Trauma-informed care is an approach to care that recognizes the presence of trauma and the role it may play in an individual’s life and their experiences in health care settings. Trauma-informed care acknowledges trauma as an injury; it also seeks to avoid labelling patients who have experienced trauma as being “uncooperative” or “difficult to work with.”
In this video, members of the Canadian Society of Disability and Oral Health (CSDH), in conjunction with AboutFace, a Canadian charity which supports individuals with facial differences and their families, discuss the challenges individuals with facial differences may encounter in accessing dental care, and outline some key strategies in implementing trauma-informed care in the dental practice.
- Danielle Griffin – Executive Director of AboutFace
- Colleen Wheatley – Social Worker in educational community settings and member of the facial difference community who has been involved with About Face for almost 30 years.
- Kariym Joachim – Clinical Research Project Manager at Hospital for Sick Children, Toronto, and member of the facial difference community who serves as Chair of the Board for AboutFace.
- Dr. Clive Friedman – Pediatric dentist with over 40 years of experience working with the special needs community.
Here are the key takeaways from the discussion:
CHALLENGES IN ACCESSING DENTAL CARE
- The dental office can be a vulnerable setting with many challenges for individuals with facial differences. First impressions can stand for a lot. A patient who has experienced trauma is more likely to show avoidance and may only attend their dental office when they are in extreme pain. A poor experience can lead to mistrust and may result in the patient not going back to the dentist.
- There is much variation in the experiences of individuals with facial differences. The trauma associated with facial differences does not necessarily exist in isolation but is often connected to other factors such as identity, ethnicity, socioeconomic background, etc.
- People who have suffered trauma often experience a fight, flight or freeze response in health care settings. It is important for dental professionals to recognize this and learn to step back and recreate a safe space for the patient. Health is a multidimensional, dynamic concept that includes the balancing of social, emotional, spiritual and mental status. We need to get away from the idea that our job is to fix the problem. Many of the skills required are those we would use with a younger patient. It is about communication, consent and giving choices.
- Individuals with facial differences often experience anxiety related to impending surgeries or medical treatments and the trauma associated with them. To make the situation even more complex, trauma is not linear. Two patients who undergo the same procedure, with the same surgeon, may experience completely different levels of trauma.
APPLYING TRAUMA-INFORMED CARE IN THE DENTAL OFFICE
- Communication is key, whether it is between the dentist and the patient, the dentist and caregivers, or the dentist and other members of the health care team. Oral health issues can often show up in other areas of physical health. The dentist can often see signs and symptoms that others don’t.
- Ask open-ended screening questions to get a better understanding of an individual’s facial difference. E.g., Is there anything that makes it difficult for you to experience a dental visit? Create a comfortable environment and give the patient an opportunity to talk about specific challenges relating to their trauma.
- Confirm consent to treatment and maintain a running dialogue. Explain what is happening and what it will feel like. Respect the fact that the patient may feel vulnerable and check that what you are doing is okay with them.
- Give the patient control by offering them as much choice as possible.
- Offer validation by acknowledging that the experience is difficult for them.
- Redirect the patient’s attention by asking them to squeeze their care giver’s hand or wiggle their fingers.
- Offer positive reinforcement.
- Consider the language you use carefully. How we refer to a facial difference in front of a patient and/or their family may have ramifications. Medical terminology (such as “facial abnormality”) may be appropriate in a medical conference setting, but when it is used in the presence of a child or adult with a facial difference, a value judgement is assigned to it.
- It is important to consider the whole person and adapt to their individual needs. The International Classification of Functioning, Disability and Health, outlines the practice of evaluating a patient without the need to know the specific details of their condition. Instead, it first considers psychosocial factors and how they impact the individual’s participation in the community and how they function in society.