How Can Dentists Better Support Adult Survivors of Childhood Sexual Abuse?

What you need to know

• About 1 in 13 adults (and 1 in 6 women) have experienced childhood sexual abuse, meaning many dental patients may be survivors
• Dental procedures can trigger trauma responses in survivors due to feelings of powerlessness and physical sensations that remind them of past abuse
• Providing trauma-informed care with choices, control, and sensitivity helps survivors access needed dental treatment

Understanding the Impact of Trauma

Imagine feeling intense panic every time you need to see a dentist - not just normal anxiety, but overwhelming fear stemming from past trauma. This is the reality for many survivors of childhood sexual abuse (CSA). The dental chair can trigger memories of abuse through physical sensations, loss of control, and intimate proximity to providers.

The good news is that with proper understanding and approaches, dentists can help survivors access essential care while avoiding re-traumatization. This groundbreaking UK study gives voice to survivors’ experiences and provides practical guidance for trauma-informed dental care.

How Trauma Affects Dental Visits

For CSA survivors, seemingly routine dental procedures can activate the body’s trauma response. Having instruments in the mouth, feeling claustrophobic, or experiencing gagging sensations may trigger flashbacks to abuse. Some survivors described feeling “frozen” or dissociating during treatment.

Many avoid dental care entirely due to these triggers, leading to poor oral health. Others force themselves to endure treatment but experience intense psychological distress. The shame some survivors feel about neglected teeth compounds the shame of their abuse history.

The Power of Disclosure

While some survivors prefer not to disclose their trauma history, many expressed wanting dentists to understand the source of their fears - even if they can’t share full details. However, finding opportunities to have these sensitive conversations can be challenging in fast-paced dental settings focused on procedures rather than building rapport.

Simple changes like thoughtfully worded intake forms or “trauma cards” (similar to organ donor cards) could help facilitate partial disclosure. Most importantly, when survivors do share their history, they need providers to respond with empathy and adapt care accordingly.

Creating Safety Through Choice and Control

The study found that giving survivors choices and control over their treatment was crucial for creating safety. This included:

• Letting patients signal when they need breaks
• Allowing them to choose positioning
• Building trust gradually before invasive procedures
• Maintaining continuity with the same provider when possible
• Being mindful of physical proximity and touch
• Offering options for additional support (like having a nurse hold their hand)

When survivors felt in control of the pace and parameters of treatment, they were better able to tolerate procedures without being re-traumatized.

What This Means for You

Whether you are a dental provider or a survivor seeking care, understanding trauma-informed approaches can help create better experiences:

For providers:

• Recognize that “difficult” patients may be trauma survivors
• Create opportunities for disclosure without pressure
• Offer choices and control whenever possible
• Respond with empathy and flexibility
• Consider additional training in trauma-informed care

For survivors:

• Know that trauma-informed dental care exists
• Consider partial disclosure if you feel safe doing so
• Ask for what you need (breaks, positioning, etc.)
• Look for providers who demonstrate understanding
• Bring support person if helpful

Conclusions

• Trauma-informed dental care is essential given how many patients are CSA survivors
• Simple changes in approach can make treatment more accessible and less traumatic
• Both providers and survivors benefit when trauma history is understood and accommodated
• Additional provider training and systemic changes could help make trauma-informed care standard practice