Theories,Models,Frameworks,Guidelines,and Recommendations for Trauma-Informed Oral Healthcare Services: A Scoping Review

Abstract

Background:

Traumatic life experiences (TLE) are common and can affect a person’s physical being and health-related behaviors, including those related to oral health. This scoping review aimed to identify evidence exploring the implementation and provision of trauma-informed care (TIC) in oral health services delivery.

Methods:

Arksey and O’Malley’s framework with enhancements proposed by Levac et al. and Peters et al. was used. Studies were selected based on a preset inclusion and exclusion criteria and the population/concept/context framework. Primary charting of descriptive data was conducted, followed by thematic analysis to identify ideas common within the included literature. Searches were conducted in Medline (via Ovid), APA PsycINFO (via Ovid), Embase (Elsevier), Scopus, CINAHL (via EBSCO), and Cochrane databases. Google Scholar and ProQuest were used to identify grey literature.

Results:

The search identified 251 records, with fifteen records meeting the inclusion criteria. Limited models, frameworks, and recommendations for trauma-informed practices in oral health services were identified. Recommendations for TIC practices were identified, and clinical practice adjustments for dental practitioners were described to improve service delivery for patients who may have experienced trauma. Avenues for future research were identified.

Conclusions:

Limited evidence exists to guide trauma-informed practice in oral health service delivery. This scoping review highlights the need for further research into approaches and practices of TIC for oral health services delivery to assess their efficacy and the need to develop evidence-based TIC frameworks to meet the unique needs of oral health service providers and populations.

Keywords

trauma-informed care oral health dentistry trauma sensitive practice models

Introduction

Oral health is fundamental for general health, mental well-being, and quality of life (Peres et al., 2019). Oral diseases such as dental caries, periodontal disease, tooth loss, and oral cancers are widespread, affecting 3.5 billion people globally, despite being largely preventable (Peres et al., 2019).

Traumatic life experiences (TLE) refer to “an event, series of events, or set of circumstances that are experienced by an individual as physically or emotionally harmful or threatening and that have lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being” (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014, p. 7). Events that qualify as TLE include experience of war and combat, surviving a life-threatening accident, living through a fire, flood or natural disaster, witnessing a severe injury or death, experiencing rape, sexual molestation or sexual assault, serious physical attack or assault, being threatened with a weapon or held captive, suffering torture or terrorism, or living through any other extremely stressful event (American Psychiatric Association, 2022; Australian Institute of Health and Welfare [AIHW], 2020). The World Health Organization’s (WHO) World Mental Health Surveys conducted general population studies across 24 countries with a combined sample of 68,894 adult respondents. Results indicated that a large proportion of people in developed countries have been exposed to at least one TLE in their lifetime, with an average of 70.4% of survey participants experiencing at least one TLE, and a mean lifetime exposure of 3.2 events (Benjet et al., 2016; Kessler et al., 2017). Of those surveyed, 30.5% were exposed to four or more TLE (Benjet et al., 2016).

TLE may result in a range of immediate or lasting adverse health effects which influence mental and physical health, interpersonal and social relationships, and academic and employment opportunities (AIHW, 2020; Bendall et al., 2018; Gerber et al., 2019; Petruccelli et al., 2019). An individual’s response to TLE can vary and may be adaptive or maladaptive with some drawing strength and resilience from a TLE, while others experience a range of negative behavioral, health, and social impacts (e.g., poor diet, social isolation, sleep disturbance, substance use and abuse, and lack of motivation to address physical health needs) (Bendall et al., 2018; McDonald, 2020).

Adverse childhood experiences (ACEs) are TLE that a child is exposed to prior to the age of 18 years (Crouch et al., 2019). A TLE can also be an example of an ACE if experienced by a person under 18 years of age. Childhood physical, emotional, or sexual abuse; physical or emotional neglect, and living with a range of household stressors such as mental illness or substance use are examples of common ACEs (Asmundson & Afifi, 2020). The study of ACEs has shown that they are highly prevalent and are associated with a range of poorer social, behavioral, and health outcomes over the lifespan (Asmundson & Afifi, 2020; Gerber et al., 2019).

Dental patients with a history of TLE or ACEs are more likely to engage in unfavorable general and oral health habits, display dental fear, and avoid routine and preventive oral healthcare resulting in poorer oral health outcomes (Akinkugbe et al., 2019; Crouch et al., 2019; de Oliveira Solis et al., 2017; Ford et al., 2020; Kabani et al., 2018; Nermo et al., 2021; Raja et al., 2014). Oral health practitioners can expect to frequently treat patients who may have suffered TLE at some point across their life span (Raja et al., 2014).

A correlation has been reported between TLE, ACEs, and poor oral health outcomes including dental decay (caries), gum disease, and oral fungal and viral infections (Akinkugbe et al., 2019; Ford et al., 2020; Hammett, 2019; Kabani et al., 2018). The relationship between TLE and oral health outcomes is cumulative in that the more TLE a person endures, the higher the likelihood that they will engage in high-risk health behaviors, avoid preventive dental care, and experience high rates of oral disease (Akinkugbe et al., 2019; Crouch et al., 2019). Social factors such as poverty, inequality, income, occupation, education, and poor diet and lifestyle behaviors are associated with oral diseases, all of which may also be influenced by TLE (Bendall et al., 2018; Nurius et al., 2013; Phantumvanit et al., 2018).

Trauma-informed care (TIC) is “a strengths-based service delivery approach that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment” (Gerber et al., 2019, p. 30). The United States SAMHSA developed the “Concept of Trauma and Guidance for a Trauma-Informed Approach” in 2014, which provides a framework for TIC that has guided health system practice internationally (Gerber et al., 2019). TIC practices consider the high prevalence and effect of TLE on people’s lives, health, and service needs and use (SAMHSA, 2014). Services working within a TIC framework acknowledge the impact of TLE on health, recognize the signs of psychological trauma, and respond at an organizational and a systemic level while resisting re-traumatization of clients and staff (Bendall et al., 2018; Gerber et al., 2019; Wall et al., 2016).

The aim of this scoping review was to explore the literature describing the implementation and provision of trauma-informed oral health services. Clear guidance for the implementation and practice of TIC in the field of oral health is lacking. A scoping review was considered the best method to provide an overview of the evidence surrounding this emerging area of practice, identify gaps in the existing knowledge, and to inform and direct future research surrounding trauma-informed oral health services (Arksey & O’Malley, 2005; Joanna Briggs Institute [JBI], 2020; Lockwood & Tricco, 2020; Munn et al., 2018).

The objectives of this review were to (1) identify existing theories, models, frameworks, guidelines and recommendations for the implementation and provision of TIC in oral health services; (2) highlight gaps in the literature related to TIC and oral health; and (3) identify avenues for future research related to TIC and oral health practice.

Methods

The methodology was based on Arksey and O’Malley’s framework with enhancements proposed by Levac et al. (2010) and Peters et al. (2020) and the JBI guidelines for scoping reviews (JBI, 2020). The review was conducted in five stages: (1) identify the research question; (2) identify relevant studies; (3) study selection; (4) chart the data; and (5) collate, summarize, and report the results (Arksey & O’Malley, 2005). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR) checklist was used (JBI, 2020; Peters et al., 2020). The protocol was registered on the Open Science Framework database (Mahood et al., 2022).

