Theories, Models, Frameworks, Guidelines, and Recommendations for Trauma-Informed Oral Healthcare Services: A Scoping Review

Abstract

Background: Traumatic life experiences (TLE) are common and can affect a person’s physical being and health-related behaviors, including those related to oral health. This scoping review aimed to identify evidence exploring the implementation and provision of trauma-informed care (TIC) in oral health services delivery. Methods: Arksey and O’Malley’s framework with enhancements proposed by Levac et al. and Peters et al. was used. Studies were selected based on a preset inclusion and exclusion criteria and the population/concept/context framework. Primary charting of descriptive data was conducted, followed by thematic analysis to identify ideas common within the included literature. Searches were conducted in Medline (via Ovid), APA PsycINFO (via Ovid), Embase (Elsevier), Scopus, CINAHL (via EBSCO), and Cochrane databases. Google Scholar and ProQuest were used to identify grey literature. Results: The search identified 251 records, with fifteen records meeting the inclusion criteria. Limited models, frameworks, and recommendations for trauma-informed practices in oral health services were identified. Recommendations for TIC practices were identified, and clinical practice adjustments for dental practitioners were described to improve service delivery for patients who may have experienced trauma. Avenues for future research were identified. Conclusions: Limited evidence exists to guide trauma-informed practice in oral health service delivery. This scoping review highlights the need for further research into approaches and practices of TIC for oral health services delivery to assess their efficacy and the need to develop evidence-based TIC frameworks to meet the unique needs of oral health service providers and populations.

A call for trauma‐informed dental care for individuals with intellectual disabilities

“…In the general population, a history of psychological trauma is associated with poorer oral health [16][17][18][19][20]58,59 and increased dental anxiety. 20,58 To date, child sexual abuse appears to be the most comprehensively explored experience with clear associations with increased dental anxiety and poor oral health.…”

“…69 For example, being placed in a supine position while also being unable to communicate while the oral health professional is working within the person's mouth appears to be a partic-ularly vulnerable situation due to the potential experience of powerlessness that constitutes an integral aspect of psychological trauma. 16,70 In addition, people having experienced child sexual abuse may struggle with gagging reflexes and therefore seek to avoid having toothbrushes, toothpaste, or dental instruments in their mouths. 20,68,71 According to Willumsen et al, 20 gagging may be associated with trauma intrusion symptoms (e.g., flashbacks) from experiences involving forced oral sex.…”

“…61 However, also physical abuse, psychological/emotional abuse and neglect have been found to be associated with poor oral health in adulthood. 17 The relationship between trauma and poor oral health appears to be cumulative, 16 in that a higher number of potentially traumatic experiences is associated with a higher risk of poor oral health. 60,62,65,66 In an adolescent sample, each cumulative increase in exposure to adverse childhood experiences was associated with a 30% increase in risk of non-daily toothbrushing.…”

“…1,2 In the general population, there is a well-established association between psychological trauma, dental anxiety and poor oral health. [14][15][16][17][18][19][20] To date, this relationship has received little attention in people with intellectual disabilities, despite this population being at increased risk of poor oral health [21][22][23][24] and at increased risk of potentially traumatic experiences. [25][26][27][28][29][30][31] In this conceptual paper, we aim to provide a brief overview of recent findings concerning the relationships between oral health and intellectual disabilities, psychological trauma and intellectual disabilities, as well as between psychological trauma and oral health.…”

Periodontal Health among Individuals with Intellectual Disabilities Living in a Saudi Institutional Rehabilitation Centre

“…Most importantly, it is important to build constructive communication. The need for cooperation between patients, parents, carers/caregivers and practitioners to overcome these challenges has been emphasised [21][22][23].…”