Trauma-Informed Care: Creating a Safe Space for Dental Patients

Leaning the chair back. The sounds of dental instruments. Closing the door to the room. 

These may seem like normal experiences at a dental office, but for some patients who have experienced trauma, they can trigger stress and anxiety. And if those triggers are ignored by the dental team, the patient could be retraumatized. 

Trauma is an event or set of events that were harmful or life-threatening that a patient witnessed or experienced directly, impacting their well-being and creating lasting adverse effects. It can include anything from automobile accidents to domestic violence to discrimination. 

How can oral health providers help patients who have experienced trauma feel safe in the dental chair? 

In a CareQuest Institute webinar, “Trauma-Informed Care: Creating a Psychologically Safe Environment in the Dental Setting,” experts explained how trauma can manifest in both patients and dental team members, the principles of trauma-informed care (TIC), and how those principles can be applied in oral health care. 

Trauma-informed care, the experts explained, considers and accounts for trauma that patients have experienced, regardless of when or how the trauma occurred. The experts believe protocols for trauma-informed care need to be universal and applicable to both dental teams and their patients. 

“Something like leaning the chair back — some patients get startled that they’re going to fall off,” Mana Mozaffarian, DMD, integration consulting dentist and former chief dental officer of Pennsylvania, said. “So, giving them a heads-up is very helpful.” 

She also created a list that offered practical strategies to reduce patient anxiety and improve workplace culture: 

• Before every appointment, remind patients to bring in objects (or people who will support them) that give them a sense of security or stress relief, such as stress balls, heavy blankets, etc. 
• At the beginning of every appointment, remind the patient that they have control to stop the procedure for any reason by raising their hand. 
• During the appointment, avoid surprises and provide cues for the steps of the procedure that create different sensations (e.g., changing the angle of the chair or using an instrument that creates a different sound or vibration). 

Learners shared their questions in a brief Q&A session toward the end of the presentation — an edited summary follows below. The full webinar, including the Q&A, is available in the CareQuest Institute webinar library. 

1. What is physically required in a dental office to make patients feel safe? 

Having a sterile environment is crucial for patient safety, but psychologically speaking, patient safety is about more than just clean instruments and clean surfaces. Trauma-informed care tells us that we need to pay attention to the physical space. A calm atmosphere makes a big difference. For example, avoid stressful TV programs, display plants and images of nature, and play soothing music. 
 

2. What do you do about patients who repeatedly fail to come to appointments? 

Dental staff may think these patients are disrespectful of the clinic’s time, but that’s often a misunderstanding. For patients dealing with trauma, a missed appointment is often a sign of the challenges of navigating daily life. Trauma significantly affects executive functioning skills. Time management may be challenging for patients who are struggling with trauma. 

This is in addition to social drivers of health. A patient may miss an appointment because of a bus that never arrived or child care that fell through. 

Of course, dental anxiety can contribute to the problem. Implementing the strategies discussed above can help improve patient attendance. When patients start to have more control, choice, and less-stressful experiences, they may be more likely to attend their appointments. 

Finally, it’s important to reconsider the term “no-show”; especially when used as a noun to refer to a person, it can be dehumanizing. Reframing missed appointments as “gaps in care” is more respectful and productive. 
 

3. What’s your take on percussive or somatic therapy? 

Any type of care you have been certified in, and you feel comfortable offering patients, can be helpful. But there is a boundary between dental care and mental health care. The most sensible course might be to refer patients to a mental health care provider to teach them techniques for reducing anxiety, and then the patient can use these techniques during the appointment. 

The advantage of integrated practices is that you can address the needs of the whole person. One practice within a federally qualified health center (FQHC) implemented a dental anxiety screener, which was essentially just the PHQ-9, a common diagnostic instrument for mental health. They ended up identifying suicidal individuals, who were then referred to inpatient treatment. So, asking questions in preparation for the dentist appointment identified an urgent need. 

At an integrated practice, there may also be the opportunity to have a mental health care provider come to the dental clinic and provide coaching or engage in breath work with the patient to reduce dental anxiety before an appointment. 

Editor’s note: You can view the full webinar, including the Q&A, in the CareQuest Institute webinar library.