Lowering Dental Visit Anxiety

Severe dental anxiety may be relieved with behavioral therapy

(RxWiki News) Many people get a little anxious about seeing the dentist. But severe anxiety about the dentist may cause people to delay or stop dental care, which can lead to serious outcomes.

Medication is sometimes used to help calm the fear in these patients, but it is not a long term solution and is not suitable for all patients.

A recent review of studies showed a significant reduction in dental anxiety in patients who have had bevavioral therapy before routine dental visits.

The results of this review also suggested that dental fears were still decreased six months to one year after therapy.

"Consider behavioral therapy for severe fear of the dentist."

The author was Lisa J. Heaton, PhD, from the Department of Oral Health Sciences at the University of Washington School of Dentistry in Seattle, WA.

Dr. Heaton reviewed 10 studies that looked at behavioral therapy and cognitive behavioral therapy for use with severe dental anxiety. 

Behavioral therapy and cognitive behavioral therapy are psychological techniques that help a patient deal with problems by breaking them down into pieces they can look at and work out solutions for. Therapists then help to change behaviors and thoughts using several different methods.

Participants in this research were dental patients who either were given a survey called the Dental Anxiety Scale (DAS) or the Dental Fear Survey (DFS) or had a psychiatric diagnosis of dental fear. Therapy given to the fearful patients was either behavioral therapy, cognitive behavioral therapy or no therapy. 

These participants were given surveys after therapy for their dental procedures to evaluate whether the therapy worked to decrease anxiety about going to the dentist. Follow-up surveys were given at different times after the therapy, ranging from six months to five years.

All 10 studies used the DAS survey at follow-up and four studies also used the DFS. The researchers also noted whether dental treatment was able to be given without medications to calm the patient.

The DAS has four questions and asks patients questions such as how they feel in the dentist's waiting room and how they feel in the dentist's chair. The answers are scored 1 through 5. The patients choose 1 if the situation does not make them anxious and 5 if they are extremely nervous, or a number in between.

When the DAS is scored, a score of less than 9 shows slight anxiety, 9 through 12 is moderate anxiety, 13 and 14 are high anxiety and 15 through 20 are severe anxiety scores.

When the 10 studies were analyzed, the results showed an average decrease in the DAS score of 2.7 in the patients who received therapy, indicating significantly less dental anxiety.

Two studies showed a significant reduction in DAS scores of 2 points in patients given behavioral or cognitive therapy compared to those given sedation for anxiety.

Three studies showed a significant anxiety decrease of 3.3 points on the DAS scale in patients given therapy compared to no treatment for anxiety.

In one study, patients who had received therapy were more willing to accept regular dental care compared to dental treatment requiring anesthesia.

In two studies, DAS scores were significantly lower in patients receiving therapy when they were re-surveyed six months and one year later, but DAS scores in two other studies showed no difference one or five years later.

Dr. Heaton concluded that both behavioral therapy and cognitive behavioral therapy were useful in reducing dental anxiety. The results suggest that behavioral therapy may help patients accept regular dental treatment, compared to dental treatments requiring anesthesia.

This research was complicated by the fact that the therapies given in the 10 different studies were hard to compare directly because they were given for different amounts of time. Behavioral therapy was given for an average of six sessions, some cognitive behavioral therapy was given once and some was given over 10 once-a-week sessions. The content of the therapy also varied between the different studies.

This study appeared in the December issue of the Journal of Evidence Based Dental Practice.

Dr. Heaton did not disclose any conflicts of interest.

Review Date: 
December 3, 2013