Inclusion and exclusion criteria were used to select studies as shown in Table 1. The population (oral health practitioners and students), concept (TIC), and context (oral health services) framework was used. Included papers needed to examine the concept of TIC in terms of theories, models, frameworks, guidelines, or recommendations at an oral health practice organizational level. Literature exploring TIC for practitioners or students from other health fields, or studies from other health disciplines or human services was excluded unless dentistry or oral health was discussed. “Trauma-specific” literature addresses management of dental patients who have experienced a particular trauma, for example, sexual assault or domestic violence. Trauma-specific literature or literature discussing dental phobia was excluded unless it discussed the broader concept of TIC, as the goal of this review was not to investigate practice aimed at any one population subset, but rather the wider practice of TIC for oral health.

Table 1.

Inclusion and Exclusion Criteria.

	Inclusion	Exclusion
Population	– Dental and oral health practitioners, staff, or students – Clients of oral health services	– Health practitioners, staff, or students from other (non-dental) health fields unless dental practice is also discussed – Clients of other (non-dental) health services unless oral health services also discussed
Concept	– TIC practice theories, models, frameworks, guidelines, and recommendations at a systemic or organizational level	– TIC practice models for specific high-risk groups (e.g., victims of sexual assault, domestic violence, refugees etc.) – Traumatic dental injuries (TDI) – Traumatic dental experiences/dental phobia
Context	– Any geographic location – Oral health service provision – Dental treatment	– TIC practice approaches for mental health, nursing or other health disciplines, professions, or services
Types of Evidence	– Primary empirical research studies – Review papers – Government reports – Books – Dental or public health association publications and reports – Study protocols – Full-text articles – Full-text conference paper or proceedings – Dissertations and theses – Standards or practice guidelines – Editorial articles (e.g., perspective pieces, position statements) – Unpublished material – Articles written in English	– Abstracts or posters – Audio or video works – Newspapers – Magazines – Speeches and presentations – Blogs – Podcasts – Websites – Factsheets – Literature requiring payment for access – Articles not available in English

Note. TIC = trauma-informed care.

Medline (via Ovid), APA PsycINFO (via Ovid), Embase (Elsevier), Scopus, CINAHL (via EBSCO), and Cochrane databases were searched in April 2022. The search strategy is shown in Table 2, and included keywords related to the following two main concepts: (1) TIC; and (2) oral health or dentistry. The Boolean operator “OR” was utilised in S1 to broaden the search results, and the truncation “dent*” used in S2 to capture the terms dental, dentist, dentistry, et cetera. No search limits or medical subject headings (MeSH) were used as TIC is a relatively new and emerging concept. At the time the search was undertaken, there were no MeSH for TIC in the included databases.

Table 2.

Search Strategy.

S1. Trauma-Informed Care	S2. Oral Health	S3
“trauma-informed” OR “trauma-informed” OR “trauma sensitive” OR “trauma focused” OR “trauma reducing” OR “trauma aware”	“oral health” OR dent*	S1 AND S2
Search strategy—Medline via Ovid

Google Scholar and ProQuest were searched using combinations of the search terms to locate unpublished studies and gray literature. Filters were used when searching Google Scholar to exclude the terms “nurse,” “doctor,” and “medical.” A series of blogs (126 items) were removed before transferring the remaining results to Endnote for screening. Filters were used in ProQuest to exclude results by source type (Wire Feeds, Newspapers, Magazines, Blogs, Podcasts, Websites, and Audio and Video works). A manual search was conducted of publications by identified peak bodies, relevant national organizations, and websites representing a range of oral health, allied health, and human services providers in Australia, New Zealand, the United Kingdom, Canada, and the United States (see Supplemental Appendix). The reference lists of all included papers were screened for additional articles, and authors and relevant experts were contacted to locate any further unpublished relevant literature. Results were transferred to Endnote for screening and removal of duplicates. All search terms and phrases, number of results, and the total number of items retrieved for screening were recorded. Following removal of duplicates, remaining records were imported into a screening and data extraction software (Covidence) and screened for inclusion by two reviewers (EM & MS). Two reviewers (EM & MS) independently conducted title and abstract screening for all shortlisted articles based on the inclusion/exclusion criteria. Conflicts were resolved by discussion between the two reviewers until a consensus was reached.

Information was charted based on the following classification: (1) Theory/Model—information that provided an explicit explanation or description of trauma-informed oral healthcare principles or interventions (Nilsen, 2015); (2) Framework—a “how-to” support that could be used to inform and guide the implementation of TIC principles for oral health services (Nilsen, 2015) and (3) Guidelines/Recommendations—information and recommendations about what policy makers or healthcare providers should do to provide trauma-informed oral health care (WHO, 2012).

The primary author (EM) independently undertook data charting and thematic analysis. Information was charted using a customized Covidence data charting template. Articles were primarily reviewed to identify descriptive data and pertinent theories, models, or frameworks. Primary data were subsequently exported to Excel, reviewed, and tabulated for the title, author, publication type, year of publication, country of origin, study design, and population. Each article was summarized to determine the scope of reporting TIC and oral health.

Following primary charting, thematic analysis to identify and chart guidelines and recommendations was undertaken in six steps; (1) read and re-read the included articles; (2) repackage details into organizing ideas; (3) develop new ideas from the notes relying on organizing ideas; (4) identify and group ideas based on logical similarities; (5) organize larger groups by comparing and contrasting the sets of ideas; and (6) link groups together into broader integrating themes (Neuman, 2014). Data relating to these groups and integrated themes were recorded into tables allowing for the frequency of common themes to be examined.

Results

Study Selection

The search identified a total of 251 records. Fifty-five duplicates were removed, resulting in 196 records for the title and abstract review. Conflicts for twenty-three items were resolved through discussion between the two reviewers, identifying thirty-two items for full-text review. Following a full-text review, fifteen records met the criteria for inclusion. The study selection process is demonstrated in Figure 1.

Figure 1.

Studies resulting from the search, included and excluded studies.

Study Characteristics

Eleven articles were published in the United States, two in the United Kingdom, and one each in Canada and Mexico. Dates of publication ranged from 2013 to 2022. Types of publications varied and included ten journal articles (Akinkugbe et al., 2019; Brown et al., 2021; Douglas, 2017; Oh & Lopez-Santacruz, 2021; Powers, 2020; Raja et al., 2014, 2015a, 2015b; Swarthout-Roan & Singhvi, 2013; Swarthout, 2022), three dissertations/theses (Amir, 2017; Bosch, 2017; Gray, 2021), and two dental practitioner support guides for providing TIC (Eaton, 2018; Hammett, 2019). Journal articles included four educational articles, two pre-/post-design studies, a cohort study, a cross-sectional study, a news article, and a literature review. Charted data for each publication are presented in Table 3.

Table 3.

Data Charting of Critical Findings for Included Papers.

