CBT could help patients with dental phobia overcome their fear, according to new research from King’s College London.
The findings mean that patients with dental phobia undergoing cognitive behavioural therapy (CBT) – talking therapy intended to help people manage problems by changing thoughts and behaviours – could receive dental treatment without the need to undergo sedation.
Cognitive behavioural therapy
People with dental phobia tend to avoid visiting the dentist and are therefore at risk of suffering more dental pain, poor oral health and a detrimental effect to their quality of life.
CBT is a short-term therapy that typically lasts between six and 10 sessions.
The therapy has been shown to help with a range of psychological issues, such as depression and anxiety disorders.
Furthermore, cognitive and behavioural interventions have been shown to be successful in reducing dental anxiety and increasing dental attendance.
‘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,’ said Professor Tim Newton from the Dental Institute at King’s College London and lead author of the study.
‘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.’
Study results
The study, which was published in the British Dental Journal, looked at the characteristics of 130 patients attending a CBT service, and the outcomes of their treatment.
Patients attending a clinic run by the King’s College London Dental Institute Health Psychology Service at Guy’s and St Thomas’ NHS Foundation Trust 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 participants scored 19 or higher on the Modified Dental Anxiety Scale (MDAS), indicating dental phobia.
The remainder scored high on one or more items of the MDAS, suggesting a specific fear of some aspect of dentistry.
Fear of dental injections and instruments were the most common high scoring items on the MDAS.
The vast majority (94%) reported quality-of-life issues from problems with their teeth, mouth or gums.
Additionally, 37% of the study participants were found to have high levels of general anxiety, while 12% had clinically significant levels of depression.
Suicidal thoughts were also reported by 12% of patients, and 3% reported a recent intent to commit suicide.
Of all patients referred, 79% went on to have dental treatment without the need for sedation and 6% had their dental treatment under sedation.
The average number of CBT appointments required before a patient received dental treatment without sedation was five.
‘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’, explained Professor Newton.
‘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.’
