Dear Marlene:

I know of one person, who didn't have insurance, and so the dentist experience was painful because there wasn't enough numbing and so an adult he didn't want to go back. But many of us don't like any medical appts. where there's an invasion in the body of tools or hands. Or where we can't speak. Or where there's partial loss of control because of laughing gas.

So there's all the stuff about being exposed and vulnerable. But also, for me at least, as a kid, when we were sent into the dentist from the car, and were asked "Where's your mother?" or told the bill was overdue or we couldn't have our appt. until a payment was made, while kids and other people are in the waiting room and can hear - that was the most embarrassing, awkward and shameful part.

On a lighter note, a dentist came to school in first grade and said:
"Be true to your teeth and they won't be false to you" and to brush EVERY morning and night no matter what.

I never forget either. I took his words so seriously and took good care of my teeth which were pretty healthy overall despite not too many dentist appointments, cleanings, etc. 

Cissy

Dear Cissy,

I'm grateful for your input, and will take note of it. Also, it's good to hear that despite your experience in the office, you had a positive outcome (healthy teeth) from the Dentist's words of wisdom.

Kindly,

Marlene

Hello

Thank you for examining Dentistry and ACE relationship. I have many examples but will comment on a few. My ACE score is 10. My early memories include my father pulling me by the arm and making me open my mouth. He would then say "your teeth are yellow and dirty you need to brush them". I honestly don't even remember if I had a toothbrush and coming from a health prof. background I know that children need assistance when they are learning to brush and look after their own teeth. I have worked with immigrant children and part of our program was brushing after the lunch that was provided and a fluoride varnish program. It was a brilliant program and after three years of following these children the program was working to reduce dental caries, extractions, and improve brushing skills and the importance of dental care. This population were very poor, diets high in sugar (especially infants) and culturally dental health was not a priority.

I can only remember going to the dentist a few times in my childhood and the outcome was always grime  and I felt ashamed and very frightened of what my parents would say.

I have had dental issues all of my life. As part of my coping with stress I clench my teeth constantly during the day and of course all night long. I have a night guard. I now have TMJ disorder and am on a year wait list to see an oral surgeon who will do arthroscopic surgery. Have already had arthrocentesis. I am constantly chipping teeth and have had to have a recent extraction. The result of this condition causes facial pain, headaches, random tooth sensitivity etc. It limits my diet and my ability to open my mouth more than a finger and a half wide. 

I have no idea if this is a related issue, however I will mention it here. I have 3 daughters who were all molested as children by their paternal gf. My eldest daughter at the age of 27 was diagnosed with stage 4 squamous cell carcinoma of the lateral tongue. After many surgeries, chemotherapy,and radiation she is 4 years past her diagnoses. I am so grateful as 5 year survival rates are very low. Needless to say she has speech, swallowing, and severe dental issues following this aggressive treatment. Her appearance has changed dramatically. I can't help but wonder if this is somehow related to her past trauma and being parented by a mother with a high ACE score, "the body remembers".  

I have a wonderful dentist and had not thought about the ACE relationship. I believe she would be very open to receiving any information you may have regarding this subject. It is a place to start in increasing awareness. I live in Canada and am unsure of what if any ACE is considered in Canadian Dental practice or training. I would be happy to provide her with any information you may have. She may also have information to share with you. This would mean having a perhaps difficult conversation with her on my part, however, she is very approachable and always eager to provide comprehensive client centred care.

kind regards

Kris L

Futures Without Violence has a training video for dentists and dental hygienists about screening for and responding to domestic and sexual violence. It's called "Ask, Validate, Refer" and it's available for free on their website. You just have to pay shipping. 

There are two women who have a Trauma Recovery Academy for Adult Survivors of Childhood Sexual abuse and their names are Athena Moberg and Bobbi Parish.  They have discussed on Twitter chats and in their YouTube weekly live broadcasts about the topic of dentistry triggers of adult survivors.  This is a HUGE problem.  They could both provide you with a wealth of information that would help the profession become more trauma-informed and aware of the very real triggers experienced by adult survivors (of which an estimated 50,000,000 adults live in the United States alone).