Author and Year	Type of Publication	Summary	Theory/Model	Framework	Guidelines/Recommendations
Swarthout-Roan and Singhvi (2013)	Journal article Educational article	Continuing Professional Development article—education regarding types of trauma and disorders. Explains trauma link to health and dental fear. Recommendations for practitioners to address patients with dental fear and trauma history.			Practitioner EducationCommunicationModified Treatment Approach
Raja et al. (2014)	Journal articleEducational article	A cover story in which the authors propose the trauma-informed care (TIC) pyramid to help engage traumatized patients in oral health care.	Theory—TIC principles of Human Services—Screening, educating, sensitive services, patient involvement.Model—Each level of the TIC pyramid is informed by research findings, clinical data, author experiences in health communication education, mandatory reporting and working with anxious patients.	The TIC PyramidLevel 1—Patient-centered Communication SkillsLevel 2—Understanding the Health Effects of TraumaLevel 3—Collaboration and Understanding your Professional RoleLevel 4—Understanding Your Own HistoryLevel 5—Screening	Practitioner EducationCommunicationInterprofessional CollaborationModified Treatment ApproachScreeningFuture Research
Raja et al. (2015a)	Journal articleCross-sectional study	A cross-sectional study was used to establish rates of TLE experienced by medical and dental patients in a non-psychiatric, outpatient sample at a large university-affiliated health center.TLE were prevalent and overall trauma history was associated with poorer self-reported health.			Practitioner EducationInterprofessional CollaborationScreeningFuture Research
Raja et al. (2015b)	Journal articlePre-/post-study	A 3-hr TIC education lecture was provided to second year dental students. A needs assessment was then performed to develop a revised range of expanded and interactive modules.Pre- and post-tests and needs assessments between initial and final modules indicted that the extended/interactive module was more effective in meeting educational objectives.	Theory—TIC principles of Human Services—Screening, educating, sensitive services, patient involvement.	Framework for revised education module which included 6 hours over 2 days including didactics, patient videos, roleplays, charting of mock cases and standardized patients.	Practitioner Education
Amir (2017)	Thesis	Exploring oral health and dental care experiences and behaviors of adults whose parents were incarcerated during their childhood.Broader models and recommendations for TIC practice discussed.		TIC pyramid proposed by Raja et al.—can be used to integrate TIC into daily practice.	Practitioner EducationCommunicationInterprofessional CollaborationUniversal Trauma Precautions
Bosch (2017) 2016	Dissertation	Mixed methods study—Cohort + Qualitative interviews with women who have ACEs history. Use of 2010 BRFSS national population health survey to examine ACEs and preventive healthcare utilization (oral health and gynecologic)No significant relationship found between ACEs and preventive healthcare service utilization.	Theory—SAMHSA’s 4 R’s (Realize, Recognize, Respond, and Resist).		Practitioner EducationCommunicationInformed Consent and ChoiceModified Treatment Approach Screening
Douglas (2017)	Journal articleEducational article	Continuing Professional Development article.Dental health professionals cannot always be aware of which patients are survivors of abuse.Implementation of the principles of sensitive practice, and trauma-informed practice should be the standard of care.		Framework—The Umbrella of Safety1. Respect2. Taking time3. Rapport4. Sharing information5. Sharing control6. Respecting boundaries7. Fostering mutual learning8. Understanding nonlinear healing9. Demonstrating awareness and knowledge of interpersonal violence	Practitioner EducationCommunicationInformed Consent and Choice
Eaton (2018)	NGO publication	A guide for dental practitioners. Discusses and provides background regarding trauma and abuse, trauma responses, triggers, and coping mechanisms. Explores how patients might feel about coming to dental appointments and provides recommendations for TIC.			Practitioner EducationCommunicationInformed Consent and ChoiceModified Treatment Approach
Akinkugbe et al. (2019)	Journal articleCohort study	Investigated associations between ACEs and oral health measures of the 2010 Behavioral Risk Factor Surveillance System.Findings suggest an association between ACEs and oral health outcomes.		TIC pyramid proposed by Raja et al.—includes behavioral and communication modifications that can improve experiences for all patients including those who choose not to disclose TLE.	CommunicationInformed Consent and ChoiceUniversal Trauma PrecautionsModified Treatment Approach
Powers (2020)	Journal articleNews article	Article that summarizes a 2019 American Public Health Association education session by Madison Hammett discussing ACEs and TIC for dentistry.			Practitioner EducationCommunicationInformed Consent and ChoiceUniversal Trauma Precautions
Brown et al. (2021)	Journal articlePre-/post-study	Presents a model for teaching trauma-informed communication skills to first-year medical and dental students.The intervention significantly increased students’ comfort level and self-reported clinical skills, and benefits persisted at 5 months.	Theory—SAMHSA’s 4 R’s and SAMHSA 6 principles of TIC.Model—3.5-hr session to introduce TIC communication skills to all first-year medical and dental students	Framework for education	Practitioner EducationInterprofessional Collaboration
Gray (2021)	Dissertation	Dentist’ self-reported practice approach to working with patients who have psychological trauma symptoms investigated through semi-structured interviews with five dentists.Results could inform training and education programs for dentists, trauma-informed procedure protocols, and may guide future studies of best practices in dental care for patients with TLE history.	Model—Proposed education model to address competencies related to clinical interviewing, addressing patient distress and phobic patients.		Practitioner EducationFuture Research
Oh and López-Santacruz (2021) 2020	Journal articleLiterature review	Review aimed to understand psychological and physical implications of ACEs for pediatric patients and identify methods to manage them. No guideline for management for children with history of maltreatment was identified. Recommendations formulated using information from child health and protective services.	Model—Education module proposed by Raja et al. mentioned.	TIC pyramid proposed by Raja et al.	Practitioner EducationCommunicationInterprofessional CollaborationModified Treatment Approach Screening
Swarthout (2022)	Journal articleEducational article	A peer-reviewed course for continuing education of dental practitioners.Defines and discusses trauma, TIC, and the neurobiology of trauma. Considers dental fear and trauma.	Theory—SAMHSA’s 4 R’s, SAMHSA 6 principles of TIC, and SAMHSA 3 E’s		Practitioner EducationCommunicationInterprofessional CollaborationInformed Consent and ChoiceUniversal Trauma Precautions
Hammett (2019)	Education brief	ACEs and trauma lead to poorer oral health. Discusses trauma, effects on health and trauma and oral health.Recommends TIC to improve patient care.	Theory—SAMHSA’s 4 R’s		Practitioner EducationInterprofessional CollaborationUniversal Trauma Precautions

Note. TLE= traumatic life experiences; ACEs = Adverse Childhood Experiences; SAMHSA = Substance Abuse and Mental Health Services Administration.

Descriptive/Thematic Analysis of Results

Results are presented below, describing the theories and models, frameworks, and themes of common recommendations identified in more detail.

Theories and models

This review identified three broad models for TIC and three models describing the implementation of practitioner education interventions. Three broad theories or models put forward by the United States SAMHSA were identified within the literature: (1) “The Four R’s”—Key assumptions for a trauma-informed approach; (2) SAMHSA’s “Six key principles of a trauma-informed approach”; and (3) “The Three E’s of Trauma” (SAMHSA, 2014).

“The Four R’s” model describes four key assumptions for a trauma-informed approach (SAMHSA, 2014). At its most basic, this refers to an organization or system that: (1) Realizes the widespread impact of trauma and understands potential paths for recovery; (2) Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; (3) Responds by fully integrating knowledge about trauma into policies, procedures and practices; and (4) seeks to actively Resist re-traumatization (SAMHSA, 2014, p. 9). This model was mentioned in four papers (Bosch, 2017; Brown et al., 2021; Hammett, 2019; Swarthout, 2022), with a further three discussing one or more of “The Four R’s” without explicit reference to the full SAMHSA model (Akinkugbe et al., 2019; Amir, 2017; Eaton, 2018).

