While health care providers possess extensive technical expertise in managing physical injury, they are often less equipped to diagnose, prevent, and manage the complex psychosocial challenges faced by patients with a history of trauma. The mental health burden of trauma is staggering: the prevalence of post-traumatic stress disorder (PTSD) and acute stress disorder following violent injuries exceeds 30%, rising to 80% after gun violence, and inadequately managed PTSD increases the risk of death from suicide by a factor of 5 to 13.

Moreover, trauma extends far beyond acute physical injury, encompassing events and circumstances that caused harm with long-lasting debilitating effects, such as exposure to combat, domestic violence, sexual assault, and mental and physical abuse. The societal prevalence is vast: adverse childhood experiences (ACEs) affect over 50% of adults, and significant portions of the population experience intimate partner violence (IPV) (over 25% of women and 7% of men) and sexual abuse.

This issue is acutely relevant in oral and maxillofacial trauma. Facial trauma itself significantly increases the risk of PTSD, anxiety, and depression, with changes in appearance and self-perception compounding psychological distress. Critically, the often close proximity, supine positioning, and invasive procedures may be uniquely triggering for survivors, potentially exacerbating anxiety and avoidance behaviors. ^,,,

A necessary clinical shift lies in adopting the underlying paradigm of trauma-informed care (TIC). TIC acknowledges the impact of past life experiences on patient–provider interactions, which ultimately affects patient engagement and health outcomes. The foundation for providing TIC includes 4 key components: (1) realize: acknowledging the prevalence of trauma and its impact; (2) recognize: identifying high-risk patients; (3) respond: providing comprehensive and patient-specific management; and (4) prevention of retraumatization. This review summarizes the key practical framework of providing TIC in oral maxillofacial trauma, using key domains highlighted by the American College of Surgeons, including shared decision-making and personalization of care ( Fig. 1 ). ^,

TIC pyramid: the 4 R’s.

Single-traumatic incidents, particularly those requiring surgical intervention, can have acute and recalcitrant effects on mental health. While the type of traumatic injury may vary, the initial shock, resultant physical limitations, and associated psychological distress can have debilitating impacts. There is a strong consensus that a bidirectional correlation exists between mental health issues and traumatic injuries. However, this understanding is often not reflected in clinical practice. ^,,

A study in 2014 noted that less than 25% of patients in level I and level II trauma centers were screened for depression, and only 7% for post-traumatic stress injury. The consequences of this underscreening are significant: more than 20% of hospitalized trauma survivors experience posttraumatic stress disorder or depression, and over half experience substance use disorders (SUDs). More detrimentally, of these patients, 50% develop suicidal ideation during the year following hospitalization. In the context of oral and maxillofacial trauma, changes in appearance, altered self-perception, and diminished confidence can significantly impact quality of life and mental health.

Following a single trauma, an individual’s mental health trajectory can be categorized into one of 4 directions : resilience, recovery, delayed onset, or chronic distress ( Table 1 ). The risks of following a delayed onset or chronic distress trajectory versus resilience and recovery are multifactorial. Factors such as the type of injury—where penetrating trauma or intentional violence is associated with a higher risk of long-term mental health issues compared to falls—and the previously discussed social determinants of health (SDOH) play a large role in post-traumatic adaptive behavior.

Understanding the SDOH enables the implementation of intentional and multidisciplinary interventions to prevent further harm. Multicentered investigations and randomized controlled trials (RCTs) have demonstrated that PTSD, depression, and SUD have a dose-related impact on a patient’s ability to return to work after injury, and increase readmission and mortality rates, while targeted mental health interventions improve these outcomes.

Prior traumatic experiences significantly alter a patient’s physiologic and psychological baseline, significantly influencing their engagement with, and reaction to, dental and surgical care. The immediate sequelae of trauma, such as heightened anxiety, sleep disturbances, and social isolation, often drive individuals toward maladaptive coping mechanisms, most notably the development of SUDs. The utilization of substances serves as a form of self-medication to manage persistent trauma symptoms, resulting an important intersection between prior trauma and SUD prevalence in surgical populations. ^,,,

Furthermore, the symptoms of previous trauma may manifest as underuse of preventative and acute medical care. Health care environments, particularly those involving physical vulnerability or invasive procedures—common in surgery and dentistry—can trigger physiologic reactions of fear and hyperarousal, leading to avoidance behaviors. Insensitivity or a lack of awareness from the provider can unintentionally result in revictimization, further deterring the patient from engaging with the health care system and delaying necessary treatment.

This vulnerability is often compounded by the concept of cumulative trauma burden, where the accumulation of multiple traumatic events throughout a lifetime, such as a high ACEs score, creates a dose–response relationship with increased risk of injuries, mental health disorders, and poor overall health outcomes. Studies found that patients with injuries from violence have experienced over 2 times more adverse childhood events compared to the general population. Recognizing and addressing this cumulative burden is essential for truly patient-specific management.