Imagine feeling anxious and panicky whenever you see a dental office or even consider going to the dentist. This fear is all too real for some people who have experienced a traumatic dental event, such as a painful extraction or a difficult procedure. But what if there was a way for dentists to not only treat their patients’ dental problems but also help them overcome their post-traumatic stress disorder (PTSD) related to dentistry? In this article, we will explore important information about PTSD and the different techniques and approaches dentists can use to help their patients cope with dental-related PTSD and receive the care they need to maintain good oral health.
Dental management considerations for the patient with post-traumatic stress disorder
What is PTSD?
Post-Traumatic Stress Disorder (PTSD) is a debilitating mental health condition that can occur after a person experiences or witnesses a traumatic event. PTSD can affect anyone, regardless of age, gender, race, or cultural background.
PTSD is a complex disorder that can arise from various traumatic experiences, including combat, sexual assault, natural disasters, car accidents, and violent crimes. According to the National Center for PTSD, about 60% of men and 50% of women experience at least one traumatic event, and about 7-8% of people will develop PTSD at some point. Women are twice as likely to develop PTSD as men, and children who experience trauma are also at a higher risk.
PTSD signs and triggers
PTSD signs and triggers
According to Dr. John Dodes, a dentist with over 30 years of experience, PTSD can manifest in dental patients in various ways. “Patients with PTSD may have difficulty sitting still in the dentist’s chair, or they may have a heightened sense of fear or anxiety during dental procedures,” Dr. Dodes explains. “They may also experience physical symptoms, such as muscle tension or sweating, making it difficult to perform dental procedures.”
The PTSD symptoms can be grouped into four categories:
- Re-experiencing: Re-experiencing symptoms include flashbacks, nightmares, and intrusive thoughts related to the traumatic event.
- Avoidance: Avoidance symptoms may include avoiding thoughts, feelings, or places associated with the trauma.
- Adverse changes in thinking and mood: Negative changes in thinking and mood can involve feelings of guilt, shame, or anger, as well as difficulty experiencing positive emotions.
- Changes in physical and emotional: Changes in physical and emotional reactions can include hypervigilance, irritability, and a heightened startle response.
PTSD triggers can differ for each individual, depending on the nature of their traumatic experience and personal history. Some common PTSD triggers include:
- Sensory stimulus: Any sensory stimulus present during a traumatic event, such as the sound of a gunshot or the sight of a specific object, can trigger PTSD symptoms.
- Physical sensations: Physical sensations such as pain, touch, or pressure can trigger trauma memories, especially if they were experienced during the traumatic event.
- Emotions: Certain emotions, such as fear, anger, or sadness, can trigger PTSD symptoms. These emotions may be associated with specific events or situations that remind the person of the traumatic experience.
- Thoughts and memories: Intrusive thoughts or memories of the traumatic event can be triggered by a wide range of stimuli, including sights, sounds, smells, or physical sensations.
- Situations or environments: Certain conditions or environments similar to where the traumatic event occurred can trigger PTSD symptoms. For example, a soldier injured in combat may experience symptoms when they hear fireworks, which may remind them of gunfire.
- Anniversaries or milestones: Certain anniversaries or milestones, such as the anniversary of the traumatic event or a birthday, can trigger PTSD symptoms.
- Social interactions: Certain social situations, such as interacting with someone present during the traumatic event, can trigger PTSD symptoms.
Does PTSD cause dental problems?
A quick answer to this question is yes. Here are some PTSD dental symptoms that may appear.
- Severe periodontal disease
- High incidence of poor oral hygiene
- Teeth grinding
- Tooth hypersensitivity
- Some people may develop dental anxiety due to traumatic dental experiences.
Dentists can play a crucial role in the treatment of PTSD. According to Dr. John Rothchild, a dentist and clinical psychologist, “Dentists are uniquely positioned to help patients who have experienced dental trauma. Not only can they provide treatment for the physical injury, but they can also identify and treat any psychological symptoms that may arise.”
Although dental professionals cannot PTSD completely, they can reduce its symptoms, especially before and during a dental procedure, particularly dental trauma, by following some techniques.
Screening for PTSD
The first step in treating PTSD in dental patients is to identify those who may be at risk. Dentists can use a brief screening tool such as the Primary Care PTSD Screen (PC-PTSD) to assess patients for PTSD symptoms. This tool can help dentists identify patients needing further evaluation or referral to a mental health professional.
One of the most important ways to help patients with PTSD is to establish a trusting relationship with them, and it requires a thoughtful and empathetic approach from dentists. For this purpose;
- Dentists should make an effort to listen to their patients.
- Dentists should create an open, non-judgmental environment, encouraging patients to share their concerns and fears.
- By acknowledging their past trauma and offering empathy, dentists can build a foundation of trust with their patients.
- Effective communication is crucial when treating patients with PTSD. Dentists must explain what they do during the procedure and provide reassurance throughout the appointment.
- Involve the patient in decision-making and allow the patient to have some control over the procedure. This may include allowing them to choose music or a movie they want to watch, giving them the option of taking breaks during the process, and allowing them to select a date for dental treatment.
Strategies to ease anxiety in affected individuals
- Provide “distraction strategies” such as music, TV, and other visual aids to help patients focus on something other than dental procedures.
- The child/patient is brought to ease using the “modeling” technique, in which the dentist shows videos of other children who have undergone dental treatment.
- Apply the “tell-show-do” technique developed by Addelston in which the patient is shown the instrument you will use, told all the functions of the instrument before putting it into the mouth of the patient, and then start using the same tool.
- There are various calming techniques that dentists can use to help patients with PTSD relax. For example, dentists can use guided imagery, deep breathing, or progressive muscle relaxation to help the patient calm down during the procedure.
- Sedation can help patients with PTSD relax during dental procedures. Nitrous oxide (laughing gas), oral sedatives, and intravenous (IV) sedation can help reduce anxiety levels, making it easier for the patient to cooperate during the procedure.
Cognitive Behavioral Therapy (CBT)
CBT is a type of talk therapy that is often used to treat PTSD. CBT can help patients identify and challenge negative thoughts and beliefs contributing to their symptoms. Dentists can work with mental health professionals to provide CBT or refer patients to a qualified therapist.
In some cases, medication may be prescribed to help handle PTSD symptoms. Antidepressants and anti-anxiety medications may be helpful for some patients. Dentists should work closely with the patient’s mental health provider to ensure medication’s safe and effective use.
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