Abigail Nelder, Ruth Potterton and Ewen McColl present a team approach to adopting a trauma informed approach to dental care.

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Students at the 'LunchLearn' session that was delivered to peerswider dental team

Introduction

Peninsula Dental Social Enterprise (PDSE) was created in 2013 and provides a 'corporate' structure for the management and development of the fabric of the dental learning clinical environment, the structure for a consistent and sustainable community engagement programme, and a vehicle to manage clinical and professional governance.

PDSE works closely as the clinical delivery arm of Peninsula Dental School, University of Plymouth. There are four large Dental Education Facilities (DEFs) in Plymouth (Devonport and Derriford), Truro and Exeter under one umbrella where students from the University treat NHS patients under supervision, alongside providing dental treatment and outreach services to local communities. PDSE is a Social Enterprise Community Interest Company (CIC) and it is the only model of its type supporting a university dental school in the UK.1,2 As a CIC, everything it does is guided by its community purpose to which its assets and profits are dedicated.

Adopting a trauma informed approach to dental care

The Inter-Professional Engagement (IPE) module at Peninsula Dental School introduces students to the concept of community engagement and social accountability. Working in small teams and partnering with local community organisations students design and deliver a health improvement project focussing on adopting positive, healthy lifestyles. Co-production and team working is at the heart of what we do, encouraging students to explore creative and engaging delivery styles whilst working in partnership with their host and local community.

This year a group of students had the opportunity to work in partnership with the Trauma Informed Plymouth Network. The network was established in 2018 and brings together individuals from across the city who want to work towards a more inclusive, trauma informed approach with those they support. It is now being recognised that trauma can affect anyone and the impact of living with trauma can have a physical effect, as well as affecting thoughts, feelings and how we are able to connect with one another.

Dentistry can trigger a range of stressful responses from patients which can have a negative impact on the dental experience. Add to this someone who has experienced trauma and accessing dental care becomes so much harder. Taking a trauma informed approach helps the dental professional empower the patient to feel safe and listened to, can break down barriers and remove shame which is so often felt by someone who has experienced trauma. This requires the dental team to connect with the patient, build trust, show kindness and work collaboratively to achieve the desired outcomes making the patient the centre of decision making and care.

Vicky Brooks, Network Co-ordinator, worked with the students to help them understand how important adopting a trauma-informed approach in dentistry would be and encouraged them to change the question from 'what is wrong with you?' to 'what happened to you?' Vicky said: 'working in a trauma informed way is so relevant to dentistry and can have a huge impact on the patient when attending appointments. More and more professions are wanting to work in this way and being with the students has given us an opportunity to share the approach with the group, early on in their learning to encourage them to adapt their practice and make some simple changes'.

The students received training from Vicky which they found hugely beneficial, so much so that they wanted to share their newfound understanding and knowledge with others. As a result, their community project developed into a 'Lunch and Learn' session for their peers with an invite going out to 2nd year dental students, supervisors and clinical staff at the dental education facility. The group worked alongside Vicky to design a drop-in session where they could share the learning and talk more about the importance of adopting this approach and share tips to make small changes to their practice that would benefit all patients.

Taking a trauma informed approach helps the dental professional empower the patient to feel safe and listened to, can break down barriers and remove shame which is so often felt by someone who has experienced trauma.

Working as a team the students created a series of posters to support their conversations during the 'Lunch and Learn'. Forming the backbone of the trauma informed approach, the students talked about using the 5 'Rs' which are:

Realise; realise potential consequences of a traumatic experience and opportunities to heal

Recognise; recognise signs of trauma

Respond; respond with empathy

Resist; resist retraumatising people

Resilience; develop resilience with people and communities to build upon strengths.

By keeping these in mind when treating patients, the students found it helped them to adopt the trauma informed approach throughout the whole appointment. They also shared how important the Trauma Lens was with its five themes of being safe, person-centred, kind, empowering and collaborative, and how it could be used when working alongside patients.

During the 'Lunch and Learn' the students spent time talking to participants, many of whom said this was the first time they had heard of this approach. They were able to share the simple message that this way of delivering care was not for one or two patients who you know have had trauma in their lives, but for all patients; that it is a way of 'being' rather than picking and choosing who you take this approach with. They were able to talk about useful tips that helped them, which included thinking about language and the environment, which can all help to make someone feel more comfortable and empowered during an appointment. One student said: 'I have never thought about what I say before. Many times I'll ask a colleague to "pass me the gun" when I needed the GIC applicator or impression dispenser, however now I know that for some people this could be a huge trigger especially living in a city that has a large number of ex-service personnel and also tragically experiencing the shooting incident in our local community in 2021. I'd never given any thought to how or what I say, but I will do now'.

Abby Nelder, the IPE Co-Ordinator said: 'this has been an amazing opportunity for our students to work alongside Vicky and the Trauma Informed Plymouth Network. Hearing how the students want to make small changes to their overall approach, not just for one or two patients, but for everyone is so encouraging and shows the benefit of this unique module. Being able to partner our students with community organisations to gain a better understanding of the needs of our communities, explore the challenges and barriers patients face and learn how to adapt their practice so early on can have a huge impact on patient care. This experience really has shown that compassion and care really does matter in dental care'.

Conclusions

Adopting a trauma informed approach in dentistry is vital to ensure all patients feel safe, listened to and able to attend appointments and manage their dental health. Providing students with an opportunity to understand the importance of being trauma informed early on in their learning enables them to begin to develop their language, attitude and approach to their patients. They then recognised that sharing this learning with the wider dental team was so important and through their 'Lunch and Learn' the students were able to equip the PDSE team with the skills to begin to practise in a trauma informed way and the desire to learn more about the approach.

However, it's not enough to simply have individuals practising trauma informed care. The whole team need to understand and adopt this approach. From the receptionist greeting the patient, making them feel safe, welcome and comfortable to the dental nurse working alongside the dentist to the practice manager when managing governance, policies and complaints. By attending the session our dental team at PDSE have continued to share the trauma informed message with other colleagues in general practice, university teams and academic staff, encouraging people to find out more and explore opportunities to adapt their approach. By working together to provide compassionate, kind and truly person-centred care, patients will feel better able to attend appointments which will ultimately lead to better dental health. The whole dental team will feel better equipped and able to understand each patient and feel more confident to think 'what's happened to you' rather than 'what's wrong with you'.