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Trauma-Informed Dentistry: Why a Trip to the Dentist is Not Easy for the Abused

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Trauma-Informed Dentistry: Why a Trip to the Dentist is Not Easy for the Abused

  1. Home
  2. Dental Articles
  3. Anxious Patients Articles
  4. Trauma-Informed Dentistry: Why a Trip to the Dentist is Not Easy for the Abused
Trauma Informed Dentistry Why A Trip To The Dentist Is Not Easy For The Abused - Sure Dental

From a dentist’s perspective, rarely – and understandingly so – will a patient disclose their perturbing history.

It’s sometimes easy to view the world as little more than a sphere of abuse.

As humans we’ve abused our planet for longer than you think. Longer than we’ve been mining precious metals for space travel and technology. Longer than since the Industrial Revolution erupted.

Longer than we ever should.

Researchers argue that humans invest the least amount of work, technology or any other resource as possible to survive and thrive.

At the beginning of just the last century, any serious consideration of the future did not thread through the familial fabric of life the way it does now. In 1900, determined contemplation of things yet to occur, and utopian visions of a wished-for world interested very few people. Men were too busy working toward their death at 48; children were trying to be born, not die and be educated until the age of ten. At 52, women were six feet under rather than discussing the ground of their espresso and their kid’s orthodontist in their exercise gear at a local cafe.

It is with thanks to unreliable contraception and a young Queen Victoria’s obsession with her Prince Albert that childhood was, for the first time, recognised as a distinct life phase. Ironically, literacy and numeracy were at higher levels then than today. No doubt every kid read Alice in Wonderland in the way Harry Potter was devoured one hundred years later.

Only without streaming, box sets and $10,000 first editions because of a typo.

Other than William Morris and a few socialists, there was little serious consideration of where society was headed.

Today we predict almost everything: what the weather will be, what resources will be scant, what housing will be needed, what pensions will be worth, where we will burying weapons and landfill for the next 30 years. We have world population numbers up to the year 2300. Global warming is hot news. Increasingly newsfeeds, newspapers and novels are stories and reports of what is happening in the future and it’s a shift not likely to change.

The gravitational pull of future-thought prompts the idea that in a thousand years the 20th century may very well be viewed as the threshold of the ultra-modern world. Notably, and only since 1950 has a new geological era emerged that scientists are calling the Anthropocene Epoch, from the Greek anthropos (human). It is the mark of the huge effect Homo sapiens have had on the planet. It’s the rock solid story of humanity’s first contemplations of future, past and present as a whole dimension; as an outcome.

It’s a weird concept. As is trying to predict progress, even in everyday tasks.

Up until the 1950s, labourers were paid to knock on doors and windows to wake people in the morning. When that was superceded it wasn’t by a door-knocking machine, it was the humble alarm clock.

Trauma Informed Dentistry Why A Trip To The Dentist Is Not Easy For The Abused - Sure Dental

What makes imagining future technologies challenging is the ability to reach beyond the realm of contemporary realities and beliefs.

As part of a set of cards printed in 1900 by then-leading German chocolate company Theodor Hildebrand & Son depicting the “sweet” life of the year 2000, mobiles were envisaged. Not phones – homes. Feel like moving to a new neighbourhood? Go by steam train – with your house attached. Like a cumbersome caboose with tapestry portieres. The outdoor broadcasting theatre was also predicted, where family and friends gathered to watch a play on a screen, or listen down the line of a wall-mounted box phone – curiously called a camera telephone because of its resemblance to the sliding box camera of the 1860s.

To truly evaluate a meritorious visualised world requires a disconnection to the known aspects of the present. The Hildebrand cards capture that parameter misalignment and maladjustment so well: houses on wheels and moveable footpaths; personal flying machines, x-ray machines to capture criminals in the act, a weather control train. Getting it so strangely wrong and so skewedly right has the disconcerting perplexity of peanut butter and Tabasco sauce.

Those visions, so deftly illustrated of what constituted normal experiences for people one hundred years hence, had them still wearing late 18th century clothing. Gas lights were neither included or replaced in the illuminated drawings and nobody could have predicted what gas lighting would one day mean.

Gaslighting is a common aspect of psychological abuse; a core feature of intimate partner violation where the name of the game is for someone appear, or feel like they’re crazy.

The term itself comes from a Patrick Hamilton’s 1925 book Gas Light that became a 1938 play, and then a 1940 British film released as Angel Street. With changed spelling in 1944 it became the unforgettable remake Gaslight. Starring Ingrid Bergman, Charles Boyer and Joseph Cotton, it earned an 18-year-old Angela Lansbury an Oscar nomination for Best Supporting Actress for her film debut.

Set in Victorian 1880s London, Mr Manningham blames his wife, Bella, for a series of missing belongings, though she has no memory of having done anything with them. She begins to hear noises in the attic at night that coincide with the flickering and dimming of the household gas lights – indicative of one being lit in the attic, interrupting the gas flow to the lighted lamps.

Bella is made to believe that what she sees is imagined and imagines what she sees cannot be believed because it never is. When it’s revealed to her by a former detective that the previous resident was murdered leaving yet to be located jewels, it becomes clear Mr Manningham is involved in the crime – and is now searching for the concealed riches.