SAMHSA’s six key principles of a trauma-informed approach were the second most referenced theory, being directly discussed in two papers (Brown et al., 2021; Swarthout, 2022). The six key principles of a trauma-informed approach as described by SAMHSA are as follows: (1) Safety; (2) Trustworthiness and transparency; (3) Peer support; (4) Collaboration and mutuality; (5) Empowerment, voice, and choice; and (6) Cultural, historical, and gender issues (SAMHSA, 2014).

The final SAMHSA theory identified was the “Three E’s of Trauma” which refers to (1) the traumatic Event(s); (2) the individual’s Experience of these events; and (3) the Effect that the TLE has. Only one paper directly referenced “The Three E’s” as a theory (Swarthout, 2022); however, the examination of traumatic events and a range of related health effects was discussed to some degree in all the included literature.

All three SAMHSA models for TIC identified are components of the 2014 publication “Concept of Trauma and Guidance for a Trauma-Informed Approach” which provides an overarching framework for TIC. They are practice principles that can be adapted and applied to all services and sectors and were not formulated by or for oral health services explicitly (SAMHSA, 2014).

Three models for dental practitioner education were identified: (1) a two-day revised range of expanded and interactive modules to educate dental practitioners regarding TIC (Raja et al., 2015b); (2) a model to address practitioner competencies in clinical interviewing and address the needs of distressed and anxious patients (Gray, 2021); and (3) a 3.5-hr session to introduce TIC to first year medical and dental students (Brown et al., 2021).

The model suggested by Raja et al. (2015b) was referred to by Oh & López-Santacruz (2021). Each proposed education model suggested methods to improve education about TIC and improve trauma-informed communication skills for dental students. All records presenting models for practitioner education acknowledged the need for training to increase competence and comfort level of practitioners to identify, understand, and manage patients who may have experienced TLE (Brown et al., 2021; Gray, 2021; Raja et al., 2015b).

Frameworks

Two frameworks for practice were identified: (1) “The Trauma-informed Care Pyramid for Dental Practice” (Raja et al., 2014); and (2) “The Umbrella of Safety” (Douglas, 2017). The “Trauma-informed Care Pyramid for Dental Practice” is suggested as a framework for practice adaptations at the appointment-level, provider-level, and practice level (Raja et al., 2014). It is designed to be customized according to setting, specialty, and the patient’s individual needs; incorporates aspects relating to communication, reporting, and working with anxious patients, and was referred to in a further three included articles (Akinkugbe et al., 2019; Amir, 2017; Oh & López-Santacruz, 2021).

“The Umbrella of Safety” provides a second framework comprising nine principles for healthcare providers to follow to ensure psychological safety for dental practitioners and their patients. The nine principles that shape this framework are (1) respect; (2) taking time; (3) rapport; (4) sharing information; (5) sharing control; (6) respecting boundaries; (7) fostering mutual learning; (8) understanding nonlinear healing; and (9) demonstrating awareness and knowledge of interpersonal violence. This framework draws from literature surrounding TIC for health practitioners and provides a guide for dental practitioners to follow when treating patients who have experienced TLE (Douglas, 2017).

Guidelines and recommendations

Two guidelines for practitioners were identified: (1) “Trauma-informed care and oral health: Recommendations for practitioners” (Hammett, 2019); and (2) “Supporting Patients with Histories of Sexual Abuse and Trauma. A Guide for Dental Professionals” (Eaton, 2018). Both guidelines provided background information regarding the health effects of TLE and provided a range of recommendations for dental practitioners.

Recommendations identified through thematic analysis of all included articles were grouped into eight broad themes: (1) Practitioner education/knowledge; (2) Communication; (3) Interprofessional collaboration/referral; (4) Informed consent and choice; (5) Modified treatment approach; (6) Universal trauma precautions; (7) Screening; and (8) Future research. Proposals relating to practitioner education and knowledge were most common (n = 13), followed by recommendations for communication (n = 10), interprofessional collaboration (n = 7), informed consent and choice (n = 6), a modified treatment approach (n = 6), universal trauma precautions (n = 5), screening (n = 4), and future research (n = 3). Within the broad themes of practitioner education/knowledge, communication, and modified treatment approach, additional common recommendations and linked sets of ideas were identified, categorized, and quantified, as shown in Table 4.

Table 4.

Recommendations—Overview and Frequency of Themes.

Broad/Integrated Theme	Frequency of Subthemes			Frequency (N = 15)
Broad/Integrated Theme	Frequency of Subthemes			Number (n)	Percent
Practitioner education/knowledge	Themes	Number (n)	Percent	13	86.6
	Trauma and health outcomes	6	40
	Trauma sensitive communication	5	33.3
	Responding and reporting	2	13.3
	Trauma-specific practices	2	13.3
	Awareness of own trauma history	2	13.3
Communication	Themes			10	66.6
	Open communication and patient engagement/collaboration (active/reflective listening, motivational interviewing, etc.)	9	60
	Clear explanation of procedures	5	33.3
	Empathy, caring, and concern	5	33.3
	Use of signals (including clear stop signal)	5	33.3
	Consultation with patients—ascertain needs, supports required, tolerance	5	33.3
	“Tell show do” technique	4	26.6
	Avoid blame and judgment	3	20
Interprofessional collaboration				7	46.6
Informed consent and choice				6	40
Modified treatment approach	Themes			6	40
	Positioning of chair—upright	3	20
	Familiarization visits/desensitization	3	20
	Provide or allow for supports (person, music, counselor, etc.)	3	20
	Allow for breaks	2	13.3
Universal trauma precautions				5	33.3
Screening				4	26.6
Future research				3	20

Common themes relating to practitioner education/knowledge identified included the importance of understanding trauma and its influence on health outcomes, trauma-sensitive communication skills, knowledge about responding to and reporting suspected or known patient trauma, trauma-specific practice skills, and awareness of how a practitioner’s own trauma history may influence care. The importance of open, collaborative communication, clearly explaining procedures, showing empathy and compassion, the use of nonverbal signals such as a stop signal during treatment, consultation, using the “tell, show, do” technique, and avoiding blame or judgment were common aspects of trauma-informed communication identified in the literature. Ideas identified under the theme of modified treatment approaches included upright chair positioning, desensitization and familiarization visits, providing or allowing for additional supports a person may need, and allowing for regular breaks during an appointment.

Discussion

This scoping review sought to identify evidence surrounding the implementation and delivery of TIC practices for oral health services. A limited number of theories, models, frameworks, guidelines, and recommendations were identified. TIC has been accepted and applied in fields such as mental health, child protection, and the penal system; however, recommendations exist to support the adaptation and implementation of TIC practices within a range of other domains, including health services (Kezelman & Stavropoulos, 2020; Purkey et al., 2018; Wall et al., 2016). The practice of TIC within the context of oral health service delivery has not been widely implemented, monitored, or evaluated; and several avenues for future research exist.

