Post-traumatic stress disorder (PTSD), which affects about 15 percent of those who served in the Vietnam War and up to 20 percent of those who fought in Iraq and Afghanistan, can rear its ugly head in unexpected places – including the dentist’s chair. Dental procedures can be scary and overwhelming, especially when past experiences make a patient more sensitive to noise, pain or physical touch. There are several things dentists can do to put PTSD patients at ease during appointments.
The presentation of PTSD varies, but people with the disorder often experience flashbacks or nightmares, sudden outbursts of anger, problems forming relationships, inability to focus, shakiness and shortness of breath. Symptoms can come on unexpectedly, and they can be triggered by sounds, smells, physical touch or other stimuli.
Keep in mind that veterans aren’t the only ones who suffer from PTSD. The condition is also common in people who have experienced sexual or physical abuse or suffered another type of trauma.
People with PTSD may present with specific dental problems. Research conducted at the University at Buffalo School of Dental Medicine found that veterans had higher levels of tooth erosion vertically, horizontally and at the gum level as a result of bruxism and clenching. Plaque build-up and gingivitis are also more common, probably because people with the disorder are less able to keep up with routine dental care.
To lower the risk of unexpected problems for you and your patient during dental appointments, include a question on an intake form that asks if they’ve ever suffered from PTSD. That information can be used to start a discussion about what can trigger flashbacks or discomfort, and what you can do to make them comfortable.
Dr. Fred Quarnstrom, DDS, a Seattle, Washington dental anesthesiologist, has a unique perspective on veterans. He served in the Navy and Marine Corps during the Vietnam War.
When working with PTSD-affected veterans, Quarnstrom suggests that fellow dentists consider their anesthesia options. “Nitrous oxide oxygen sedation will help with mild cases of PTSD, with oral conscious sedation as an alternative,” he says. “I’ve only ever had four patients who were so severe they needed general anesthesia.”
Create a relaxing atmosphere
“Relaxation techniques are very well-received by PTSD patients,” says Dr. Ingrid Herrera-Yee, a clinical and research psychologist and military spouse. Basic mindfulness exercises can help them relax. So can meditation steps such as focusing on a phrase or word, or doing deep breathing and progressive muscle relaxation.
In addition to creating a soothing atmosphere in the office, Herrera-Yee has several tips for helping patients remain calm during visits. Consider breaking up procedures into shorter time blocks. If a patient balks at a treatment recommendation, work with them to find more amenable alternatives. The most important thing is to establish a rapport with them so trust can develop.