By Joyce Lukima:
Chief Operating Officer
I know many people have anxiety related to dental care, I also know many people do not. Speaking from my experience as a survivor of the traumas I have lived through, I can now recognize that my life experiences compounded the anxiety and fear. Living in poverty with limited access to health and dental care also placed my family and I in a position to only seek care when it was an emergency. It also left my family vulnerable to negligent practitioners who would accept medical assistance. I hope that this is something that has changed. It has taken years for me to recognize that self-care is participating in preventative care. I also recognize the benefits I have which are connected to my employment, these are important but conditional.
I hope by sharing my experiences and the difference a trauma-informed practitioner made for me will inspire others to seek the care they need to live a healthy life.
Dental care has always been a challenge for me, not the brushing and flossing, but actually seeking dental care from a professional. My first memory of anything dental was when the dentist came to my elementary school.
We were given disclosing tablets which were fascinating and probably the only positive memory I have related to dental care in childhood. I did not think a lot about my teeth, I did the basics, brush twice daily, floss occasionally; I am not sure where I learned to do this. I assume in school, possibly from an adult relative in my life (but highly unlikely).
Somewhere in my teens there was a change in medical assistance that provided for dental care, I recall my sisters and I being carted off to the dentist and this is where my dental trauma begins. By this time, I had been exposed to <a href="https://www.traumainformedcare.chcs.org/what-is-trauma/>trauma associated with domestic, sexual, and gang violence in addition to the turbulence caused by moving more than the average kid. I say this to explain my coping skills at the time, dissociation and shutting emotions down. This experience resulted in a mouth full of fillings and one damaged tooth. This was all done without adequate anesthesia. I did not realize this until I was in college and the damaged tooth erupted in pain. The kind dentist who placed a temporary filling in validated my fear related to dentists after seeing the inside of my mouth. He tried to convince me that my experience in childhood was an anomaly, he was not successful. Anyone who is a survivor of multiple traumas knows that one nice person does not fix it. It helps, but it does not fix the hurt.
More than a decade later, through the coaxing of caring friends, I tried another dentist. She was lovely and validated my experience; but she then sent me to an oral surgeon. This left me emotionally and financially overwhelmed. I think I dissociated when they started telling me the multiple steps and costs that were necessary. I left and did not step into a dentist’s office for another decade. During all of this time I dealt with bouts of pain and other symptoms, but used home remedies to cope with them.
Another survivor referred me to a dentist. She shared how this dentist explained everything, did nothing unless you were okay with it, and there was no lecturing, no judgment, and no shame. The words “trauma informed” were starting to surface in the public/professional conscious. They were not words that were associated with dentists or oral surgeons, but looking back, my doctor’s approach was trauma informed. Her approach was exactly as it had been described to me.
I found myself going to the dentist on a regular basis. I was fortunate enough to have dental care provided at my place of employment; that combined with having a dental practice that I felt safe with made a huge difference. The fact that dental coverage, which in my mind is health coverage, is optional is disturbing. Our society obsesses on the aesthetics of teeth - are they straight enough and white enough? – but the health of individuals seems to be an afterthought, not recognizing health issues related to lack of access to dental care as well as the reality of living in a lookist culture. A person who does not meet this American ideal is put at a disadvantage financially and socially. Think about it when you see someone without perfection or with visibly damaged teeth.
From the beginning my dentist and dental hygienist talked to me about concerns they had related to my teeth and subsequently my health, but they did not pressure, they let me know the consequences of not addressing what had over the years grew into multiple dental issues. Still no pressure, simply a gentle, “we want to address this before it becomes an emergency”.
If this could have all been done by my doctor, I would have trusted her enough to have had it done several years ago. But it took years for me to get to the place where I followed up on the referrals with the oral surgeon. Feeling safe and trusting a stranger, especially one that is going to anesthetize and cause physical trauma to me, even if the end result is for my health, was frightening. All of my defenses were up and I had to practice much self-talk to ground myself. At this stage in my life it is rare that I dissociate (outside the typical driving and not remembering the drive) but being in a space where I felt this vulnerable definitely brought on the feeling that I was lifting out of my body; not only was it stressful, but it was irritating. I thought I was beyond this. Although I did all the right things (researched and looked at reviews) my experience with the initial oral surgeon did not go well. I was upfront about my anxiety and he disregarded it, thinking manufactured charm and arrogance would somehow comfort me. I left without making a follow up appointment. Almost a year later I tried again with another doctor, this time it went much better, he was direct, explained everything, attempted humor in a way that was authentic. He did not understand my anxiety, but he accepted and validated it. The surgery and subsequent procedures were not without stress, but I felt that I understood what was happening every step of the way. This simple thing made all the difference.