TIC has developed as part of a greater paradigm shift in health from biomedical models of patient care to strengths-based methods designed to meet the changing needs of individuals and the shifting sociocultural environment (Jacob, 2017; Kezelman & Stavropoulos, 2020). Medical models in health are limited and may lead to individuals feeling helpless, lacking control over their lives, and becoming passive in their interactions with practitioners, whereas, modern practice approaches focus on improving skills and knowledge for practitioners and communities, and aim to provide effective, personalized care for users (Benjamin et al., 2019; Brinkmann, 2016; Byrne et al., 2016). The basic foundations of TIC include aspects of safety, trustworthiness, choice, collaboration, and empowerment; along with an understanding of the need to be sensitive to culture, ethnicity, and identity (Kezelman & Stavropoulos, 2020; Purkey et al., 2018; SAMHSA, 2014; Wall et al., 2016).

References to many of SAMHSA’s key concepts were found in the included records, as well as throughout much of the background reading for this review. “The Four R’s,” “six key principles,” and “Three E’s of Trauma” are recognized as essential foundations of TIC. In addition to the theories identified through this review, “SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach” provides recommendations for TIC across ten implementation domains. This guide is provided as a starting point for organizations wishing to embed TIC at a systemic level and covers a range of considerations for the implementation of TIC in the areas of (1) Governance and Leadership; (2) Policy; (3) Physical Environment; (4) Engagement and Involvement; (5) Cross Sector Collaboration; (6) Screening, Assessment, Treatment Services; (7) Training and Workforce Development; (8) Progress Monitoring and Quality Assurance; (9) Financing; and (10) Evaluation (SAMHSA, 2014).

Becoming trauma-aware is highlighted by organizational TIC guidelines as being the first step to creating a trauma-informed organization, a process that occurs across a continuum (Kezelman & Stavropoulos, 2020; SAMHSA, 2014). Practitioners should be educated regarding the high prevalence of trauma and the many ways in which it impacts a range of health outcomes, trauma sensitive communication techniques, knowledge about responding to and reporting disclosures of violence and abuse, addressing the explicit needs of patients with specific trauma experiences, and having knowledge of how their own trauma can influence interactions with patients and their families (Bosch, 2017; Brondani et al., 2017; Brown et al., 2021; Raja et al., 2014; SAMHSA, 2014).

Practitioner education regarding TIC was commonly discussed in the literature included in this review. Most theories, models, frameworks, guidelines, and recommendations identified by this review have not been adopted within oral health systems or subsequently evaluated in practice. The included pre-/post- design studies examining practitioner education modules are the exception to this, however, due to their limited number and lack of quality appraisal, conclusions about the effectiveness of these interactive and collaborative models of education for trauma-informed communication and practice cannot be drawn. This review highlights the importance of empirical research exploring the impacts of these interventions. A scoping review undertaken by Jackson and Jewell (2021) investigated educational practices for providers of TIC. Findings indicated considerable variation in the training of TIC practices across disciplines, with no clear conclusions able to be drawn to guide best practice (Jackson & Jewell, 2021).

Frameworks for TIC in oral health service delivery identified in this review included the “Trauma-informed Care Pyramid for Dental Practice” and “The Umbrella of Safety.” Both have been put forward to support oral health practitioners in the provision of trauma-informed services and were adopted from frameworks developed for other health and human services sectors (Douglas, 2017; Raja et al., 2014). Both frameworks incorporate a range of key TIC principals that have been adapted to suit the needs of dental practitioners; however, at this stage neither have been implemented or evaluated in practice.

A key principle of TIC is resisting re-traumatization of patients who have experienced TLE (Gerber et al., 2019; SAMHSA, 2014). Dental treatment techniques may cause anxiety and re-traumatization due to the powerlessness experienced when dental patients are placed in a supine position and are unable to communicate while a provider works within their mouth (Kranstad et al., 2019; Raja et al., 2014). Creating an environment that is empowering and safe while fostering trust, choice, and collaboration is paramount. Open and effective communication skills utilizing techniques such as active listening, reflective listening, motivational interviewing, and patient-centered communication form the basis of trauma-informed patient interactions (Bosch, 2017; Purkey et al., 2018; Swarthout, 2022).

Patient communication that is rushed, strained, or denigrating can cause a patient to feel physically and emotionally unsafe (Purkey et al., 2018). Treatment options should be explained in ways that are clearly understood and permission to move forward must be explicit, particularly if physical touch is required (Bosch, 2017; Douglas, 2017; Eaton, 2018; Hammett, 2019; Swarthout, 2022). Patient interactions should be appropriate for a person’s age, cultural background, language, and personal level of understanding, with care taken to monitor for signs of patient discomfort or disengagement (Gerber et al., 2019).

Recommendations for trauma screening practices in oral health services were conflicting. Bosch (2017) and Brown and colleagues (2021) suggest that a policy for universal ACE screening should be adopted to help practitioners identify and tailor treatment for individuals who have experienced TLE (Bosch, 2017; Brown et al., 2021); whereas Raja and colleagues (2014) acknowledge that routine screening may not be efficient in terms of time and resource use and could be intrusive for some patients. Although universal ACE screening would seem ideal, practitioners must have the time, communication skills, and resources for referral that would subsequently be required to facilitate routine screening. Raja and colleagues suggest that screening could be useful for patients identified to be at higher risk of TLE or for patients who have obvious orofacial or physical injuries (Raja et al., 2014). Determining best practices for TLE screening is complex due to the range of different potential exposures, the variety of potential health outcomes, and the inconsistency of available recommendations across different disciplines and contexts. Further research to inform best practice in the use of trauma screening is needed to determine whether screening is accurate, leads to improved patient outcomes, or contributes in any way to patient harm or re-traumatization (Asmundson & Afifi, 2020; Gerber et al., 2019).

The authors of this scoping review are Australian health practitioners and were interested to discover that none of the identified literature was written from or for the Australian context. Up to 75% of Australians are likely to experience one or more traumatic events within their lifetime (AIHW, 2020; Bendall et al., 2018; Wall et al., 2016). In Australia, groups at elevated risk of TLE include First Australians, people who are refugees or homeless, young people in out-of-home care, emergency and armed forces personnel, and lesbian, gay, bisexual, transgender, intersex, queer/questioning, and asexual (LGBTIQA+) individuals (AIHW, 2020; Bendall et al., 2018). While the content and principles of TIC could still apply to Australians, aspects of TIC will require adaptation for Australian oral health practitioners and Australia’s diverse populations. Examples of this include catering for the specific needs of First Australians and consideration of how oral health services function within the Australian health system.

At the time of writing this review, no overarching policy to mandate TIC and no systematic framework to guide the transition to trauma-informed service delivery exists in Australia (Wall et al., 2016). There are a range of Australian organizations with recommendations for the implementation of TIC within their specific health or human services domains, and several broad operational frameworks for organizations wanting to implement TIC practices (Kezelman & Stavropoulos, 2020; Wall et al., 2016). None relate specifically to oral health service delivery. The Australian Institute of Family Studies suggests that the lack of an overarching framework for TIC in Australia may result in inconsistent or haphazard development of trauma-informed models that do not share a consistent language or implementation framework for TIC (Wall et al., 2016). This is not an uncommon criticism of TIC approaches, with the lack of consistent terminology and amorphous nature of TIC concepts resulting in confusion and a lack of comparability across disciplines (Birnbaum, 2019).

