Could post-traumatic stress disorder (PTSD) be affecting your oral health?

Could post-traumatic stress disorder (PTSD) be affecting your oral health?

Dental visits tend not to be among the most popular things to do for many people, but if you have post-traumatic stress disorder (PTSD), dental visits can be extremely challenging.

By avoiding dental visits, people with PTSD miss out on important prevention and early-intervention opportunities designed to encourage good oral health and prevent problems now, and into the future. As a result, their oral health can deteriorate until they experience pain, infection, a range of negative psycho-social outcomes, and the need to seek emergency treatment. However, emergency treatment can be intrusive and particularly challenging for those with PTSD. So, avoiding this scenario wherever possible is ideal.

The solution is to improve people with PTSD’s ability to cope by focusing on prevention and early-intervention treatments, which are usually more easily managed and often less daunting.

What is post-traumatic stress disorder (PTSD)?

PTSD can result after experiencing (or sometimes observing) a severely traumatic event; for example, assault, torture, physical or psychological abuse, or natural disaster. Sometimes it can also occur following a single distressing medical or dental procedure.

In PTSD, strong memories of the traumatic event can intrude on daily living via flashbacks and nightmares, and sufferers can have sudden and strong physical and emotional responses to sights, smells, sounds, tastes, or contexts associated with the trauma. Common symptoms of PTSD include severe distress such as panic attacks and/or significant emotional distress, being hypervigilant (e.g. looking for danger constantly), being startled easily or being easily angered or upset.

Unfortunately, dental clinics tend to contain many things that can trigger flashbacks and severe distress in people with PTSD. In most cases the problem is not the dental procedure itself, but the sense of powerlessness that people feel throughout the procedure, the unequal power relationship with the dental professional, or fears of losing control of their own behavior or bodily functions. Others report problems with feeling ‘invisible’, being embarrassed or judged, having to lie down, being touched, being trapped, being worried about choking, suffocating or unable to talk, or being in contact with latex.

The point is that there are many different things that can trigger significant distress in people with PTSD, and different people will experience different triggers, depending on the nature of their own trauma.

When you are facing a challenging experience, it is important to remember that the distress you are feeling is your body reacting automatically to the context that you find yourself in, in order to protect you. Your body doesn’t realise that you are not actually in any danger, or that its reactions are interfering with your ability to experience your life in the way that you would like.

If you have PTSD, what can you do to make a visit to the dentist less distressing?

Perhaps consider some of the following tips for dealing with dental visits:

• Identify your triggers.
o Remember that it is the triggers that cause you distress (and not having your teeth looked after). You want to look after your teeth, so don’t let the triggers stop you.

• Talk to your dental professional about your triggers. You don’t need to disclose your PTSD or its cause if you feel uncomfortable, but it is important to talk about your triggers. Once your dental professional knows the things that cause you distress, they can work out ways to avoid them. Give them their best chance of helping you.

• Perhaps begin by asking for a brief appointment that lets you simply sit in the chair and perhaps have your teeth looked at without any touching. This may help you establish some trust with your dental professional while familiarising yourself with the context and giving yourself some confidence.

• Go for regular check-ups and welcome any preventive treatment offered to you. It is much easier and faster to deal with small problems (or better yet to prevent them altogether) than to turn up only when you are in pain or discomfort.

• Bring headphones and listen to a story, which is often a better distraction than music.

• Ask to be shown and told everything before it is done.

• Ask to be able to sit up slightly in the dental chair. Perhaps put one foot on the floor if that helps you feel more in control.

• Establish some hand signals with the dental professional so that you can communicate even when your mouth is open.

• Ask for small breaks during treatment to give you a chance to swallow, breathe, and speak.

• Practice relaxation techniques before your appointment and put them in to practice during. Take slow deep breaths right down into the pit of your stomach throughout. Controlled breathing is very effective in the management of anxiety.

• Take a small blanket and cover yourself while you lie in the chair.

• Take a trusted friend and ask that they be present throughout treatment.

• Ask for any post-op instructions to be written down in case you are unable to pay attention during your appointment.

• Speak with your dentist and general practitioner (GP) to explore the possibility of taking a sedative before your appointment.

Another, longer-term option is to retrain the body to understand which situations are ‘safe’.

Retraining should be done with the support of a qualified specialist professional such as a clinical psychologist. Clinical psychologists can be consulted privately or through your GP. With a referral and a Mental Health Care Plan from a GP, Medicare rebates for visits to a clinical psychologist help to ensure access to those who need it.

Strategies to deal with your particular set of triggers can be developed in consultation with your mental-health professional and then practiced by you in the settings that you find least-to-most challenging in order to lessen their impact and give you back control.

PTSD can cause barriers that limit your life experiences. But, with some short and long-term planning and action, these barriers can be managed and overcome. By working through the anxiety you may feel in relation to a dental visit, and letting your oral health professionals help you to do this, you are not only protecting your health and physical well-being, you are also taking significant steps to help your psychological well-being also.


Such is the level of interest in this topic, an adaptation of this article, authored by Dr Merrilyn Hooley and focusing on dental fear and anxiety has been published on the Medibank Live Better page.