Trauma-Informed Care: Essentials of Compassionate Dentistry

By Noelle Copeland, RDH

Dental care is expanding its focus from purely clinical outcomes to include the psychological well-being of patients, especially those impacted by trauma. Trauma-informed care (TIC) stems from the understanding that trauma is pervasive among patients and can significantly impact their healthcare experience and outcomes.

This approach shifts the focus from "What's wrong with you?" to "What happened to you?" fundamentally changing the interaction between dental professionals and patients.

The integration of TIC is more than a compassionate adjustment—it's a necessary paradigm shift that enhances patient management and care quality. Dental professionals can profoundly influence patient experiences by adopting TIC principles, encouraging a proactive approach in embracing these practices for improved patient outcomes and satisfaction.

The Roots of Trauma-Informed Care

Trauma-informed care originated within mental health services as a response to the high prevalence of trauma and its profound impact on individual health and behavior.

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma as resulting from an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life-threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.

Trauma can arise from various sources, such as:

• Abuse: Physical, emotional, or sexual abuse.
• Neglect: Failure to meet a child’s basic needs.
• Violence: Experiences of violence, including witnessing violence.
• Medical Trauma: Trauma from invasive medical procedures or severe illnesses.
• Intergenerational Trauma: Trauma that is transferred from the first generation of trauma survivors to the second and further familial generations.

The Need for Trauma-Informed Care in Dentistry

Patients with traumatic histories often perceive dental settings as spaces of vulnerability. Dental settings are unique in that they involve procedures that can trigger trauma responses, such as a sense of loss of control, physical pain, or invasion of personal space.

Patients with traumatic histories may exhibit increased anxiety, avoidance of care, and poor adherence to treatment. Recognizing and mitigating these responses is crucial for dental professionals to recognize.

Traumatic experiences—whether psychological, physical, or emotional—profoundly impact an individual's healthcare interactions. In dental settings, where procedures can invoke vulnerability and anxiety, understanding and addressing these impacts is crucial.

Recognizing trauma's role in patient behavior and response is not merely an exercise in empathy; it's an essential strategy for effective patient engagement and treatment success.

Principles of Trauma-Informed Care

Trauma-informed care is based on understanding how trauma affects health and behavior while emphasizing several foundational principles that reshape the dental care approach.

• Recognition: Acknowledging the impact of trauma and understanding recovery paths.
• Safety: Prioritizing physical and emotional safety to help patients feel secure.
• Empowerment and Choice: Engaging patients in their care decisions to enhance control.
• Trustworthiness: Keeping practices consistent and communications transparent.
• Peer Support and Collaboration: Utilizing networks and collaborative care to validate experiences and promote healing.

Practical Strategies

To genuinely integrate TIC into dental practices, professionals must adopt both mindset and methodological changes. Universal trauma precautions in a dental setting are strategies and practices that assume every patient could potentially have a history of trauma. This approach aims to prevent re-traumatization and ensure a safe and supportive environment for all patients, regardless of whether they have disclosed a trauma history.

Detailed examples of universal trauma precautions that can be implemented in practice include:

Patient Greeting and Reception Area

• Ensure that all staff greet patients warmly and respectfully, using their preferred names and providing a brief orientation about what they can expect during their visit.
• Design the waiting area to be calming and inviting, with comfortable seating, soothing colors, and access to amenities like water or relaxing music.
• Provide clear signage and information about dental procedures and what patients can expect.

Sensitive Communication

• Train all dental staff to use language that is non-triggering and supportive. Avoid medical jargon that might confuse or alarm patients.
• Use open-ended questions allowing patients to share their comfort levels and concerns at their own pace, such as "How can I make you more comfortable today?"

Respect for Personal Space

• Always ask for permission before touching a patient, even for something as simple as adjusting the dental chair. Explain each procedure step before initiating it so there are no surprises.

Control and Empowerment

• Allow patients to have a say in their treatment whenever possible, including the option to stop or pause a procedure at any time. Provide a clear signal they can use if they need a break.
• Ensure that patients fully understand the procedures they will undergo. Provide detailed explanations and obtain explicit, informed consent before beginning any treatment.

Minimizing Triggers

• Arrange dental tools out of direct view of the patient to avoid potential triggers.
• Adopt a gentle approach during dental procedures, being mindful of the potential for patients to experience discomfort or fear.

Privacy and Confidentiality

• Use private rooms for treatments when possible to provide a secure and enclosed environment that respects patient privacy.
• Ensure that discussions about personal health history or treatment options are conducted privately, away from the waiting area or other patients.

Flexible Scheduling

• Offer flexible scheduling options to accommodate patients who may experience anxiety or stress about being on time or feeling rushed during their appointments.
• Allow patients to easily reschedule appointments without penalty if they feel unable to attend due to anxiety or other issues related to past trauma.

Staff Training and Awareness

• Conduct regular training sessions for all dental staff on the principles of trauma-informed care, including recognizing signs of trauma and understanding how to apply universal precautions.
• Foster a practice-wide culture of compassion and understanding, emphasizing the importance of considering patients' emotional and physical well-being.

Patients who feel safe and understood are more likely to attend regular appointments and follow through with recommended treatments. Furthermore, TIC practices can differentiate a dental practice in a competitive market, attracting and retaining those who value and require sensitive care management.

A Call to Action

Implementing trauma-informed care is a critical evolution in dentistry that responds to the complexities of human experience.

Dental professionals are urged to view TIC not as an optional add-on but as an integral part of modern dental practice. By fostering an environment of safety, respect, and understanding, you enhance the therapeutic relationship and champion a broader movement toward holistic, patient-centered care in all medical disciplines.

If you're not yet subscribed to receive the Incisor newsletter, filled with cutting-edge dental news sent directly to your inbox twice a month, you can do so here.

Author: Noelle Copeland RDH brings over 29 years of clinical dental experience to her role as a leading oral health practitioner. Specializing in health science copywriting and dental content creation, Noelle serves as a trusted and regular ghostwriter for industry giants like Dentsply Sirona, Align Technology, Trivium Test Prep, and Reality Works, Inc. She is an established dental copywriter and was the leading dental expert on "The Brilliant Oral Care Podcast" show on Spotify. Noelle continues to offer her expertise and knowledge in the dental field to brands, private practices, and dental corporations.