CBT could be effective adjunct in reducing dental phobia

COGNITIVE behavioural therapy (CBT) could provide an effective means of treating dental phobic patients without the need for sedation, according to researchers at King’s College London.

A study in the British Dental Journal surveyed 130 patients (99 women and 31 men) attending a psychologist-led CBT service and assessed their levels of dental anxiety, general anxiety, depression, suicidal thoughts, alcohol use and oral health-related quality of life.

Three-quarters of the patients 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 per cent) reported a knock-on effect from problems with their teeth, mouth or gums on their daily living and quality of life.

Of all patients referred for CBT, four-fifths (79 per cent) went on to have dental treatment without the need for sedation and 6 per cent had their dental treatment under sedation. The average number of CBT appointments required before a patient received dental treatment without sedation was five.

Cognitive behavioural therapy is a short-term therapy, typically lasting 6-10 sessions. It has been shown to help with a range of psychological problems, most notably for depression and anxiety-related disorders. Both cognitive and behavioural interventions have been shown to be successful in reducing dental anxiety and increasing dental attendance.

Professor Tim Newton from the Dental Institute at King’s College London and lead author of the study said: "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.

"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.

"However, there is a need for people with dental phobia to be carefully assessed by trained CBT practitioners working with dental health professionals. Some of the patients referred to us were found to be experiencing additional psychological difficulties, and needed further referral and management.

"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."

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