Cognitive Behavioral Therapy for Children with Dental Anxiety

Abstract

Dental anxiety affects approximately 9% of children and is associated with poor oral health, pain, and psychosocial problems. The objective of this study was to investigate the efficacy of cognitive behavioral therapy (CBT) for children with dental anxiety in specialist pediatric dentistry. The study used a parallel-group superiority randomized controlled trial design. The primary outcome measure was the behavioral avoidance test; assessors were blind to treatment allocation. Participants were 8 boys and 22 girls 7 to 18 y old (mean ± SD, 10 ± 3.1). Children fulfilling the diagnostic criteria for dental anxiety were randomized to CBT (n = 13) or treatment as usual (n = 17), such as various sedation methods. Psychologists provided 10 h of CBT based on a treatment manual. Treatments were conducted in a naturalistic real-world clinical setting. Assessments were conducted before the treatment, 3 mo after the start of treatment, and at 1-y follow-up. The analyses of the primary outcome measure by repeated-measures analysis of variance and independent t test showed that children receiving CBT made superior, statistically significant improvements at follow-up (16.8 ± 2.4) compared with treatment as usual (11.4 ± 3.1, P < 0.01). A large between-group effect size (Cohen’s d = 1.9) was found. Following treatment, 73% of those in the CBT group managed all stages of the dental procedures included in the behavioral avoidance test compared with 13% in the treatment-as-usual group. Furthermore, 91% in the CBT group compared with 25% in the treatment-as-usual group no longer met the diagnostic criteria for dental anxiety at the 1-y follow-up according to the secondary outcome measure. Measures of dental anxiety and self-efficacy showed larger improvements in the CBT group compared with controls. We conclude that CBT is an efficacious treatment for children and adolescents with dental anxiety and should be made accessible in pediatric dentistry (ClinicalTrials.gov: NCT01798355).Knowledge transfer statement: The results of this study can be used by decision makers and clinicians when planning to implement evidence-based treatment in pediatric dentistry and give children and adolescents access to methods for treating dental anxiety. The results can also be used by parents of children with dental anxiety when asking dentists to cooperate with psychologists using cognitive behavioral therapy.

Are Technology-Based Interventions Effective in Reducing Dental Anxiety in Children and Adults? A Systematic Review

“…[20][21][22] These interventions focus on alleviating psychological distress, 23 perceived pain, anticipatory fear and avoidance towards dental treatment. Extant research supports Cognitive Behavioral Therapy (CBT) as the gold standard psychological therapy for the treatment of dental anxiety in both children 24,25 and adults. 26 However, owing to limited training opportunities available for general dentists for learning to administer therapeutic (cognitive behavioral) interventions, patients with dental anxiety may be referred to specialists or dental fear clinics, but these services are not widely available.…”

Non-pharmacological methods of fighting dental anxiety

“…In another study, Shahavaz et al have observed that children undergoing the regular CBT easier cope with fear and dental procedures. Moreover, after the therapy is finished, 91% of the subjects show no dental anxiety, as rated using various diagnostic criteria, which proves that it is highly effective [25]. The effectiveness of computer-based cognitive-behavioural therapy in reducing dental anxiety (as measured with MDAS) has been confirmed for patients aged 9-16 and 18-70 [6,26].…”

Children's experiences following a CBT intervention to reduce dental anxiety: one year on

“…The same team subsequently reported outcomes from a randomised controlled trial involving 30 dentally anxious young patients. 13 The key finding was that children who received CBT (with a trained clinical psychologist) made statistically significant improvements in their acceptance of dental treatment and a reduction in their anxiety levels compared to those receiving dental treatment without this additional psychological support. In recognition of the limited access to psychologist-led CBT, the authors of the present paper were the first to develop and evaluate a guided self-help CBT resource for the specific management of dental anxiety in children aged 9-16 years.…”

“…An important finding was that 70% of young patients had managed to accept an injection at their own dentist during the follow-up period, suggesting that they had maintained the positive behaviours and thoughts generated by the CBT intervention. The trial conducted by Shahnavaz and co-workers 13 also undertook a one-year review and found that 91% of the CBT group, compared to 25% of the 'usual care' group, no longer met the diagnostic criteria for dental anxiety.…”

“…Although there was some anticipatory anxiety about leaving the secondary care service, it was reassuring to observe a maintenance of anxiety reduction, which concurs with findings from other dental CBT studies. 13,19 Children had clearly adopted new cognitions and behaviours following their previous (successful) course of dental treatment, supported by the principles of CBT. It is well recognised that the use of sedation or general anaesthesia (GA) alone, to facilitate treatment for dentally anxious children, does not actually promote transferrable skills, or changes in attitudes and behaviours in the same way as a psychological intervention would do.…”