Recommendations exist that could support the implementation of TIC across all sectors to benefit stakeholders and clients at a systemic level (Bendall et al., 2018; Kezelman & Stavropoulos, 2020; Wall et al., 2016). Due to the unique nature of dental practice, tailoring of TIC practices needs to occur to meet the contextual needs and discipline-specific challenges faced by oral health practitioners (Kezelman & Stavropoulos, 2020; Wall et al., 2016). Implementing a range of both broad and dental-specific recommendations for TIC would result in a more accessible oral health service that is sensitive to the needs of survivors of TLE.

The evidence for TIC in the delivery of oral health services is limited and while existing theories, models, frameworks, guidelines, and recommendations have been identified by this review; most have not been adopted within oral health systems or subsequently evaluated in practice. Much of the literature considering TIC and dentistry is drawn from broad principles of health and human services practice and TIC guides for health practitioners and has been combined with practitioner knowledge to create frameworks or recommendations for trauma-informed dentistry.

This scoping review identified a range of implications for oral health practice, policy, and research surrounding TIC that have been detailed in Table 5.

Table 5.

Implications for Practice, Policy, and Research.

Practice

• Oral health services require a shift from biomedically fixated models of care toward practice that is integrated, multifaceted, and focused on the needs of diverse and vulnerable populations• Given the high prevalence of TLE, adopting a trauma-informed approach to care could contribute to the development of sensitive, supportive oral health services for both the people who work within them and the individuals who require them• Modifications to clinical practice and improved communication skills could better support patients with history of TLE• The power imbalance and intrusive nature of dentistry could easily re-traumatize patients who have experienced TLE, therefore fearful patients who report previous distressing dental experiences could be considered for TLE screening• Oral health practitioners and services might consider ways to create physically safe and welcoming environments• Community development approaches to practice recognize that individuals and communities are best able to understand their own needs and should therefore play a role in developing solutions to their problems; therefore, co-design and collaboration with communities and service users is recommended when implementing changes

Policy

• Policy and protocols establishing universal trauma-informed practices should be embedded in all aspects and at all levels of oral health service delivery• Engagement of families and communities with lived trauma experience to support the design and implementation of trauma-informed policies• Encourage the inclusion of trauma-informed screening, treatment, and referral services in delivery system

Research

• Avenues for future research identified in the included literature included: 1. Examining the effect of TIC practices for fearful, anxious dental patients and assessing the use of multidisciplinary teams for the treatment of dentally anxious patients with TLE history 2. Implementation research to examine the levels of “The Trauma-informed Care Pyramid” in practice within oral health service operations 3. Investigating the barriers and facilitators to interprofessional collaboration and whether patients access referral pathways 4. Examining the diverse types of TLE and their influence on health, coping, and stress 5. Surveying trauma history in relation to stressors and service usage• Longitudinal studies could be undertaken to examine aspects of service delivery before and after TIC implementation to evaluate its effectiveness in areas such as training and workforce development, oral health outcomes, consumer engagement and involvement, and cross sector collaboration• The effectiveness and acceptability of screening for TLE and adverse childhood experiences in dental settings could be investigated, with universal screening allowing for prevalence of TLE among oral health service users to be determined• Qualitative research with practitioners and patients could investigate a variety of aspects related to provision of TIC in oral health settings

Note. TIC = trauma-informed care; TLE= traumatic life experiences.

Challenges and Limitations

TIC is an emerging concept and, as such, is not included in the MeSH for the searched databases. A wide range of practice approach concepts and terms such as “person-centered care,” “dental home,” or “person-led” may incorporate elements of trauma-informed practice that have not been uncovered through the search strategy undertaken for this review. “Trauma-specific” literature and papers examining dental anxiety and phobia, along with various types of evidence were excluded which may have resulted in missed related data. The limited number of countries chosen for hand searching of organizational publications and language limitations may have resulted in the exclusion of relevant articles. Quality appraisal of included papers was not conducted limiting the ability of reviewers to draw significant conclusions. Thematic coding and charting of the data may be difficult to replicate exactly due to the variety of themes identified, overlap within and across themes, and personal interpretation of the work.

Conclusions

This scoping review identified limited evidence to guide the implementation of trauma-informed practices in oral health services. Practicing TIC involves realizing that TLE are common and considering the effect traumatic events have on people’s lives, health, and service needs and use. Practitioner education, effective communication skills, interprofessional collaboration, choice and consent, universal trauma precautions and screening are domains of oral health service delivery to which TIC practices can be applied. A variety of clinical practice adjustments and recommendations for dental practitioners were identified to improve services for patients who may have experienced trauma. The findings from this review highlight the need for further research into the practice of TIC within oral health settings, and the need to develop and assess a framework for trauma-informed oral health services designed to meet the unique and diverse needs of oral health service providers and populations.

Supplemental Material

sj-docx-1-tva-10.1177_15248380231165699 – Supplemental material for Theories, Models, Frameworks, Guidelines, and Recommendations for Trauma-Informed Oral Healthcare Services: A Scoping Review

Supplemental material, sj-docx-1-tva-10.1177_15248380231165699 for Theories, Models, Frameworks, Guidelines, and Recommendations for Trauma-Informed Oral Healthcare Services: A Scoping Review by Emma Mahood, Mishel Shahid, Nicole Gavin, Ann Rahmann, Santosh Kumar Tadakamadla and Jeroen Kroon in Trauma, Violence, & Abuse

Footnotes

Contribution Statement

EM devised the project, conducted the search, analyzed the findings, and authored the report with input and advice from MS, NG, AR, ST, and JK Screening of articles for inclusion was conducted by EM & MS. ST and JK equally supervised the overall project.

Authors’ Note

Emma Mahood is also affiliated to Queensland Health, Brisbane, Australia.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Santosh Kumar Tadakamadla acknowledges the support from NHMRC fellowship, Australia (APP1161659).

ORCID iD

Emma Mahood

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Emma Mahood, BAppHSc (Oral Health), MPH, is an Oral Health Therapist working in Queensland Health’s Oral Health Service. Her research interests include mental health, the social and economic determinants of health, and preventing oral disease in vulnerable populations.

Dr Mishel Shahid, BDS, MDPH, is a PhD candidate at the School of Medicine and Dentistry, Griffith University, Australia. Her research interests include health services research focused on explaining mechanisms that reduce health inequalities and improve the accessibility and use of oral health services for vulnerable populations.

Nicole Gavin, RN, PhD, is the Research Director in Community and Oral Health at Metro North Health, Brisbane, Australia. She is an experienced clinician researcher with a background in hematology and bone marrow transplantation nursing. Her research focuses on infection, infection prevention and control, central venous access devices, recognizing and responding to deterioration, consumer engagement, co-design, supportive and palliative care, and models of care.

Dr Ann Rahmann, BPhty, Grad Cert Phty, PhD, is the Research Development Officer in Community and Oral Health. Her research interests focus on optimizing subacute rehabilitation outcomes including the transition back to home, and the assessment and management of older people with balance issues.

Dr Santosh Tadakamadla, PhD, is the discipline lead of dentistry at La Trobe University in Australia. His research interests include promoting oral health, addressing health inequalities, and improving oral health of vulnerable populations through innovative approaches.

