Survivors of Torture Clinic: Managing the Effects of Anxiety and PTSD in the Dental Chair

Gerasopoulou-Pappa, Aikaterini, Seo, Soo Won
Faculty / Advisor: Sheridan, Olivia
University of Pennsylvania School of Dental Medicine, Department of Preventive and Restorative Sciences

Introduction

Dental anxiety is one of the most common conditions affecting patients in the dental setting. In the Survivors of Torture (SOT) clinic, the patient population that we care for consists of vulnerable populations, victims of abuse, and recent immigrants, who are more likely to suffer from dental anxiety in combination with other psychiatric conditions. A specific patient encounter in the SOT clinic allowed us to delve deeper into how psychiatric conditions combined with past traumatic experiences can exacerbate dental anxiety in already vulnerable patients. A 36 year-old female patient who recently immigrated from Brazil presented to the SOT clinic with a complex mental health history, a language barrier which made communication with the patient herself difficult, as well as severe anxiety that was easily triggered. A majority of our chairside interactions with the patient depended on building rapport and establishing trust between the two providers, the patient, and her husband, who acted as her interpreter.

Methods

Behavioral methods used to make the patient more comfortable included discussing topics of interest to her, maintaining eye contact as well as a friendly and pleasant tone of voice, normalizing her anxious feelings and thoughts followed by reassurance, encouraging questions and breaks, and practicing the tell-show-do technique before any procedure was attempted. In addition, the patient fell victim to a physical and sexual assault between her dental care appointments in the SOT clinic, which prompted us to find new ways of making her comfortable with a new evolving issue, as well as obtaining a history of the incident without triggering painful memories for the patient.

Results

As a result of our behavioral management of the patient, the treatments attempted were successfully completed without any adverse reactions from the patient, and increased comfort level in the dental setting was noted.

Conclusion

Moving forward, it is important to assess each individual patient’s level of anxiety and how their medical history interacts with their ability to undergo different types of dental treatment. Keeping the patient’s needs at the forefront of our management and personalizing our approach will ensure the most optimal treatment outcome.