Even small adjustments, tailored to a patient’s preferences, can help. One patient who had been assaulted from behind requested that other people in the room remain in front of the chair. Another patient who had been raped in a car said that being lowered slowly back in the dentist’s chair brought back those memories, so she preferred to lie flat during the whole visit. Zaks is also very mindful of the heightened gag reflex of patients who have been assaulted orally.
Some modifications to her procedures are more joyful. Many patients have found music soothing during a visit, and Zaks once even brought a live band into the dental surgery.
And for all patients, Zaks provides information about what she’s doing, why, and how long it’s expected to take – seeking the patient’s consent throughout. This can help alleviate some of the anxiety and helplessness associated with dentophobia.
Respectful, collaborative, caring communication – which benefits all patients but may be especially appropriate for people with histories of trauma – has been shown to improve patient outcomes in various types of medicine. For instance, patients who feel cared for are more likely to take their healthcare professionals’ advice.
In the US, the Texas Association of Community Healthcare Centres (TACHC), a membership organisation of federally qualified health centres that work with medically underserved populations, is collecting data on these kinds of patient outcomes as it expands its training on trauma-informed approaches. This training extends not only to frontline health workers across the different fields of medicine, but also to back-office staff.
Roxana Cruz, an internal medicine physician and TACHC’s director of medical and clinical affairs, gives an example of how this universal training can be helpful. So many patients turn up at dentists’ offices feeling anxious, and some with traumatic histories might be loud and disruptive because “when a person is fearful, they don’t necessarily have full cognitive abilities in the frontal part of the brain”. So front-desk staff are trained to deescalate with deep breathing techniques.
Then a dental hygienist will explain to the patient what instruments will be used and what sounds will be heard, even asking if the patient would like to touch any tools. “It’s orienting a person to their environment in a very deliberate and caring manner,” Cruz says. While TACHC’s services include behavioural health, not everyone needs to be a therapist in order to integrate these kinds of basics into their profession.
TACHC also takes a universal approach to its screening for potential trauma. Its non-profit health centres serve and employ many people who have been exposed to trauma, whether from displacement, family separation, or other factors. So, by working under the assumption that anyone who walks through the door may have trauma exposure, staff avoid singling anyone out, while also creating an environment of greater compassion for all, Cruz says.
