Justice Strategic Initiative. (2014, July). SAMHSA’s Concept of Trauma and Guidance for a Trauma-informed Approach [HHS Publication No. (SMA) 14-4884]. Substance Abuse and Mental Health Services Administration. https://ncsacw.acf.hhs.gov/userfiles/files/SAMHSA_Trauma.pdf
- Fleishman, J., Kamsky, H., Sundborg, S. Trauma-informed Nursing Practice. The Online Journal of Issues in Nursing. 2019; 24(2). https://ojin.nursingworld.org/table-of-contents/volume-24-2019/number-2-may-2019/trauma-informed-nursing-practice/
- Schirato, C. Personal interview, September 2023.
