Dentaltown June 2017 - 92

continuing
education

One important consideration after disclosure is to ensure patients are comfortable
with how we record their histories in our
notes, and whether they want other health
care providers to know. One male survivor
mentioned that health care providers wrongly
assumed he was an abuser-partly because of
his gender but mainly because one clinician's
notes were unclear: "history of sexual abuse"
was written in his health record, instead
of "survivor of childhood sexual abuse."
Contrary to what is commonly cited in the
media, there is no evidence to suggest that
male survivors of childhood sexual abuse
are more likely to become perpetrators.6 7

Oral health counseling
for the survivor
Although well-meaning, we're often
inclined to couch our health education in
negative terms-we tend to inform patients
of dire consequences if they don't comply
with our oral hygiene instructions, rather
than focusing on the positive results they
can achieve by improving their self-care.
Knowledge alone is usually not sufﬁcient to
motivate change within a patient; empathy
and active listening on our part are necessary
to facilitate change.
We can build trust by balancing clear
guidance with positive feedback. Motivational interviewing8 integrates well with the
principles of sensitive practice, because it is
a collaborative, nonjudgmental and nonconfrontational technique that fosters patient
autonomy. This helps patients consider the
beneﬁts of good oral and systemic health
that would be gained through improved

self-care. The motivation to change becomes
more lasting and effective because it comes
from within themselves.

Conclusion
Child abuse, especially sexual abuse, is
underreported; fewer than half of survivors
disclose their experiences to anyone. Dental
health professionals cannot always be aware
which patients are survivors of abuse;
we should implement the principles of sensitive practice
w it h al l pat ients.
In short, sensitive
practice should be a
standard of care. ■
References
1. Handbook on Sensitive Practice for Health
Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse, researched
and written by Schachter, C., Stalker, C.,
Teram, E., Lasiuk, G., and Danilkewich, A.
2 DSM5, 2013.
3 Brier, J., and Elliott, D.M. (2003). Prevalence and
psychological sequelae of self-reported childhood physical
and sexual abuse in a general population sample of men
and women. Child Abuse and Neglect, 27(10), 1205 22.
4 Finkelhor, D. (1994). The international epidemiolog y of
child sexual abuse. Child Abuse & Neglect, 18(5), 409-417.
5 Hibbard, R.A., Desch, L.W., American Academy of Pediatrics
Committee on Child Abuse and Neglect, and American Academy
of Pediatrics Council on Children With Disabilities (2007).
Maltreatment of children with disabilities (Clinical report). Pediatrics.
119(5), 1018-25.
6 Becker, J.V. (1994) Offenders: Characteristics and treatment. The
Future of Children, 4(2), 31, 178-197
7 Salter, D., McMillan, D., Richards, M., Talbot, T., Hodges,
J., Bentovim, A., et al. (2003). Development of sexually abusive
behaviour in sexually victimised males: A longitudinal study. Lancet,
361(9356), 471-476
8 Motivational Interviewing: Helping People Change; William R.
Miller and Stephen Rollnick; Guilford Press, Sep 1, 2012.
Additional references
The handbook Sensitive Practice for Health Care Practitioners: Lessons
from Adult Survivors of Sexual Abuse can be downloaded as a PDF
from the Government of Canada website:
http://publications.gc.ca/site/eng/329299/publication.html

Take more CE by Linda Douglas-online, anytime
Hygienetown Clinical Director Linda Douglas has created three other hygiene-related
CE courses that are also available on Dentaltown's website. To take the courses and
earn up to 11 hours of CE credit, head to dentaltown.com/ce-by-linda-douglas.

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