Brenda Gregory Yuen

Stout Street Clinic is a clinic in Denver, CO that serves homeless adults and families and they have a fantastic dental clinic.  They do great work with a population that has very high rates of trauma.  You may want to reach out to them!  I do not know of any specific person to reach out to, but their reputation in the homeless community is really great and I think that speaks volumes.  Best of luck!

Laura Avellaneda-Cruz posted:

Futures Without Violence has a training video for dentists and dental hygienists about screening for and responding to domestic and sexual violence. It's called "Ask, Validate, Refer" and it's available for free on their website. You just have to pay shipping. 

Thank you, Laura! I will look into ordering the video.

Kindly,

Marlene

Brenda Yuen posted:

There are two women who have a Trauma Recovery Academy for Adult Survivors of Childhood Sexual abuse and their names are Athena Moberg and Bobbi Parish.  They have discussed on Twitter chats and in their YouTube weekly live broadcasts about the topic of dentistry triggers of adult survivors.  This is a HUGE problem.  They could both provide you with a wealth of information that would help the profession become more trauma-informed and aware of the very real triggers experienced by adult survivors (of which an estimated 50,000,000 adults live in the United States alone).

Brenda Gregory Yuen

Thank you, Brenda! I will look up their YouTube broadcasts.

Kindly,

Marlene

Kristi Schaefer posted:

Stout Street Clinic is a clinic in Denver, CO that serves homeless adults and families and they have a fantastic dental clinic.  They do great work with a population that has very high rates of trauma.  You may want to reach out to them!  I do not know of any specific person to reach out to, but their reputation in the homeless community is really great and I think that speaks volumes.  Best of luck!

Thank you, Kristi! I will look up the clinic, and reach out to them.

Kindly,

Marlene

Dear Marlene,

Kudos to you for wanting to address this important issue! At the Health Federation of Philadelphia, We have done training on ACEs and trauma informed care to a number of dental programs that are part of our network of FQHCs as well as to a program that was training dental community health outreach workers.  Providers and staff have been very receptive. I will search for our materials and either post them as clips to ACN or e-mail them to you.  

Leslie

Here is one resource that we use on this topic

Hi Marlene,

Thank you so much for taking on such an important issue!  I have met many people who avoid the dentist because of past dental experiences - one had 7 teeth pulled as a child without the benefit of pain control because the novocaine did not take effect until she left the dentist office, then she was finally numb.  Throughout the unbearably painful experience, she wondered to herself if it hurt this much with novocaine, imagine how much it must hurt if she didn't have it.  Needless to say, she refuses to go to the dentist as an adult.

Another friend has PTSD from being a witness to a police shooting and a traumatic car accident (no connection to dental fear). She has had several dental procedures over the past 2 years and has been living in pain because of her trauma history. We joked that we should have "dental doulas", but maybe this is actually a good option for people.  Perhaps some pre-dental students could get some exposure to dentistry and volunteer hours by providing a service like this?

The cycle of trauma and lack of good dental work greatly affects those who live in poverty.  We know that children are unable to focus in school when they are in pain and adults have a difficult time with job interviews, meeting new people, or just smiling because of their teeth.  Drug use complicates the issue even more. I'm a nurse, and sometimes my patients who live in shelters or go to the food bank have very limited options of what they can eat in these already low-choice places. 

Thank you for working on this!  

Kim

I found Leslie's post /attachment to be a welcome contribution to this discussion. 

I use one of a series of five different {"Please Read & Inquire"] "business cards" put out by: < http://www.traumainformedcare.com >, when dealing with an assortment of health care providers, including Dentists and Oral Surgeons. I hope folks can get this link to work, and/or that I copied the address correctly.

I have been engaged in developing and training on ACEs for Dentists, and allied dental personnel for the last few years (and related to trauma in general for many years).  Our local college has a dental hygienist program and the program director has integrated a 2 hour lecture into student curriculum.  I also presented at a state dental conference this summer.  I utilize Futures without Violence material,  substantial information on dysregulation of the immune system, as well as an array of existing research on specific dental and periodontal conditions association with trauma/stress.  For example the following are cited: 

—1.  Endocrine Changes: Alterations in the concentration of adrenal corticoids alter the response of oral tissues to bacterial toxins and other hormones involved in the general adaptation syndrome.

