CDS CIC share resources for developing your trauma informed dental practice

By Maeve McLernon, Consultant in Special Care Dentistry, Community Dental Services CIC (CDS) 

Community Dental Services CIC (CDS), is an employee-owned social enterprise and a referral only dental service, providing special care and paediatric dental services and oral health improvement programmes across much of the East of England and the Midlands.  CDS brings dental care to people who cannot easily be treated in general dental practice: patients typically have learning disabilities, mental health issues or severe anxiety.  

A significant minority of our patients have experienced past trauma or abuse, resulting in barriers to receiving dental care. Recognising and understanding trauma allows CDS to be better informed with employees sharing best working practice. At a recent companywide day, employees were guided to better understand a patient’s response to the dental environment and make the necessary adjustments to the way they are treated.  

Opening up the conversation with patients surrounding how they feel at the dentist and how the environment may trigger them can allow for solutions to reduce the risk of re-traumatising. For example: 

  • If the patient struggles to recline fully in the dental chair, we can look at more upright positioning.  
  • If the patient struggles to have people stand behind them, we approach more work from the side 
  • If the patient struggles to have foreign objects in their mouth, we may spend time allowing them to practice placing the mirror, radiograph holder etc. themselves, and use a countdown. 
  • Even seemingly benign things like praising the patient may in fact draw parallel to abuser behaviour and may be best avoided.

Only by building trust and shared knowledge with patients can we understand triggers that can be omitted from the dental clinic, and how to best approach each individual patient. 

Maeve McLernon, a Consultant in Special Care Dentistry who works for CDS in Derbyshire and treats patients who have been impacted by trauma, shares some helpful facts and resources:  

“Trauma informed dentistry seeks to understand and support patients with historic or current experiences of trauma or abuse. 

The seminal Adverse Childhood Experiences (ACE) study (Felitti, et al., 1998) suggests that childhood trauma is common: 

  • 30 per cent of the sample of over 17,000 people reported substance use in their household 
  • 27 per cent reported physical abuse  
  • 25 per cent reported sexual abuse 
  • 13 per cent reported emotional abuse  
  • 17 per cent reported emotional neglect  
  • 9 per cent reported physical neglect 
  • 14 per cent reported seeing their mother treated violently. 

More recent statistics from the national crime survey for England and Wales suggested as many as 1 in 5 adults have been abused in their childhood. It is thought only around 13% of all abuse is ever reported to police. Similarly, the World Health Organisation estimates are that up to 20% of girls and 10% of boys experience childhood sexual abuse. Research shows childhood abuse is not limited by ethnicity or socio-economic status. 

This means wherever you practice dentistry you are certain to see and treat patients that have experienced trauma or abuse, all at different stages of processing and coping with what has happened.  

Why is it important to be trauma-informed? 

A review of the literature provides evidence that trauma-informed practice is effective and can benefit both trauma survivors and staff. For trauma survivors, trauma-informed services can bring hope, empowerment and support that is not re-traumatising. Moreover, such services can help close the gap between the people who use services and the people who provide them. 

Trauma informed practice helps professionals to understand  

  • Many patients will experience fears and trauma responses about coming to the dentist that are linked to feelings, memories, or sensory input.
  • Many patients are mistaken as “dental phobics” when in fact we are witnessing a trauma response.
  • The fight or fight response is widely recognised as stress responses; in fight we may see patients seem combative or very tense whereas with flight they may not return for planned treatment. It is particularly important that dentists are also aware of “freeze” or “fawn”, which are also important stress responses. These occur if the body does not feel it can achieve fight or flight. Patients that “freeze” may not be responsive during treatment or may struggle to engage with decision making, whereas those that “fawn” will appear overly grateful or compliant.
  • Due to poor professional awareness of the freeze or fawn responses, patients may be at greater risk of being re-traumatised in these situations. 
  • Most patients will never disclose past abuse or trauma to their dentist, what is important is understanding why our patients may have certain reactions within the dental environments and recognise how we can support them.
  • Acknowledging that patients with a history of abuse are more likely to have low self-esteem and therefore engage with risky behaviour and/or poor health (including oral health) practices allows dental professionals to approach patients with compassion and tailored oral health advice.
  • By understanding common trauma responses along with taking some small steps to listen to patients and to give them the opportunity of being more in control of their treatment, dental professionals can make a positive impact.” 

Resources to develop your trauma informed practice: 

  • Transforming Psychological Trauma – NHS Education for Scotland  
  • Free and available to anyone to sign up. 
  • Free online modules and resources 
  • Access National Trauma Training Programme online resources HERE 
  • #Checkwithmefirst – NHS London and The Survivors Trust  
  • Free 
  • Two multi-professional virtual workshops  
  • Access resources HERE 
  • VictimFocus – charity 
  • Free resources specifically for dental professionals  
  • Access HERE