Cognitive behavioral therapy (CBT) has been shown to help people with dental phobia minimize their fear of going to the dentist and has allowed many of these patients to receive advanced treatments without sedation, according to a new study by King’s College London.
People with dental phobia tend to avoid going to the dentist at all costs, even when they are suffering from oral pain. In the U.K., where the study took place, it is estimated that about 1 in 10 people suffer from dental phobia, according to the most recent Adult Dental Health Survey.
“People with dental phobia are most commonly given sedation to allow them to become relaxed enough for a short period of time to have their dental treatment performed. However this does not help them to overcome their fear in the long term,” said Professor Tim Newton from the Dental Institute at King’s College London and lead author of the study.
“The primary goal of our CBT service is to enable patients to receive dental treatment without the need for sedation, by working with each individual patient to set goals according to their priorities. Our study shows that after on average five CBT sessions, most people can go on to be treated by the dentist without the need to be sedated.”
CBT, which is typically completed in six to 10 sessions, has been shown to help with a range of mental health problems, particularly depression and anxiety disorders. Both cognitive and behavioral interventions have been shown to be successful in reducing dental anxiety and increasing dental attendance.
For the study, researchers evaluated 130 patients (99 women and 31 men) attending a psychologist-led CBT service and the outcomes of their treatment. Patients were surveyed for their levels of dental anxiety, general anxiety, depression, suicidal thoughts, alcohol use, and oral health-related quality of life.
Three-quarters of those assessed scored 19 or higher on the Modified Dental Anxiety Scale (MDAS), indicating dental phobia. The remainder all scored high on one or more items of the MDAS, suggesting a specific fear of some aspect of dentistry.
Fear of dental injections and the dental drill were the most common high scoring items on the MDAS. Nearly all patients (94 percent) reported that problems with their teeth, mouth, or gums affected their daily living and quality of life.
Several of the patients surveyed were found to have other psychological conditions: 37 percent had high levels of general anxiety and 12 percent had clinically significant levels of depression. Suicidal thoughts were reported by 12 percent of patients and three percent (four patients) reported a recent intent to commit suicide.
Individuals were referred to support services via the care of their GP and for suicide risk, immediate action was taken based on local service guidelines.
Of all patients referred, 79 percent went on to have dental treatment without the need for sedation and six percent had their dental treatment under sedation. The average number of CBT appointments required before a patient received dental treatment without sedation was five.
“CBT provides a way of reducing the need for sedation in people with a phobia, but there will still be those who need sedation because they require urgent dental treatment or they are having particularly invasive treatments. Our service should be viewed as complementing sedation services rather than as an alternative, the two together providing a comprehensive care pathway for the ultimate benefit of patients,” said Newton.
A recent study published in the same journal, co-authored by Professor Tim Newton, showed that more women than men reported dental phobia in the 2009 Adult Dental Health Survey. Those with dental phobia were more likely to come from a lower income background, have more cavities and suffer from poorer oral health overall.
The findings are published in the British Dental Journal.
Source: King’s College London