POST-TRAUMATIC

STRESS DISORDER

IN A DENTAL ENVIRONMENT

INTRODUCTION Results from a traumatizing event Event is individually horrifying & had the

potential to physically harm the person Fear is triggered, then they re-experience

the event even though the threat has been removed

Causes suffering & social dysfunction Chronic PTSD- episodes occur more than 3

months Clinician should be aware of different

behavioral side effects to prevent discomfort or triggers

Clinician should be educated on managing these episodes in a clinical environment

SIGNS & SYMPTOMS Take proper precautions if you see the

following signs Social functioning difficulties Self-neglect Anger Anxiety

The patient may experience Intrusive recurrent thoughts, images, or flashbacks

of their traumatic event Sleep disturbances Emotional numbing Misinterpretation of other’s actions around them Perception of a foreshortened future Hyperarousal

VETERANS & EMERGENCY SERVICE PERSONNEL Misinterpretation of external stimuli

Patient falls asleep during procedure- wake up to someone putting instruments in their mouth= Defensive response

Flashing overhead light=Danger responseLoud sounds (high volume vacuum suction or

drill) Prevent triggering an episode- tell them

what you are planning to do in advance Veterans & alcohol abuse is associated with

PTSD Oral hygiene materials not available in war

zone

EXPERIENCE WITH CANCER TREATMENT This experience is an event that extends

from the point of diagnosis until the end of treatment.

A child that has undergone chemotherapy may perceive gloves and masks as a sign of harm, and may react out of fear with irrational behavior.

Other chemotherapy patients may be scared of being exposed to radiation while receiving dental xrays.

ABUSE Children, youth, adults, & elderly Neglect, trauma, sexual,

emotional, or physical abuse Suspects- who the victim trust the most Overwhelmed with traumatic event

causes feelings of helplessness, fear, and embarrassment leading to more severe issues, like PTSD

Patients try to avoid uncomfortable situations that could trigger reaction

Clinician- soft tone, no firm suggestions, avoid commanding, take precaution during physical contact

SIGHT OF BLOOD The clinician should grab gauze from the

tray, apply pressure, stop the bleeding, and put the gauze out of sight to prevent the patient from seeing it.

There are different scenarios, but each are equally devastating to the patient.

Veterans & emergency personnel Cancer patient Abused children and adults Women that has suffered a miscarriage

KEEPING YOUR DISTANCE Proxemics- study of territory

Intimate zone: 1-18 inches awayComfort zone: 4-12 feet away

Ease the discomfort- develop rapport Patient’s with PTSD want more space Clinician of the opposite sex more feared Claustrophobia- feels trapped in small

space Lost trust in people & now have a fear of

something bad happening again

STOP & EXPLAIN Gain trust Always explain what you will be doing

before you actually do it Tell them honestly what they will be

feeling There can be signals for communication

while the clinician is working in the mouth a wink, a sound, or raising their hand

DENTAL MANAGEMENT “Improving my smile is the least of

my concern compared to the other issues I’m dealing with”.

Clinicians should educate patient on oral hygiene & improve or modify their techniques

No improvement unless at-home tasks are done Systemic diseases & medications should be

reviewed at each appointment Common PTSD drugs: beta-blockers, SSRIs, anti-

anxiety agents, anticonvulsants, & antipsychotics Dental considerations: monitor vital signs, chronic

dry mouth, semi-supine position, may neglect self-care, short appointments, increased bleeding, poor healing, & frequent recall schedule to avoid periodontal infection

CONCLUSION PTSD can effect someone that has had to

fight cancer, or that has suffered from neglect, trauma, sexual, emotional, or physical abuse

There are steps clinicians can take to help make their dental treatment a little more comfortable

While some PTSD patients are open about their disorder, others may not be. We must be aware of the signs and symptoms so that we can take precautions if we believe the patient may be suffering from the disorder.

It is important to be aware of ways to handle a patient with PTSD and the dental implications that comes with the disorder.

REFERENCES Bush, N. (2009). Post-traumatic stress disorder related to the cancer experience.

Oncology Nursing Forum, 36(4), 395-400. Grogan, S., & Murphy, K. (2011). Anticipatory stress response in PTSD: Extreme

stress in children. Journal Of Child & Adolescent Psychiatric Nursing, 24(1), 58- 71.

Jaffe, S., & Schub, T. (2011). Quick lesson about post-traumatic stress disorder. Cinahl Information Systems (Glendale, California), (2p) (5 ref)

Katsounari, I. (2011). Post-traumatic stress disorder and psychosis. Mental Health Practice, 15(4), 14-18.

McCarthy, E. (2010). Epidemiology and Management of Alcohol Dependence in Individuals with Post-Traumatic Stress Disorder. CNS Drugs, 24(12),

997- 1007. Nield-Gehrig, J. S. (2010). Patient Assessment Tutorials Second Edition: A step-

by- step guide for the dental hygienist. Philadelphia, PA: Lippincott Williams & Wilkins.

Pickett, F. A., & Terezhalmy, G. T. (2010). Dental Drug Reference with Clinical Implications Second Edition. Philadelphia, PA: Lippincott Williams & Wilkins.

Richardson, L., Frueh, B., & Acierno, R. (2010). Prevalence estimates of combat related post- traumatic stress disorder: critical review. Australian & New Zealand Journal Of Psychiatry, 44(1), 4-19.

PICTURE REFERENCES Stop sign:

http://www.clker.com/clipart-6863.html Drugs:

http://www.writers-free-reference.com/10classaction.htm

Soldier: http://www.entheology.org/edoto/anmviewer.asp?a=266&print=yes

Cancer: http://abclocal.go.com/wabc/story?section=news/health&id=7696578

Abuse: http://www.shutterstock.com/pic-66196585/stock-photo-conceptual-image-of-child-abuse-similar-available-in-my-portfolio.html

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