Dr Eva Wolf – Professor Gisela Priebe | Improving Dental Care for those exposed to Sexual Abuse

For many people, a trip to the dentist can be nerve-wracking and mildly unpleasant, but for those exposed to sexual abuse it can be a deeply distressing experience that triggers overwhelming fear, anxiety, and physical symptoms. Despite oral health being essential for our overall wellbeing, many struggle to seek the dental care they need, leading to long-term health and quality of life consequences. Dr Eva Wolf from Malmö University, in Sweden, has led a team of researchers to help further understand the connections between a history of sexual abuse and fear of dental care, as well as how dentists can use a trauma-informed, patient-centred approach to better support these people.

Sexual Abuse and Dental Fear

Sexual violence is considered one of the most significant violations of human rights, but it is so common around the world that it is considered by the Word Health Organization as a public health concern. It is hard to accurately know how many people have faced this type of abuse, but a large review study has estimated that 8% of men and 18% of women have been exposed to sexual abuse.

Sexual violence has huge mental, physical, and behavioural health implications for individuals, as well as human and financial costs to society. The costs of gender related violence in the EU were estimated to be €366 billion where 79% is violence against women. However, less quantifiable aspects, such as personal suffering, fear, pain, premature death, loss of trust, and poor interpersonal relationships are seldom taken into account.

Previous studies have found that a history of sexual abuse may be associated with extreme fear of receiving dental care, which often leads to delays in dental care and worsening oral health. Whilst dental anxiety is quite common, people who have experienced sexual abuse often find dental care extremely anxiety-provoking and upsetting, sometimes due to aversion to being touched, feeling out of control in the dental care appointment, and additional discomfort due to the use of instruments in their mouths.

This can become a vicious cycle — people find it hard to go to the dentist for small problems, which without dental care risk becoming bigger problems, which then need more complicated and invasive care. Dr Eva Wolf, a specialist dentist and researcher from Malmö University in Sweden, has led a team of researchers to understand the impact of sexual abuse on dental care, and how dentists can support these patients effectively.

How Oral Health Affects the Body and Mind

Oral or dental health includes the ability to speak, smile, smell, taste, chew, swallow, and convey a range of emotions through facial expressions, without pain or discomfort. Thus, beyond physical health, oral issues can also impact a person’s self-esteem and confidence, with consequences for wellbeing.

Qualitative methods

Dr Wolf conducted interviews with adults who had experienced sexual abuse. The participants represented society in Sweden, and so included men and women aged 19 to 56 years old, from a range of socio-economic backgrounds, some were single while others had partners, and some were parents. All participants self-reported some degree of dental fear.

Participants were encouraged to answer questions and share their stories in their own words. The researchers asked follow-up questions to help participants reflect and elaborate. All interviews were recorded and typed up word-for-word by a certified secretary, and any personal details were removed to keep identities confidential.

The team, including Gisela Priebe, a psychologist with extensive research experience in working with individuals exposed to sexual abuse analysed the interviews. Dr Wolf and the team followed a step-by-step approach known as qualitative content analysis. First, the team read each transcript several times to get a full understanding. Then, they broke the text into smaller parts —called ‘meaning units’—whenever the topic or message shifted. These units were condensed by removing unnecessary words, while keeping the core meaning. Each condensed unit was then given a code – a word or phrase that captured its main idea. The codes were compared and grouped based on similarities or differences. These groups formed categories that described the main content of the interviews. Finally, the researchers identified a deeper message or overall theme, representing the underlying meaning across all the interviews. Several researchers were involved in reviewing and discussing the data, to ensure the analysis was fair and consistent.

Barriers to Dental Health

Many people who have been exposed to sexual abuse struggle to maintain oral hygiene or attend dental appointments regularly. Emotional barriers like shame, fear of being judged, or fear of triggering trauma can lead to avoidance, thus worsening oral health over time. These challenges are compounded by complex histories that may include mental health issues, addiction, or economic hardship. The participants also revealed that dental visits often evoke strong psychological and physical reactions, echoing past abuse. This includes feelings of powerlessness, loss of control, and dissociation, which is where the patient may mentally detach from the situation. The physical setting of dental treatment can closely resemble aspects of past abuse, making even routine procedures deeply distressing, and so make it harder for these patients to seek the care they need.

A recurring theme across the interviews was shame. Participants felt shame about being sexually abused, blaming themselves or fearing others would judge them. Experienced also was shame for not maintaining regular oral hygiene routines, especially when everyday tasks like brushing their teeth became emotionally charged or physically intolerable. Participants felt ashamed of the visible consequences of delayed care — broken or missing teeth, bad breath, or discoloured enamel — which they worried might lead to judgment or rejection. Described was feeling ‘exposed’ at the dentist, as though the mouth told a story they wished could remain hidden. This shame can be reinforced in the dental setting, especially if comments from dental staff are perceived as critical or dismissive.

Body Remembrance

For many people who have been exposed to sexual abuse, the effects of abuse aren’t just remembered — they can also stay in the body. Even many years later, a person’s body can still react to things that remind them of what happened, even if they don’t think about it consciously. This ‘body remembrance’ means that certain physical sensations, positions, or smells can trigger intense, involuntary reactions – these are deeply learned survival mechanisms being reactivated.

Participants in the study described how even routine dental care could cause extreme distress. Some spoke of becoming physically sick before appointments, shaking uncontrollably in the waiting room, or feeling frozen and unable to speak once in the chair. Others experienced full-body tension, overwhelming panic, or a sudden sense of dissociation — as though they were no longer present in their own body. These reactions felt impossible to escape, no matter how much they mentally prepared or tried to stay calm. The distress could build up for days in advance, and the aftermath could linger long after the appointment was over.

Understanding that these reactions are rooted in trauma is essential for creating compassionate, effective dental care. For people who have been exposed to abuse, being able to attend and tolerate a dental visit can require extraordinary courage and emotional energy, and the cost of not being believed or understood can be retraumatising.

How Dentists Can Better Support This Population

A key focus of the team’s research was how dental care providers can better support people who have experienced sexual abuse. The participants in the study expressed that a large part of dental anxiety came from feeling vulnerable or powerless, rather from physical pain.

The team’s work highlights the need for dental professionals to build trust and create a safe, respectful environment through a trauma-informed approach to care. Key findings show that predictability and a strong working alliance are essential. Many patients do not arrive with automatic trust in their dentist. Instead, they worry that the experience will feel as distressing as they fear. This makes it vital for dental professionals to accept responsibility for building a sense of safety and control. Dentists, dental hygienists and dental nurses can foster trust by actively involving patients in their care. Seeking permission before each step, and allowing the patient to set the pace helps restore a sense of agency in the dental care situation. Dental professionals should also respond sensitively to signs of distress, such as freezing, shaking, or avoiding appointments — these subtle cues may reflect a trauma response and should not be overlooked.

Patients want to feel seen, heard, and never judged. This means recognising the emotional toll of dental fear, avoiding blame for missed visits or poor oral health, and creating a non-judgemental space. Listening carefully to both verbal and non-verbal communication is key. Collaboration within the dental team also matters. A supportive relationship between dentist and nurse can increase a patient’s sense of security. In some cases, patients saw the nurse as more approachable or emotionally attuned. Ultimately, adopting a trauma-informed, patient-centred approach — where power is shared, communication is clear, and emotional needs are respected — can make dental care more accessible and less distressing. Dentists, dental hygienists, and dental nurses who are alert to signs of discomfort and aware of their influence as healthcare providers can play a vital role in restoring trust and promoting long-term oral health.