Dental anxiety treatment by a dentist in primary care: A 1-year follow-up study

Effectiveness of behavioural therapy and inhalational sedation in reducing dental anxiety among patients attending dental clinics - a systematic review and meta-analysis

OBJECTIVE

The study aims to compare the effectiveness of behavioural therapy and inhalational sedation in reducing dental anxiety among patients visiting dental clinics.

METHODS

A search was conducted in PubMed, Cochrane databases, Scopus, and Google scholar through August 2024. All the randomized control trials, cohort studies, case control, cross-sectional studies that evaluated the effectiveness of behavioural therapy with inhalational/conscious sedation among children and adults to reduce dental anxiety were included. Outcome assessed was change in the dental anxiety scores as measured by the validated tools. PRISMA guidelines were followed for the meta-analysis. Meta-analysis was conducted using Cochrane Review Manager (Revman) version 5.3. Random effects model was used to compare the two groups in reducing dental anxiety. Quality of the studies included was evaluated using the Risk of Bias Assessment tool and Newcastle-Ottawa tool. Heterogeneity was assessed using I2 values. Certainty of evidence was assessed using GRADE pro software. The protocol was registered in PROSPERO (CRD-NIHR) database with Reference ID CRD42024581013.

RESULTS

A total of 940 participants were included in the analysis. Behavioural therapy was significantly more effective than inhalational sedation in reducing dental anxiety among patients prior to the dental treatment (SMD: -0.87; 95% CI: -1.29 to -0.45; P < 0.0001; I2:78%). Additionally, behavioural therapy demonstrated more effectiveness than inhalational sedation in reducing the dental anxiety among children (SMD: -0.64; 95% CI: -1.16 to -0.11, P = 0.02%; I2:88%). Certainty of evidence was high among the randomized controlled trials and moderate among the observational studies.

CONCLUSION

The findings of this review and meta-analysis suggests that behavioural therapy is more effective than inhalational sedation in reducing dental anxiety specifically among children.

Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental or Injection Phobia: Randomized Controlled Trial

BACKGROUND

Dental phobia (DP) and injection phobia (IP) are common in children and adolescents and are considered some of the biggest obstacles to successful treatment in pediatric dentistry. Cognitive behavioral therapy (CBT) is an evidence-based treatment for anxiety and phobias. As the availability of CBT in dentistry is low, internet-based CBT (ICBT) was developed. Open trials have shown that ICBT is a promising intervention, but randomized trials are lacking.

OBJECTIVE

This randomized controlled trial tests whether therapist-guided ICBT supported by a parent could reduce fear, allowing children and adolescents with DP or IP to receive dental treatment.

METHODS

We enrolled 33 participants (mean age 11.2, SD 1.9 y) whom a clinical psychologist had diagnosed with DP, IP, or both. After inclusion, participants were randomized to either ICBT (17/33, 52%) or a control group of children on a waitlist (16/33, 48%). ICBT was based on exposure therapy and comprised a 12-week at-home program combined with visits to their regular dental clinic. Participants corresponded weekly with their therapist after completing each module, and 1 parent was designated as a coach to support the child in the assignments during treatment. All participants completed measurements of the outcome variables before treatment start and after 12 weeks (at treatment completion). The measurements included a structured diagnostic interview with a clinical psychologist. Our primary outcome measure was the Picture-Guided Behavioral Avoidance Test (PG-BAT), which assesses the ability to approach 17 dental clinical procedures, and a positive clinical diagnosis. Secondary outcome measures included self-report questionnaires that measured self-efficacy and levels of dental and injection anxiety. The children and their parents completed the questionnaires.

RESULTS

All participants underwent the 12-week follow-up. After treatment, 41% (7/17) of the participants in the ICBT group no longer met the diagnostic criteria for DP or IP, whereas all participants in the control group did (P=.004). Repeated-measure ANOVAs showed that ICBT led to greater improvements on the PG-BAT compared with the control group; between-group effect sizes for the Cohen d were 1.6 (P<.001) for the child-rated PG-BAT and 1.0 (P=.009) for the parent-rated PG-BAT. Reductions in our secondary outcomes-dental fear and anxiety (P<.001), negative cognitions (P=.001), and injection fear (P=.011)-as well as improvements in self-efficacy (P<.001), were all significantly greater among children in the ICBT group than in the controls. No participants reported adverse events.

CONCLUSIONS

ICBT seems to be an effective treatment for DP and IP in children and adolescents. It reduced fear and anxiety and enabled participants to willingly receive dental treatment. ICBT should be seriously considered in clinical practice to increase accessibility; this therapy may reduce the need for sedation and restraint and lead to better dental health in children and adolescents.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02588079; https://clinicaltrials.gov/study/NCT02588079.

Changes in symptoms of anxiety, depression, and PTSD in an RCT-study of dentist-administered treatment of dental anxiety

BACKGROUND

Educating dentists in treatment methods for dental anxiety would increase the patients' access to treatments that are important to their oral health. However, to avoid adverse effects on comorbid symptoms, involvement by a psychologist has been considered necessary. The objective of the present paper was to evaluate whether a dentist could implement systematized treatments for dental anxiety without an increase in comorbid symptoms of anxiety, depression or PTSD.

METHODS

A two-arm parallel randomised controlled trial was set in a general dental practice. Eighty-two patients with self-reported dental anxiety either completed treatment with dentist-administered cognitive behavioural therapy (D-CBT, n = 36), or received dental treatment while sedated with midazolam combined with the systemized communication technique "The Four Habits Model" (Four Habits/midazolam, n = 41). Dental anxiety and comorbid symptoms were measured pre-treatment (n = 96), post-treatment (n = 77) and one-year after treatment (n = 52).

RESULTS

An Intention-To-Treat analysis indicated reduced dental anxiety scores by the Modified Dental Anxiety Scale (median MDAS: 5.0 (-1,16)). The median scores on the Hospital Index of Anxiety and Depression (HADS-A/D) and the PTSD checklist for DSM-IV (PCL) were reduced as follows: HADS-A: 1 (-11, 11)/HADS-D: 0 (-7, 10)/PCL: 1 (-17,37). No between-group differences were found.

CONCLUSIONS

The study findings support that a general dental practitioner may treat dental anxiety with Four Habits/Midazolam or D-CBT without causing adverse effects on symptoms of anxiety, depression or PTSD. Establishing a best practice for treatment of patients with dental anxiety in general dental practice should be a shared ambition for clinicians, researchers, and educators.

TRIAL REGISTRATION

The trial was approved by REC (Norwegian regional committee for medical and health research ethics) with ID number 2017/97 in March 2017, and it is registered in clinicaltrials.gov 26/09/2017 with identifier: NCT03293342.