Evaluation of Self-Help Cognitive Behavioural Therapy for Children's Dental Anxiety in General Dental Practice

The efficacy of iatrosedation and music listening techniques in attenuating dental anxiety in patients undergoing dental crown preparation: A randomized clinical trial

Dental anxiety is a common problem encountered in dental clinics that affects both patients and dentists. Adequate management of dental anxiety is critical for optimal treatment outcomes for the patient. This study aims to assess the efficacy of two anxiety-reduction techniques (iatrosedation and music listening) for dental crown preparation in adult patients. In this clinical trial, 60 patients were randomly assigned to three groups: Group 1, iatrosedation; Group 2, music listening; and Group 3, control. Patients in all three groups underwent dental crown preparation. To measure the anxiety levels of the patients, heart rate was calculated using a pulse oximeter, and verbal rating scale scores were assessed. One-way analysis of variance, post hoc analysis, and Spearman's correlation were used to compare the mean values of the three groups. Significant differences were observed in the heart rate and verbal rating scale scores among individuals in the study groups. A more substantial reduction in anxiety levels was found in patients exposed to iatrosedation (Group 1), which was followed by music listening (Group 2). Recorded heart rate and verbal rating scores were the highest in the control group patients. The iatrosedation technique significantly reduced dental anxiety for patients undergoing dental crown treatment; however, music listening was less effective than iatrosedation. Educating patients regarding the dental care they are about to receive is vital for reducing their anxiety.

Development and validation of the Iranian version of the Children's Experiences of Dental Anxiety Measure (CEDAM)

OBJECTIVE

The aim of this study was to develop the Iranian version of the Children's Experiences of Dental Anxiety Measure (CEDAM) and evaluate its validity and reliability in assessing dental anxiety in children aged 9-16.

METHODS

The CEDAM was translated into Persian following the guidelines of the IQOLA project. A ‎sample of children completed the measure in a clinical setting, with a subgroup completing it ‎again to assess test-retest reliability. Concurrent criterion validity was evaluated by having all ‎participants complete the Modified Child Dental Anxiety Scale (MCDAS) alongside the ‎CEDAM. Construct validity was examined using exploratory and confirmatory factor ‎analyses.‎ RESULTS: The study included 275 children between the ages of 9 and 16. The Iranian version of CEDAM ‎exhibited excellent internal consistency with a Cronbach's ⍺ coefficient of 0.83. Test-retest ‎reliability was also high, with an intraclass correlation coefficient value of 0.96. Furthermore, there was a significant and ‎positive correlation between CEDAM and MCDAS scores (ρ = 0.72, p < .01). Exploratory ‎factor analysis identified two factors, and confirmatory factor analysis confirmed that the ‎instrument aligned well with the factor structure obtained from the exploratory analysis.‎ CONCLUSION: This study provides evidence supporting the validity and reliability of the Iranian version of ‎CEDAM as a valuable tool for evaluating dental anxiety in Persian-speaking children between ‎the ages of 9 and 16.‎.

Comparison of the effect of acceptance and commitment therapy and cognitive behavioral therapy on pain tolerance and intensity perception in patients with dental anxiety: A randomized trial

Background

Dental anxiety has negative effects on dentists' pain management. Patients have different levels of pain tolerance. Therefore, providing psychological interventions can reduce treatment avoidance and promote oral health. This study compared the effect of acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) on pain coping strategies and pain perception intensity in patients with dental anxiety.

Materials and Methods

This clinical trial with a pretest-posttest control group design and a 3-month follow-up period was performed on 45 patients with dental anxiety. They were randomly selected by convenience sampling method and assigned to two experimental groups and one control group. The first experimental group underwent 10 sessions of ACT, the second experimental group underwent 10 sessions of CBT, and the control group underwent oral care training. Data were collected by the Rosenstiel and Keefe's Coping Strategies Questionnaire and McGill Pain Questionnaire and analyzed by SPSS (version 24) software. The considered significance level is 0.05.

Results

The results showed no significant difference between ACT and CBT in pain coping strategies and pain perception intensity (P < 0.05) but indicated a significant difference between the treatment groups and the control group. Moreover, the results showed a significant difference between posttest and follow-up and pretest in pain coping strategies and pain perception intensity (P < 0.01) but indicated no significant difference between posttest and follow-up (P < 0.05).

Conclusion

ACT and CBT can play an important role in the sustainable improvement of pain coping strategies and pain perception intensity in patients with dental anxiety.

The CALM trial protocol: a randomised controlled trial of a guided self-help cognitive behavioural therapy intervention to reduce dental anxiety in children

BACKGROUND

Globally, around 13% of children experience dental anxiety (DA). This group of patients frequently miss dental appointments, have greater reliance on treatment under general anaesthesia (GA) and have poorer oral health-related quality of life (OHRQoL) than their non-dentally anxious peers. Recently, a low-intensity cognitive behavioural therapy (CBT)-based, self-help approach has been recommended for management of childhood anxiety disorders. A feasibility study conducted in secondary care found this guided self-help CBT resource reduced DA and a randomised controlled trial was recommended. The present study aims to establish the clinical and cost-effectiveness of a guided self-help CBT intervention to reduce DA in children attending primary dental care sites compared to usual care.