Prof Jeroen Kroon, BChD, MCHD, PhD, is the Lead Dental Public Health & Preventive Dentistry at the school of Medicine and Dentistry, Griffith University, in Australia. His research interests include preventive dentistry, epidemiology, public health, and evidence-based dentistry.

References

Akinkugbe

A. A.

Hood

K. B.

Brickhouse

T. H.

(2019). Exposure to adverse childhood experiences and oral health measures in adulthood: Findings from the 2010 Behavioral Risk Factor Surveillance System. JDR Clinical & Translational Research, 4(2), 116–125. https://doi.org/10.1177/2380084418810218

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (5th ed.). American Psychiatric Association Publishing. https://psychiatry.org/psychiatrists/practice/dsm

Amir

(2017). Exploring oral health and dental care experiences, perceptions and behaviours of adults whose parents were incarcerated during their childhood. [Master’s thesis, University of British Columbia]. UBC Theses and Dissertations. Retrieved from https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/10.1111/jphd.12341

Arksey

O’Malley

(2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. https://doi.org/10.1080/1364557032000119616

Asmundson

G. J. G.

Afifi

T. O.

(Eds.). (2020). Adverse childhood experiences: Using evidence to advance research, practice, policy, and prevention. Academic Press. https://www-sciencedirect-com-443.web.bisu.edu.cn/book/9780128160657/adverse-childhood-experiences

Australian Institute of Health and Welfare (AIWA). (2020). Stress and trauma. Retrieved October 20, 2021, from https://www.aihw.gov.au/reports/australias-health/stress-and-trauma

Bendall

Phelps

Brown

Metcalf

Cooper

Rose

Nursey

Fava

(2018). Trauma and young people. Moving toward trauma-informed services and systems. [Mental health service report]. Orygen, The National Centre of Excellence in Youth Mental Health. https://www.orygen.org.au/Orygen-Institute/Policy-Reports/Trauma-and-young-people-Moving-toward-trauma-info/Orygen_trauma_and_young_people_policy_report

Benjamin

Haliburn

King

(Eds.). (2019). Humanising mental health care in australia : A guide to trauma-informed approaches. Routledge.

Benjet

Bromet

Karam

E. G.

Kessler

R. C.

McLaughlin

K. A.

Ruscio

A. M.

Shahly

Stein

D. J.

Petukhova

Hill

Alonso

Atwoli

Bunting

Bruffaerts

Caldas-de-Almeida

J. M.

de Girolamo

Florescu

Gureje

Huang

. . . Koenen

K. C.

(2016). The epidemiology of traumatic event exposure worldwide: Results from the world mental health survey consortium. Psychological Medicine, 46(2), 327–343. https://doi.org/10.1017/S0033291715001981

10.

Birnbaum

(2019). Confronting the social determinants of health: Has the language of trauma informed care become a defense mechanism? Issues in Mental Health Nursing, 40(6), 476–481. https://doi.org/10.1080/01612840.2018.1563256

11.

Bosch

(2017). Adverse childhood experiences and preventive healthcare service utilization. (Publication number 10164903) [Doctoral dissertation: Saint Louis University]. ProQuest Database. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306082/

12.

Brinkmann

(2016). Diagnostic cultures: A cultural approach to the pathologization of modern life. ProQuest Ebook Central. https://ebookcentral-proquest-com.libraryproxy.griffith.edu.au

13.

Brondani

M. A.

Alan

Donnelly

(2017). Stigma of addiction and mental illness in healthcare: The case of patients’ experiences in dental settings. PLoS One, 12(5), 0177388. https://doi.org/10.1371/journal.pone.0177388

14.

Brown

Mehta

P. K.

Berman

McDaniel

Radford

Lewis-O’Connor

Grossman

Potter

Hirsh

D. A.

Woo

Krieger

(2021). A trauma-informed approach to the medical history: Teaching trauma-informed communication skills to first-year medical and dental students. MedEdPORTAL: The Journal of Teaching and Learning Resources, 17, 11160. https://doi.org/10.15766/mep_2374-8265.11160

15.

Byrne

Happell

Reid-Searl

(2016). Lived experience practitioners and the medical model: World’s colliding? Journal of Mental Health (Abingdon, England), 25(3), 217–223. https://doi.org/10.3109/09638237.2015.1101428

16.

Crouch

Nelson

Radcliff

Martin

(2019). Exploring associations between adverse childhood experiences and oral health among children and adolescents. Journal of Public Health Dentistry, 79(4), 352–360. https://doi.org/10.1111/jphd.12341

17.

de Oliveira Solis

A. C.

Araújo

Á. C.

Corchs

Bernik

Duran

É. P.

Silva

Lotufo-Neto

. (2017). Impact of post-traumatic stress disorder on oral health. Journal of Affective Disorders, 219, 126–132. https://doi.org/10.1016/j.jad.2017.05.033

18.

Douglas

L. M.

(2017). Trauma-informed, sensitive practice. British Dental Association.

19.

Eaton

(2018). Supporting patients with histories of sexual abuse and trauma. A guide for dental professionals. Victim Focus. https://www.victimfocus.org.uk/resources-for-professionals

20.

Ford

Brocklehurst

Hughes

Sharp

C. A.

Bellis

M. A.

(2020). Understanding the association between self-reported poor oral health and exposure to adverse childhood experiences: A retrospective study. BMC Oral Health, 20(1), 51–51. https://doi.org/10.1186/s12903-020-1028-6

21.

Gerber

M. R.

SpringerLink Springer

(2019). Trauma-informed healthcare approaches: A guide for primary care (1st ed.). Springer International Publishing. https://go.exlibris.link/1k9ccTX3

22.

Gray

(2021). Dentists’ self-reported practice approach to working with patients who have psychological trauma symptoms. (Publication number 28088069) [Doctoral Dissertation, Adler University]. ProQuest Database. Retrieved from https://www-proquest-com-s.web.bisu.edu.cn/docview/2447301070?pq-origsite=gscholar&fromopenview=true

23.

Hammett

(2019). Trauma-informed care and oral health: Recommendations for practitioners. [Education Brief]. Health and Medical Policy Research Group. https://www.hmprg.org/wp-content/uploads/2019/01/Trauma-Informed-Care-and-Oral-Health.pdf

24.

Jackson

M. L.

Jewell

V. D.

(2021). Educational practices for providers of trauma-informed care: A scoping review. Journal of Pediatric Nursing, 60, 130–138. https://doi.org/10.1016/j.pedn.2021.04.029

25.

Jacob

K. S.

(2017). Perspectives about mental health, illness, and recovery. Current Opinion in Psychiatry, 30(5), 334–338. https://doi.org/10.1097/YCO.0000000000000346.

26.

Joanna Briggs Institute (JBI). (2020). JBI manual for evidence synthesis. Joanna Briggs Institute. https://jbi-global-wiki.refined.site/space/MANUAL

27.

Kabani

Lykens

Tak

H. J.

(2018). Exploring the relationship between adverse childhood experiences and oral health-related quality of life. Journal of Public Health Dentistry, 78(4), 313–320. https://doi.org/10.1111/jphd.12274

28.

Kezelman

C. A.

Stavropoulos

(2020). Organisational guidelines for trauma-informed service delivery. Blue Knot Foundation. https://blueknot.org.au/product/organisational-guidelines-for-trauma-informed-service-delivery-digital-download/

29.

