Treating Patients who are Victims of Sexual Abuse
Dr. Marika Guggisberg spoke with Dr. Suham Alexander about an article she recently published on treating patients who are victims of sexual abuse. The article is titled: Improving Clinical Practice: What Dentists Need to Know about the Association between Dental Fear and a History of Sexual Violence Victimisation (Online)
Dr. Marika Guggisberg has been a lecturer in the Sexology Program at the School of Public Health, Curtin University in Perth after her Postdoctoral Fellowship at the Curtin Health Research Institute. She received her PhD from The University of Western Australia (Faculty of Law/Faculty of Medicine and Dentistry) in 2010. She has a Masters Degree in Criminal Justice, and Honours in Psychology. She studied Social Work and Adult Education in Switzerland from where she migrated to Perth, Western Australia with her family in 2003. Marika is the author of Women Violence and Comorbidity: The Struggle with Victimisation Mental Health Problems and Substance Use (2010) and co-authored Prisons, Prisoners and Health Care: History and Contemporary Issues (2011), published by Lambert Academic Publishing. Marika is also the primary editor of the e-book Understanding Violence: Contexts and Portrayals (2009) by Interdisciplinary Press, Oxford, UK. She has published numerous articles in international journals on the profound impact of childhood and adult violence within the family. She continues to present at national and international conferences highlighting the complexity of intersecting issues of intra-familial violence. Marika has decades of experience working with victims and offenders inside and outside the criminal justice system, and is passionate about raising awareness of the issue of sexual violence and working towards early intervention and better recovery of victims as well as preventatively with potential and identified sex offenders.
Highlights
What is the association between dental fear and the history of sexual violence victimization?
Fear of the dentist is recognized as being associated with poor oral health and therefore, a barrier to seeking and receiving dental health care which may have long-term consequences. Similarly, adults who have a history of sexual violence victimisation also suffer from anxiety and fear of the dentist. Research has shown that many victims of sexual violence find dental visits can bring up undesired memories of past experiences. This results in a feeling of disempowerment as well as an anticipation of pain/discomfort.
A literature review revealed 10 main themes and strategies that could be used to alleviate and assist patients with their anxiety and fear related to dental visits.
| Theme | Strategies to Help Patients |
| Lack of Control | •Collaboration with patients – informed consent, transparent communication, sharing treatment decisions, asking permission before dental treatments
•“Inform before You Perform” – explaining what is being done and why •Treatment breaks and “stop” signals •Providing written information about treatment |
| Avoidance | •Motivation strategies – encouragement and validation of their courage and energy
•Offer same day appointments |
| Embarrassment, fear of judgement and criticism | •Motivation strategies – encouragement and validation of their courage and energy
•Offer same day appointments |
| Flashbacks | |
| Patient body position | •Use a semi-supine position with one foot on the ground, whenever possible
•If supine, explain all aspects of the procedure to the patient and provide visual aids for patient to watch, provide a blanket to cover patient’s body |
| Sex of the dentist | •Allow a chaperone/friend to accompany the patient in the room
•Leave the operatory door open |
| Physical proximity to the patient | •Avoid leaning in or touching the patient’s body
•Inform the patient in advance of unintentional physical contact with his/her body |
| Oral manipulation and fellatio special effects | •May need to control a severe gag reflex in these patients
•Toolkit may include: -relaxation, distraction and desensitization techniques -complementary treatments such as hypnosis or transcutaneous electrical nerve stimulation -psychological and behavioural therapies •Avoid pharmacological treatments |
| Smell of latex gloves and aftershave | •Use vinyl gloves as an alternative to latex gloves
•Avoid the use of aftershave |
| Public awareness and dentists’ knowledge of the association between sexual violence and dental fear | •Learn to identify nonverbal cues from patients when they are suffering from distress or anxiety
•Ask patients questions regarding their comfort level when having dental treatment or what they find challenging about treatment and what makes them feel more comfortable. This opens the door for patients to disclose a history of sexual violence and allow for collaboration with the patient. |
Patients with a history of sexual violence report significantly higher incidences of TMJ discomfort, bruxism, gingivitis and the number of teeth extracted. Assisting these patients with the dental fear and anxiety will help to decrease their overall dental problems and help them maintain proper oral care. It is essential that dental practitioners understand the relationship between dental fear and anxiety in patients who have been victims of sexual violence to help provide the appropriate care for this patient population in a meaningful yet non-threatening manner.
Reference
- Larijani HH, Guggisberg, M. Improving clinical practice: What dentists need to know about the association between dental fear and a history of sexual violence victimisation. Int J Dent. 2015. 2015:452814.