METHODS

This 4-year randomised controlled trial will involve 600 children (aged 9-16 years) and their parent/carers in 30 UK primary dental care sites. At least two dental professionals will participate in each site. They will be assigned, using random allocation, to receive the CBT training and deliver the intervention or to deliver usual care. Children with DA attending these sites, in need of treatment, will be randomly allocated to be treated either by the intervention (CBT) or control (usual care) dental professional. Children will complete questionnaires relating to DA, OHRQoL and HRQoL before treatment, immediately after treatment completion and 12 months post-randomisation. Attendance, need for sedation/GA and costs of the two different approaches will be compared. The primary outcome, DA, will be measured using the Modified Child Dental Anxiety Scale. Scores will be compared between groups using a linear mixed model.

DISCUSSION

Treating dentally anxious patients can be challenging and costly. Consequently, these children are frequently referred to specialist services for pharmacological interventions. Longer waiting times and greater travel distances may then compound existing healthcare inequalities. This research will investigate whether the intervention has the potential to reduce DA and improve oral health outcomes in children over their life-course, as well as upskilling primary dental healthcare professionals to better manage this patient group.

TRIAL REGISTRATION

This clinical trial has been registered with an international registry and has been allocated an International Standard Randomised Controlled Trial Number (ISRCTN27579420).

A Short Form of the Children's Experiences of Dental Anxiety Measure (CEDAM): Validation and Evaluation of the CEDAM-8

Background: The Children’s Experiences of Dental Anxiety Measure (CEDAM-14) is a child-centred measure of dental anxiety which assesses a range of behaviours, thoughts and feelings/physical symptoms related to dental anxiety. A short form of the CEDAM-14, which places less time burden on patients and clinicians, could promote the feasibility and applicability of the CEDAM in clinical settings. The aim of the study was to develop a short version of the CEDAM that can be used to assess children’s dental anxiety in clinical practice. Methods: A short version of the CEDAM was developed using a combination of item impact and regression methods. Measurement properties including floor/ceiling effects, variance, criterion validity, construct validity and internal consistency was calculated for the short form. Results: An eight-item CEDAM short form was developed (CEDAM-8) that had good psychometric properties, was significantly correlated with the CEDAM measure (r = 0.90; p < 0.01), had minimal floor and ceiling effects (3.5% and 1.2%, respectively) and was sensitive to change. Conclusion: The CEDAM-8 is a useful assessment tool for clinicians that is easy and quick to administer and could help to understand children’s experiences of dental anxiety and changes in anxiety over time and following intervention.

Evaluation of a new paediatric dentistry intravenous sedation service

Introduction Intravenous sedation (IVS) with propofol offers an alternative to inhalation sedation or general anaesthesia (GA) for dentally anxious young people who require treatment. It offers a greater level of anxiolysis than inhalation sedation and reduced morbidity when compared with GA.Methods Data were collected prospectively from a convenience sample of children requiring IVS. Participants completed the Children's Experiences of Dental Anxiety Measure (CEDAM) at the start of every visit. Patient demographics, treatment completed, surgery and recovery time were recorded. Feedback was obtained following their first visit.Results Treatment was successful for 91.5% (43/47) of patients. The average surgery and discharge time was 32.9 (8-105 minutes) and 33.1 (5-84 minutes), respectively. The CEDAM scores were between 14 and 30 (mean score 20.8). Thematic content analysis of the feedback was carried out and themes relating to communication, environment, appointment times, service satisfaction and advice to other patients emerged.Discussion CEDAM scores may have been lower than expected due to under-reporting by patients or clinicians' perception of higher anxiety levels. Feedback was reviewed regularly and improvements made where possible.Conclusion The majority of patients successfully received dental treatment under IVS. Changes have been made to the service to improve patient experience and maximise productivity.

'Message to Dentist': Facilitating Communication with Dentally Anxious Children

Dental anxiety affects children worldwide and can have negative consequences on oral health. This study aimed to evaluate a novel communication aid ‘message to dentist’ (MTD), as part of a wider cognitive behavioural therapy approach to reduce dental anxiety in young patients. Dentally anxious children, aged 9–16 years, were invited to complete the MTD proforma, before and following their course of treatment. They scored how worried they were and their anticipated pain levels on a scale of 1–10 (10 being the worst outcome). They also wrote down their coping plans and post-treatment reflections. One hundred and five children, from a UK general dental practice and a hospital clinic, were included. They had a mean age of 11.6 years, and 65% were female. There was a significant reduction in self-report worry (from 4.9 to 2.1) and anticipated pain (from 5.1 to 2.0) scores (p < 0.05, paired t-test). Many children (30%) used listening to music/audiobook as a coping strategy. Thematic analysis revealed concerns around pain, uncertainty, errors and specific procedures. The MTD proforma proved an effective means of facilitating communication between anxious children and the dental team, allowing them to identify their worries and make personalised coping plans.