Post Traumatic Stress Disorder & Dentistry

Post Traumatic Stress Disorder: Understanding and treating Patients with PTSD

Post Traumatic Stress Disorder (PTSD) is often described as a severe anxiety disorder that may develop after exposure to an emotionally or physically threatening event.  PTSD typically results in psychological trauma.  Many people associate PTSD with Veterans but it can affect anyone who has experienced a traumatic event in the past.  PTSD is often associated with emotional symptoms such as nightmares, obesity, illicit drug use as well as pain medication dependency and abuse.

PTSD and Dental Symptoms:

Treating people with PTSD requires patience and understanding. They can suffer from:

  • Bruxism (clenching, grinding and gnashing of teeth)
  • Severe muscle spasms and myofacial pain: very common due to parafunctional (overuse or excessive) jaw movement
  • Drug induced xerostomia (dry mouth): the use of anti-depressants to treat PTSD can result in dry mouth and patients may experience an increase in cavities and periodontal problems due to a lack of saliva.  Dry mouth can pose significant problems for patients with dentures due to the loss of retention and stability of their removable prosthesis
  • TMJ (jaw joint) disorders: very common due to parafunctional habits
  • Hypersensitivity of the teeth: related to a patients bruxism

Treatment:

It is important to note that dental treatment may exacerbate Post Traumatic Stress Disorder, triggering memories of a traumatic event and evoking feelings of powerlessness and vulnerability which can be overwhelming.  Patients with PTSD may exhibit responses to treatment  that are ‘out of context’.  Treatment protocols should always consider the following:

  • Treatment plans must be clear with detailed strategies for managing stress and acute episodes of anxiety outlined prior to commencing any treatment.
  • Showing concern and empathy is critical.  The pacing of treatment is equally as important.  This allows a person with PTSD to feel a little more in control of their environment and dissipates stress
  • It has been suggested that patients with PTSD should be treated as you would any dental phobic patient
  • Pre-medication can be used for extreme cases BUT it is very important to know what other medication the patient is taking to avoid any adverse drug interaction
  • Address bruxism via bite splint therapy and xerostomia via increased H2O intake, Xylitol, and in rare instances medication to stimulate saliva production.

Patients with PTSD need our help, empathy and our EXPERTISE.