The trauma of dental trauma
What are the impacts of a childhood dental injury and to what extent does the ensuing treatment help recovery, both physical and emotional?
This was the question addressed by Professor Helen Rodd in the Charles Tomes lecture given recently. Her topic was ‘The trauma of trauma: psychosocial impacts of dental injury in childhood.’
Professor Rodd’s overall message was that the psychosocial impact of both the injury and the treatment can be profound and much more could and should be done to help children recover from lost or broken teeth. There also needs to be more research to understand how children cope with injury and treatment.
Around 12 per cent of British 12-year-olds experience injury to one or more of their permanent incisors. Of that percentage, boys are likely to outnumber girls by 2:1. Meanwhile, 4 per cent of 15-year-olds who have an accident report that they fear their injury will be a lifelong burden.
Professor Rod said, “To date, we have been not at all good at including patient reported outcome measures in clinical trials.”
“What value is a fabulous MTA apical barrier if the patient’s evaluation of their own dental appearance and willingness to smile was not also sought as a core outcome?”
Studies are starting to emerge relating to dental injury, however, not least because of the work being undertaken by Professor Rodd at the University of Sheffield. She is part of a multidisciplinary team which has built a reputation for giving children a voice in relation to their dental conditions.
Professor Rodd described her work and the innovative ways in which children are being invited to provide their thoughts and feelings.
“Thinking about some of the really, really distraught children we see for follow-up trauma care, we may have completely overlooked the possibility of them also suffering from post traumatic stress disorder (PTSD).
“We also need to be better at recognising this possibility and offer appropriate psycho-educational interventions such as cognitive behavioural therapy (CBT), another research interest of ours, which we have found to work very well for children with dental anxiety.
“We should also remember that children don’t just have to deal with the accident from their perspective but they are also exposed to the distress and other emotions of their friends or parents.
“Above all, we need to listen carefully to our patients, many of them have a sense of worry and anxiety about treatment and the future of their tooth.”
Fortunately, according to Professor Rodd, modern medicine and dentistry, particularly orthodontics, is now very much more attuned to the importance of psychosocial influences in health and disease and recognises that a purely biomedical approach to care may fail to fully restore a patient’s wellbeing.
There is further good news ahead – an international expert panel, led by UK paediatric dentist Peter Day, is developing a research framework for any future trial involving trauma related treatments. This will ensure that children’s views will be heard in outcomes that matter to them, such as anxiety and oral health related quality of life (OHRQoL).
Professor Rodd concluded, “Trauma research must now challenge the traditional biomedical model of health and disease – which neglects the social context of the condition – so that we can achieve the best possible short and long-term outcomes for our young patients and their family.”