Assessing Abuse and Neglect and Dental Fear in Women

Access to special care dentistry, part 6. Special care dentistry services for young people

“…22,71,[80][81][82][83] As yet, most of the studies are relatively small, no doubt diminished by rare disclosure to dentists and repres sion of CSA experiences, 83 but clearly women with a high degree of dental fear are more likely to have been victims of trauma (childhood neglect, sexual molestation or rape), 80 with up to 34% of them reporting a history of childhood molestation, attempted rape or incest. 81 Parallels have been drawn between the long-term effects of CSA and the spe cifi c factors that lead to increased stress being in a horizontal position, feeling claustrophobic, being alone with some one more powerful, loss of control and anticipating or experiencing pain.…”

“…81 Parallels have been drawn between the long-term effects of CSA and the spe cifi c factors that lead to increased stress being in a horizontal position, feeling claustrophobic, being alone with some one more powerful, loss of control and anticipating or experiencing pain. 71,83,84 Additionally, the oral cavity is a frequent site of CSA 85 and while visible signs of CSA involving the oral cavity are rare, 86 their emotional significance has a long lasting impact. 83 Willumsen reported that 75% of women who have reported abuse that included oral penetration had high levels of dental fear.…”

“…22,83 The ability of these individuals to accept minor or major discomfort associated with instru ments in the mouth was reduced and feeling unable to breathe and/or severe gagging or choking interfering with treatment delivery were increased. 71 It is also important to note that men who have experienced CSA are more likely than women to have experienced abuse involving oral sex. 87 People who survive CSA develop cop ing strategies, 80 for example women may ensure that all necessary services are provided by other women and they may become over-protective of their children, unable to leave them with others as they trust no-one.…”

“…82 It is well reported that, although often suffering from poor self-esteem and confi dence, they need total control in stressful situ ations to be able to cope. 22,71,83 Dealing with dental treatment is difficult for all the reasons mentioned, plus the fact that the experience may provoke symptoms of post-traumatic stress, fl ashbacks and dissociation. 81 Interestingly, women who report dental fear and sexual abuse are often unaware that their dental fear may be related to the CSA.…”

“…80 ciations between childhood and adult traumatic experiences (such as physi cal, emotional or sexual abuse, incest or neglect) and physical health outcomes such as obesity, chronic pain, somatic disorders, gastro-intestinal disease and agoraphobia. 71,72 Sexually abused women have been found to be three times more likely to develop an eating disorder 73 such as obesity, bulimia or anorexia. Similar associations with eating disor ders have also been reported in men who have suffered childhood sexual abuse (CSA).…”