Surviving child sexual abuse: the relevance to dental practice.
Child sexual abuse (CSA) occurs in all communities, ethnic backgrounds, religions, cultures, social and economic classes, and is experienced by both males and females. The physical and psychological effects of CSA have significant effects on adult health outcomes. Parallels have been drawn between the physical and emotional environment of dental treatment and features of the CSA experience. Consequently, adult survivors of CSA can find it difficult to tolerate dental treatment, and may repeatedly cancel dental appointments or avoid dental treatment altogether. Awareness of patient characteristics in the dental setting that indicate past CSA include discomfort with body positioning, dislike of being touched, sense of loss of control, fear of judgement and sensitivity to perceived criticism, sensitivity to particular smells and sensitivity to having instruments in the mouth. Some aspects of the dental environment and dental treatment can act as 'triggers' that can take survivors of CSA back to the emotions associated with that event. An understanding of the fears and anxieties this can cause in the dental setting allows the dental team to help the individual cope with the dental experience, improving it for both the patient and the provider. The development of general strategies that foster establishing a positive rapport, sharing control and treating the individual as a partner in the healthcare relationship can cultivate a positive dental experience that can have far reaching effects.


CONCLUSIONS
The prevalence of child sexual abuse (CSA) is surprisingly high, so adults who have experienced CSA can find it difficult to tolerate dental treatment, and may repeatedly cancel dental appointments or avoid dental treatment altogether.
Dougall
Alison
A
Division One/Special Care Dentistry, Dublin Dental School and Hospital, Lincoln Place, Dublin 2.
Fiske
Janice
J
D000328:Adult; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology*; D016854:Dental Anxiety / Q000209:etiology*; D017742:Dental Care for Chronically Ill / Q000379:methods*; D003812:Dentist-Patient Relations; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008297:Male; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology