Sexual Abuse in Childhood and Dental Fear
An interview with Dr. Carmen Santos
Dr. Santos is an expert in childhood sexual abuse and its
relation to dental fear.† See her biography at the end of this
Carmen, let me
thank you on behalf of all those patients who are seeking help from
dentalfear.com.† Iím familiar with your work and you have made a significant
contribution to both dentistry and psychology.†
Itís my pleasure to help your endeavor in any way I can.†
Thanks for inviting me to participate.
Is dental anxiety
more common among men or
Surveys estimate that approximately 80% of the adult
population in the United States report some level of anxiety regarding dental
treatment.† A significantly large percentage of females report higher levels of
dental fear on standardized measures of dental anxiety than men.† There are also
high prevalence rates in the area of sexual abuse and dental anxiety among
women.† Among those reporting dental fear and a history of sexual abuse, the
fear was not always related to fear of pain nor was the fear precipitated by a
traumatic dental experience.† Although there is a high prevalence of dental fear
among women, this is not to suggest that all women with dental anxiety have also
What are the
statistics on childhood sexual abuse?
Estimates are as high as one in four females having been
sexually abused in childhood.† The figures for men are more allusive since men
are more reluctant to talk about past abuse but the estimates run around one in
†What are some of
the basic similarities between those with dental anxiety and those who have
experienced sexual abuse?
Varying forms of abuse that inflict pain or create problems
of lack of control and powerlessness may have a dramatic impact on the
individual's ability to manage routine activities that may involve physical
discomfort.† Often fear of loss of control, vulnerability, and the anticipation
of pain have been closely identified as issues affecting dental phobics.†
Similar issues have been found to be true of trauma survivors.† Again, this is
not isolated to sexual trauma, but can include varying forms of other physical
and emotional trauma, where feelings of powerlessness and helplessness are
What are some of
the symptoms reported by those with dental anxiety who are also sexual abuse
The symptoms typically reported consisted of fear, anxiety,
nausea, dissociation, flashbacks and feelings of shame.† The shame can be about
being anxious, about their poor oral health, or about having someone find out
about the abuse.
How could a visit
to the dentist trigger memories or feelings of past abuse?
Many aspects of dental treatment have been found to
symbolically represent sexual abuse for many survivors.† The following
conditions may trigger a repetition of earlier trauma:† being alone with a
person more powerful than oneself, being placed in a horizontal position, having
someone nearby and touching you, having objects placed in one's mouth, being
unable to talk or swallow, and experiencing or anticipating pain. Many dental
experiences may remind the patient of their abuse experience in that they
produce awkward sensations of suffocation, such as in the use of rubber dams, or
gagging sensations, or feeling restrained in their movement.
There is much disagreement about what defines sexual abuse
and what constitutes molestation and how a severity index can be applied to an
individual's trauma experience.† Sexual abuse may involve any number of
behaviors, not all of them include actual body contact.† Abuse may be considered
on a continuum that may range from exhibitionism to actual intercourse, moving
from nudity, to the exposure of genitals, kissing, fondling, masturbation, oral
sex, digital penetration to penile penetration.
Is it possible for
someone to experience dental fear and not understand its relationship to
Yes.† Given the high numbers of women affected by sexual
abuse in the population, it seems quite likely that many of these women are
receiving treatment for various unrelated medical and dental issues. Their prior
traumatization may have a significant impact on these treatments and yet may go
unrecognized or misunderstood by all those involved in the health care delivery
system.† Many survivors, are unaware of the potential long term consequences of
abuse or may fail to associate difficulties in receiving needed treatment as
related to their abuse histories.† As a result, dental treatment is often
avoided without a clear understanding of why, and even if the patient is aware,
they may not disclose the information.
What would a
dissociative episode or "flashback" look like?
Dissociation may be one coping strategy used by trauma
survivors to try and cope with overwhelming anxiety.† A person may show signs of
dissociation when they become unresponsive to questions or commands, stare
blankly into space or appear dazed, appear suddenly startled, spontaneously cry
or are unable to explain why they are crying, or seem confused about where they
are or what is going on.† A patient may even indicate that they feel as if they
are watching from a distance or that the experience feels unreal and they may
show changes in their breathing.
appropriate in the reduction of dental anxiety for someone with a sexual abuse
Although this is a helpful tool for many anxious patients,
most sexual abuse survivors prefer not to be sedated.† For many who have
experienced sexual trauma the use of sedation may raise the likelihood of
increased feelings of loss of control† and helplessness, especially in a
situation where they already may feel vulnerable. When sedation is necessary,
arrangements with the patient to allow a family member, close friend or at least
the presence of someone they trust in the room during the procedure may be
What do patients
with trauma histories and dental fear find most helpful in reducing their
Answer:† Many patients report that having an empathic and
understanding dentist who is patient and willing to listen to their concerns and
having control over how their dental treatment proceeds were key in the
reduction of their dental anxiety.† Therefore, having a dentist who listens and
is willing to help them feel comfortable, and being able to stop procedures or
have control can enhance the patient's ability to tolerate and participate
cooperatively even during difficult dental procedures.
Do patients with
dental fear and trauma histories have poorer dental health?
In one sample of female patients with dental fear and trauma,
their avoidance of dental treatment on average exceeded three years.† The longer
treatment is avoided the greater the likelihood of dental problems that may
require more invasive and difficult treatments.† They may also appear more
ashamed and embarrassed by their poor oral health.† Since, unlike snakes and
high places, in the long run the dentist is hard to avoid totally, these
patients will inevitably encounter dental professionals and have poorer dental
What are some
helpful tips for coping with dental fear?
Although treatment recommendations are speculative at best
and not meant to be clinical prescriptions, one study provided some helpful
tips, here are a few of them:†
Let your dentist know that you are anxious.† This does not
mean you have tell them about past issues if you choose not to do so.
Agree on a non-verbal signal to indicate increased anxiety
and a message to stop treatment.
Use relaxation aids such as headphones with music or other
Ask your dentist to provide regular reassurance and
explanations regarding the procedures being performed, especially when a
procedure is almost completed.
Ask that you be allowed to handle the suction instrument
Ask to bring a friend or family member to the appointment
with you when possible or have another staff member present during exams.
for extra time for your appointments.
Once again, thanks Carmen.† Iím
sure many patients in cyber space will be helped by the information you have
provided through this interview.
Dr. Carmen I. Santos is a licensed clinical
psychologist with over 24 years of clinical experience. She received her Master
of Arts Degree in 1993 and her doctorate from The University of Hartford School
of Professional Psychology in 1997. Her dissertation topic was titled: The
Identification and Treatment of Adult Female Survivors of Sexual Abuse with
Dental Anxiety.† Dr. Santos is presently the Assistant Director of the
Counseling Center at Trinity College in Hartford, Connecticut. She also
maintains a private practice in the Hartford area and does some consultation and