By Dr. Sarah D. Parsons
Many patients report to our offices with PTSD. These patients have undergone perceived severe mental or physical abuse that elicits mental, physical, or combined responses. It can be challenging to treat these patients due to their fear and intolerance of pain and anxiety. Often times we seek additional sedation measures such as nitrous, minimal, moderate, or even deep/hospital sedation.
Profound local anesthesia is the cornerstone to management of any dental case in general but is especially important to any successful management of PTSD. The more that we as clinicians can deliver successful and profound anesthesia, the better outcome our cases achieve. Never as a clinician should we dismiss a patient’s reporting of discomfort or pain during a procedure. Rather in these instances, we should consider and evaluate our anesthesia.
Sedation of any form is not a replacement for profound local anesthetic but rather an adjunct to help ease the anxiety of the dental patient. Prior to additional doses of sedatives, profound anesthesia should be confirmed. Many patients tolerate more complicated procedures and sedation cases are more successful, if profound anesthesia is achieved.
Adequate interviewing of a patient with PTSD is helpful prior to any dental procedure performed. This can also aid us in the decision of what sedation level is appropriate. Many clinicians believe that only moderate to deep sedation will be useful to treat a PTSD patient. However, this is not always the case and a comprehensive examination and treatment plan should be performed prior to any dental procedure.
Here are some questions you may want to consider in your interview with a patient that has PTSD prior to any dental treatment:
- May I inquire the reason for your PTSD diagnosis
- Are there any specific lights, sounds, or situations which trigger your PTSD?
- During your procedure, there will be clinicians whom will be female/male or both. We will be over you and looking down at you during the procedure. Will this trigger your PTSD? Would you be more comfortable with an all male or all female team?
- What are some calming measures you use during a PTSD episode? If you are triggered during this procedure, what measurements would you like me to use to help you through your episode?
- Do you feel you should be more sedated or more awake for your procedure?
Management and treatment of PTSD patients can be successful in your dental practice. These patients can become loyal and long term great patients. If you manage your treatment of these patients successfully with profound anesthesia and appropriately sedate to the level they require, they will return and become some of your practice’s biggest fans and cheerleaders.