Kessler

R. C.

Aguilar-Gaxiola

Alonso

Benjet

Bromet

E. J.

Cardoso

Degenhardt

de Girolamo

Dinolova

R. V.

Ferry

Florescu

Gureje

Haro

J. M.

Huang

Karam

E. G.

Kawakami

Lee

Lepine

J. P.

Levinson

. . . Koenen

K. C.

(2017). Trauma and PTSD in the WHO World Mental Health Surveys. European Journal of Psychotraumatology, 8(sup5), 1353383. https://doi.org/10.1080%2F20008198.2017.1353383

30.

Kranstad

Softestad

Fredriksen

T. V.

Willumsen

(2019). Being considerate every step of the way: A qualitative study analysing trauma-sensitive dental treatment for childhood sexual abuse survivors. European Journal of Oral Sciences, 127(6), 539–546. https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/full/10.1111/eos.12661

31.

Levac

Colquhoun

O’Brien

K.K.

(2010). Scoping studies: advancing the methodology. Implementation Science, 5(1), 69. https://doi.org/10.1186/1748-5908-5-69

32.

Lockwood

Tricco

A. C.

(2020). Preparing scoping reviews for publication using methodological guides and reporting standards. Nursing & Health Sciences, 22(1), 1–4. https://doi.org/10.1111/nhs.12673

33.

Mahood

Kroon

Tadakamadla

Shahid

Gavin

Rahmann

(2022, April 28). Existing theories, models, frameworks, guidelines, and recommendations for trauma-informed oral health care services: A scoping review protocol. https://doi.org/10.17605/OSF.IO/86GVZ

34.

McDonald

(2020). “It’s fine; I’m fine”: Considerations for trauma-informed healthcare practices. Journal of Aggression, Maltreatment & Trauma, 29(4), 385–399. https://doi.org/10.1080/10926771.2019.1710641

35.

Munn

Peters

M. D. J.

Stern

Tufanaru

McArthur

Aromataris

(2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology, 18(1), 143–143. https://doi.org/10.1186/s12874-018-0611-x

36.

Nermo

Willumsen

Rognmo

Thimm

J. C.

Wang

C. E. A.

Johnsen

J.-A. K.

(2021). Dental anxiety and potentially traumatic events: A cross-sectional study based on the Tromsø Study—Tromsø 7. BMC Oral Health, 21(1), 600–600. https://doi.org/10.1186/s12903-021-01968-4

37.

Neuman

W. L.

(2014). Social research methods: Qualitative and quantitative approaches (7th ed.). Pearson. https://ebookcentral-proquest-com.libraryproxy.griffith.edu.au/lib/griffith/reader.action?docID=5175740

38.

Nilsen

(2015). Making sense of implementation theories, models and frameworks. Implementation Science, 10(1), 53. https://doi.org/10.1186/s13012-015-0242-0

39.

Nurius

P. S.

Uehara

Zatzick

D. F.

(2013). Intersection of stress, social disadvantage, and life course processes: Reframing trauma and mental health. American Journal of Psychiatric Rehabilitation, 16(2), 91–114. https://doi.org/10.1080/15487768.2013.789688

40.

J. E.

López-Santacruz

H. D.

(2021). Adaptation measures in dental care for children with history of Adverse Childhood Experiences: A practical proposal. Special Care in Dentistry, 41(1), 3–12. https://onlinelibrary-wiley-com-443.web.bisu.edu.cn/doi/10.1111/scd.12527

41.

Peres

M. A.

Macpherson

L. M. D.

Weyant

R. J.

Daly

Venturelli

Mathur

M. R.

Listl

Celeste

R. K.

Guarnizo-Herreño

C. C.

Kearns

Benzian

Allison

Watt

R. G.

(2019). Oral diseases: A global public health challenge. The Lancet (British edition), 394(10194), 249–260. https://doi.org/10.1016/S0140-6736(19)31146-8

42.

Peters

M. D. J.

Marnie

Tricco

A. C.

Pollock

Munn

Alexander

McInerney

Godfrey

C. M.

Khalil

(2020). Updated methodological guidance for the conduct of scoping reviews. JBI Evidence Synthesis, 18(10), 2119–2126. https://doi.org/10.11124/JBIES-20-00167

43.

Petruccelli

Davis

Berman

(2019). Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis. Child Abuse & Neglect, 97, 104127–104127. https://doi.org/10.1016/j.chiabu.2019.104127

44.

Phantumvanit

Makino

Ogawa

Rugg-Gunn

Moynihan

Petersen

P. E.

Evans

Feldens

C. A.

Khoshnevisan

M. H.

Baez

Varenne

Vichayanrat

Songpaisan

Woodward

Nakornchai

Ungchusak

(2018). WHO global consultation on public health intervention against early childhood caries. Community Dentistry and Oral Epidemiology, 46(3), 280–287. https://doi.org/10.1111/cdoe.12362

45.

Powers

M. P.

(2020). Trauma-informed care by dentists can ease stress, anxiety of patients. The Nation’s Health, 49(10), 31. https://www.thenationshealth.org/content/49/10/31.2

46.

Purkey

Patel

Phillips

S. P.

(2018). Trauma-informed care: Better care for everyone. Canadian Family Physician, 64(3), 170–172. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851387/pdf/0640170.pdf

47.

Raja

Hoersch

Rajagopalan

C. F.

Chang

(2014). Treating patients with traumatic life experiences: Providing trauma-informed care. Journal of the American Dental Association, 145(3), 238–245. https://doi.org/10.14219/jada.2013.30

48.

Raja

Hannan

S. M.

Boykin

Orcutt

Hamad

Hoersch

Hasnain

(2015a). Self-reported physical health associations of traumatic events in medical and dental outpatients: A cross-sectional study. Medicine (Baltimore), 94(17), 734. https://doi.org/10.1097/MD.0000000000000734

49.

Raja

Rajagopalan

C. F.

Kruthoff

Kuperschmidt

Chang

Hoersch

(2015b). Teaching dental students to interact with survivors of traumatic events: Development of a two-day module. Journal of Dental Education, 79(1), 47–55. https://doi.org/10.1002/j.0022-0337.2015.79.1.tb05856.x

50.

Substance Abuse and Mental Health Services Administration [SAMHSA]. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. (HHS Publication No. (SMA) 14-4884). Substance Abuse and Mental Health Services Administration. https://ncsacw.acf.hhs.gov/userfiles/files/SAMHSA_Trauma.pdf

51.

Swarthout-Roan

Singhvi

(2013). The roots of dental fears. RDH, 33(12), 53–61. https://dentalacademyofce.com/courses/2547/pdf/1312cei_roan_rdh_web.pdf

52.

Swarthout

(2022). Trauma-informed approach to care in the dental setting. RDH, 42(3), 46–53. https://dentalacademyofce.com/courses/4558%2FPDF%2F2203CEDswa_final.pdf

53.

Wall

Higgins

Hunter

(2016). Trauma-informed care in child/family welfare services. (CFCA paper No. 37). Australian Institute of Family Studies. https://aifs.gov.au/cfca/publications/trauma-informed-care-child-family-welfare-services

54.

World Health Organization (WHO). (2012). WHO handbook—Guideline development. World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/75146/9789241548441_eng.pdf;jsessionid=81E245BF4F98CF56868199CAA4E61AB3?sequence=1

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