To keep his wife in the dark, he gradually convinces her that she’s insane.

Along with other forms of psychological abuse, gaslighting functions in part by perpetrators convincing others that what they are experiencing is not real or significant, while belittling the entire experience, observation or opinion.

According to the Random House Historical Dictionary of American Slang 1994 edition, the general public was using gaslight as a verb as early as the mid 1950s, and within a decade had entered the academic sphere. In his 1961 book Culture and Personality anthropologist Anthony F.C Wallace states, “It is also popularly believed to be possible to ‘gaslight’ a perfectly healthy person into psychosis by interpreting his own behaviour to him as symptomatic of serious mental illness.”

Due in part to the currency of contemporary social media and despite it sometimes being as reality-warping and eggcorn disformative as nominative determinist Sam Bankman-Fried, there is global focus on improving and supporting better mental health. The term ‘gaslight’ is recognised; although Professor and activist Beth E. Richie prefers a “hostile social environment.” Sociologist Kathleen Ferraro Ph.D, Professor of Sociology at Northern Arizona University calls it the “surreality” of deleterious relationships.

The repercussions for abuse survivors reverberate beyond the ostensible. Many people have a sexual, physical or emotional history of abuse. According to the UK’s Office for National Statistics it’s as high as 20% of the British adult population.

Trauma affects the body on a cellular level, and it’s no surprise how confronting being at the dentist’s can be.

Sexual abuse and the vulnerabilities of dental appointments are decidedly parallel. The feeling of not being able to escape, the focus and the probing of the sensual and sensitive area of the mouth; having to lie still, unable to speak, under the control of someone in very close proximity with the expectation of physical discomfort.

Specific aspects of the appointment, like the necessity to use latex, fingers and implements, along with sensations of oppressiveness, are strong links to past experiences of danger and pain.

Overall, these patients may be perceived by their dental practitioners as anxious and nervous and gently treated accordingly under that banner. However, their dental and trauma experiences are more complex in nature and the dentist environment is a compounding and concealed hotline to previous trauma.

Trauma Informed Dentistry Why A Trip To The Dentist Is Not Easy For The Abused - Sure Dental

From a dentist’s perspective, rarely – and understandingly so – will a patient disclose their perturbing history.

With the substantial overlay of strategies that work for fearful and anxious patients generally, the trauma-informed dentistry and its care modalities for supporting patients of abuse, practicing clinics have proven that the easiest way to greatly improve every patient’s oral health is to implement that higher level of care and consideration.

According to Dr Jessica Eaton, author and founder of the Eaton Foundation, the first Male Mental Health and Wellbeing Centre in the UK, “A trauma-informed approach to understanding human distress is a way we can explore the trauma responses without medicalising the person. Instead of seeing the trauma responses as mental illnesses, disorders and abnormal behaviours, a trauma informed approach sees the trauma responses as normal, rational and purposeful.”

The year 2022 brought the release of the findings of the first UK study to present qualitative data from child sexual abuse survivors and their experiences of dental care. It brings further understanding into how to avoid psychological re-traumatisation at the dentist.
Trauma-informed dental treatment prioritises care by offering individualised choice and control.

Victoria-based Dr Sharonne Zaks is not your average dentist.

Or musician. Or Melbourne International Comedy Festival participant. With more than two decades of specialised research and clinical experience focussed on caring for anxious and phobic patients, and survivors of sexual assault and trauma, Sharonne’s trauma-informed care approach is used to train dentists, and empower survivor patients worldwide.

It is the shared focus, structure and discipline of her like-minded Queensland counterpart, Dr Sonia Sonia who arrived in Australia from India in 2007.

Armed with a dentistry degree and desire for a new life far from her abusive father, her name is the result of a Customs and Immigration error. Her new life had demanded a new name. She liked it. It was her. Twice.

After setting up her own practice in Brisbane and as a survivor of domestic abuse herself, Dr Sonia recognised the signs and injuries in many of her patients. She soon realised that fixing a woman’s damaged teeth was a crucial step in helping leave a destructive situation.

Trauma-informed dental care is individualised, collaborative care with flexible approaches to support both client and practitioner. It facilitates relational safety that allows abuse and traumatic stress triggers to be gradually reframed, disengaged and deflated of the visceral grip in the dentist’s chair, all achieved with the patient in control and the pace they set.

Its intention in the wider sense, is for this neural plasticity to build new pathways in the brain to better manage the residual impact of distressing and debilitating experiences that brought such interruption and imbalance to children and people so undeserving of its heft.

With calls for not just dentists, but all healthcare professionals to pragmatically address the iatrogenic harm of healthcare treatments has brought about effective understanding of the psychology of trauma and the process-based tools to essentially change someone’s life.

Trauma-informed treatment is much more than simply better outcomes for oral health. It’s the offering to someone of a future view of world that becomes more expansive rather than oppressive, more encouraging than crippling and a change in the profound value of the global psychological landscape.

When humans have the capacity to not traumatise each other, we’ll stop passing it on to the planet. It’s time to transcend this sphere of abuse.


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