Suggestions for Dental Providers

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The potential effects of childhood sexual abuse on dental/oral health and wellbeing are barely recognized within the profession of dentistry and dental hygiene. Dental providers may see patients on an ongoing basis, and so there is a high potential for developing rapport and trust. Yet, oral care is not structured to encourage regular discussion between client and practitioner. The work dentists and hygienists perform is invasive, and for patients who may have experienced oral sexual abuse, preventative or restorative dentistry may involve procedures that create acute anxiety and allow the client very limited means of control. The following are ways to help survivors of abuse.

  1. Practitioners in our study suggested an approach of "Universal precautions"
    • Routinely ask patients how you could help them feel more comfortable with the examination, procedure, or test, and if there is anything they think you should know before proceeding. Consider a possible abuse history if patients show signs of anxiety or tension. A "universal precautions" approach indicates an awareness of the prevalence of abuse, and sensitivity to any signals that may suggest an abuse history. It also demonstrates respect for the patient and offers them control and input into the test, examination, or procedure without necessarily needing to disclose their history.
  2. Become more informed about childhood abuse
  3. Make your clinical setting more client-friendly
    • Most medical environments are intimidating rather than accommodating to patients. Provide a comfortable office environment for patients, particularly if they choose to disclose an abuse history.
    • Making small changes to the physical environment (e.g., cartoons, artwork, adjustable lighting, music, and informational posters on walls) can ensure a safe and welcoming environment to anxious clients.
    • Pamphlets or articles in waiting areas should describe what patients can expect from medical examinations. Materials that mention abuse and that it can be a part of a patient's history may also help.
  4. Approaching patients
    • Use a gentle touch, it is less frightening.
    • Use relaxation techniques with women who have difficulty with certain examinations.
    • Be aware of cultural and/or other differences where women have disabilities, are immigrants or visible minorities from diverse cultural backgrounds, are aboriginal, have literacy challenges, or are lesbians.
  5. Respect boundaries
    • Ask patients beforehand if they would mind somebody in training being involved in the examination or procedure. Include a description of the sex and status of the person, and ask this question ahead of time without the person standing there, so patients are given the option, without having to say in front of somebody, "No I don't want you there."
  6. Find ways to provide patients with a greater sense of control and comfort over procedures
    • Offer an initial appointment just to talk.
    • Involve the survivor in care and plan treatment together.
    • Provide a checklist that helps women identify which concerns they have about the health care encounter (e.g., discomfort with certain procedures, boundary issues and others).
    • Ask patients for ideas to make the examination or procedure more comfortable (e.g., specific signals to stop or have a time out)
    • Start with a straightforward procedure with patients who require a lot of time and are fearful. Also, suggest the patient come back another day.
  7. Use interdisciplinary team meetings, hold case conferences, debrief with others, and share ideas and strategies for different ways of improving care for women survivors of abuse.
  8. Help patients stay in the present and avoid dissociating
    • Use the patient's name.
    • Help them to stay connected by asking for example, "Are you able to hear me? Is this okay?"
    • Engage the patient in what is being done in each part of the examination, test or procedure (e.g., what you are doing and why), rather than in talk that distracts from what you are doing.
  9. Integrate survivors' suggestions into your work situation

    The women interviewed with histories of CSA made suggestions for providing care to make things easier for them.

    • Having a support person with them
    • Being asked before any examination what might make it easier
    • Having examinations or procedures fully explained
    • Dimmer lights or brighter rooms
    • Being able to see a practitioner of a specified gender to perform certain procedures
  10. Let the patient know that she can stop the procedure or exam at any time if she finds it too uncomfortable and that you will respect her wishes and limitations.

    Position the chair to make the person more comfortable. If the patient prefers, place the dental chair in a more upright position.

    Have the dental assistant present if the patient finds that helpful.

    Be careful about inadvertent touching.

    Allow the patient to hold the suction if she would wish to.

    Offer a mirror to see what is going on, headphones, a body covering (e.g., a blanket or x-ray cover). A support person or dental assistant can be available or a hand to hold if the patient wishes.

    If possible, allow for some private space. Have a separate room in the practice where private discussions could take place and clients could feel less anxious, perhaps hire a counsellor part-time to provide support as needed.

    Consider an expanded role for the dental assistant, especially if gender of the provider is an issue. Women may feel more comfortable speaking with a female hygienist or assistant.

    Some women may feel more comfortable keeping the door open during an examination or procedure.

    Survivors of abuse are often hypersensitive to their environment (e.g., sounds, smells to warn of coming danger). Dentistry is full of smells and sounds which can overwhelm patients. Advise the patient ahead of time what sounds they might hear during the procedure (e.g., suction, drilling).

    Tell the patient ahead of time what the procedure may feel like. Dental procedures which entail considerable physical work can be very frightening to patients with an abuse history.