—2.  Neglect of Oral Hygiene

—3.  Dietary Intake and Nutrition

—4.  Gingival Circulation: Autonomic Nervous System increasing vasoconstriction of blood vessels decreasing O2 and nutrient supply to tissues.

—5.  Alteration in Salivary Flow and Components: Increase and decrease in salivary flow; Altered chemical composition – IgA.

—6.  Lowered Host Resistance

—7.  Bruxism

—8.  Acute Necrotizing Ulcerative Gingivitis  (ANUG)

—9.  Aggressive Periodontitis

—10.  Systemic  Inflammatory Diseases

—11.  Poor Wound Healing

—12.  Traumatic Injury:   to Head, Neck or Mouth.

For many years I have believed this is an often over looked area with trauma.  We have learned this for the past 50 years with domestic violence/IPV and so too with ACEs.  With integration of healthcare (physical, behavioral, dental) the approach to integration of ACEs into dentistry is considered a part of integrated healthcare.  However  the content,connection as a 'risk indicator and risk factor' for dental health, and thus relevancy for dentists....must be specifically tailored and addressed for their field.

I have my PhD in Public Health and am not a dentist.  I have pulled my training together on my own with the help/review  of dentists, educators, and research in the field.  I hope this helps.  Feel free to contact me.

Marcia

Leslie Lieberman posted:

Here is one resource that we use on this topic

Dear Leslie,

I'm grateful for your input and your resource contribution!

Kindly,

Marlene

Dear Kim,

Thank you for the valuable insight. I especially like your idea about "dental doulas." Perhaps, dental doulas could be a new profession...

Kindly,

Marlene

Robert Olcott posted:

I found Leslie's post /attachment to be a welcome contribution to this discussion. 

I use one of a series of five different {"Please Read & Inquire"] "business cards" put out by: < http://www.traumainformedcare.com >, when dealing with an assortment of health care providers, including Dentists and Oral Surgeons. I hope folks can get this link to work, and/or that I copied the address correctly.

Dear Robert,

Thank you for your contribution: http://www.traumainformedcare.com/

I visited the site and found great information, and Trauma Informed tools that I can reference. The "business cards" are a brilliant idea!

Kind Regards,

Marlene

Dear Marcia,

Thank you for the excellent information. I currently know of one dentist that is interested in receiving Trauma Informed care for himself and his staff. Therefore, my purpose is to attain information that is specifically relevant to dentistry. I greatly appreciate your input!

Kind Regards,

Marlene

Robert Olcott posted:

I found Leslie's post /attachment to be a welcome contribution to this discussion. 

I use one of a series of five different {"Please Read & Inquire"] "business cards" put out by: < http://www.traumainformedcare.com >, when dealing with an assortment of health care providers, including Dentists and Oral Surgeons. I hope folks can get this link to work, and/or that I copied the address correctly.

Robert: 

I missed this link the first time you shared it. It's wonderful and I'll share on Becoming Trauma Informed and Beyond. Thank you for sharing all the resources you do. It's incredible. Cissy

Bringing trauma-informed care to the dental chair

Dental health professionals can use simple strategies in their offices to create a trauma-informed practice, improve oral health care, and provide comfort and support to their patients.

Based on that, the collaborative created a packet of materials that includes an overview of ACEs and its connection to oral health, as well as an explanation on trauma-informed care. It also provides oral health-specific strategies and shares community resources related to trauma. The collaborative is now working to disseminate the educational materials more widely.

To read more of Melanie Padgett Powers' article, visit, http://publichealthnewswire.or...-health-session-2019

Visit the collaborative’s website to access their ACE resources.

Hi there. As a patient, one of the experiences that I find most triggering is the noise. The open layout of many dental offices, is a nightmare for me. I try to find dental practices that include offices that have individual patient rooms. I also really struggle with medical professionals in general since I've had so many traumatic experiences with the medical field. More compassion and less ego would serve more patients all around. Thank you for your interest in helping.