Unexpected Link Between Surviving Trauma And Avoiding Dentists
Five years ago, dentist Sharonne Zaks met a patient who burst into tears as soon as she sat in the chair.
The woman was acutely anxious and couldn't bring herself to floss or even put a toothbrush in her mouth. For her, they were triggers of painful memories she'd rather forget.
Going to the dentist can be an unpleasant experience for anyone, but for survivors of trauma, it can be retraumatising.
With time, Zaks' patient felt supported enough to share her experience of sexual trauma. Through the patient, her approach to dentistry changed.
"I started to think, there are a lot of parallels between sexual assault and a dental appointment," Zaks told 10 daily.
Zaks said the inherent "powerlessness" of dental visits can resemble and revive a person's original trauma.
"Unfortunately in a dental setting, there is a whole lot of power imbalance -- from the physical relationship [lying in someone's lap] to not having the ability to speak or move," she said.
"That sets up this trigger for memories to flood back."
For sexual assault survivors, this reliving can be "visceral". The horizontal positioning of the dental chair can be an early trigger, as survivors are laid back under an authoritative figure, the smell of Latex rife as their mouths are touched or filled.
"It's quite common that memories of assault or trauma don't come back until they're in the dental chair," she said.
New research, conducted by Zaks with the Centre Against Sexual Assault & Family Violence (CASA), found these triggers cause fear, panic and widespread avoidance of the dentist.
In a 2016 survey -- thought to be the first of its kind -- 64 survivors of sexual assault were asked about their oral health and dental experience.
Up to 69 percent of respondents reported avoiding urgent dental work due to feeling unsafe, ashamed and vulnerable. Unlike common dental phobia, these were tied not to procedures, but to being in the dental setting in the presence of staff.
Despite the survey's small sample size, Zaks said the results were "absolutely representative of every single survivor".
Calling herself an "open-minded" person who "always felt like [she] was doing things differently", Zaks decided to act on the results.
In 2017, she was awarded two grants to help produce a series of training videos for other dentists and survivors on a trauma-informed approach.
For Zaks' own practice, that starts with a "consult".
"I just listen with high-quality attention to find out where a person is coming from, what's happened to them in the past and how we can make things easier," she said.
She said this factors in the patient's experience before, during and after an appointment, considering everything from who walks into the room first to how the dentist is standing. In some cases, Zaks has brought in a masseuse to massage her patient's feet while she works on their teeth. In other cases, they've played favourite songs or sung opera.
"It all comes from the same central mindset: How can we give more power, choice and control back?" she said of the approach.
This is a time-exhaustive approach, and the 18-month project meant Zaks had to drop back her clinical hours.
But she maintains its worth. Presenting at the recent Australian Dental Association's Annual Congress, Zaks said her work has prompted lots of "light globe moments" from colleagues.
Now, she wants to see the entire dental industry reformed.
"I think as dentists, we have a massive opportunity to help people in this way, and to be mindful of knowing the signs of someone who has had trauma," she said.
Zaks' training videos are now being used to train dentists in Texas, ahead of their roll-out on the Australian Dental Association's Continuing Professional Development (CPD) portal.
Looking forward, she is adamant her message goes beyond dentistry.
"It's about how we can help each other through our fear in general, and that there's a light at the end of the tunnel."
If you or someone you know is impacted by rape or sexual assault, call 1800RESPECT on 1800 737 732 or visit 1800RESPECT.org.au. In an emergency, call 000.