Minimum intervention oral healthcare for people with dental phobia: a patient management pathway

Abstract

Dental phobia is relatively common among adults and often associated with poorer oral health as a consequence of delaying dental treatment until advanced disease has caused intolerable symptoms. The increased rates of active disease may also have an impact on oral health-related quality of life (OHR QoL). Minimum intervention oral healthcare (MIOC) combines four key domains: detection and diagnosis, prevention and control of oral disease, minimally invasive (MI) operative interventions and review/recall. Team delivery and patient-focused care are the underpinning tenets to these four domains. The MIOC approach offers advantages to both patients with dental phobia and the oral healthcare team involved in their long-term management. This paper presents an adaptation of MIOC for patients with dental phobia, which is founded on a comprehensive assessment approach followed by the provision of dental care with behavioural management techniques in combination with conscious sedation. This approach has the potential to provide a comprehensive personalised patient management pathway for delivering better oral health for this vulnerable patient group in a primary care setting.

Impact of Educational Videos on Dental Anxiety and Fear in Patients Undergoing Root Canal Treatment in Shiraz, Iran

“…Mark (2017) concluded that some methods, such as adapting to body posture and relaxation, can reduce dental anxiety (24). Heidari et al (2020) also reported a relationship between anxiety and unpleasant experience before dental appointment (27).…”

Augmented, Virtual and Mixed Reality in Dentistry: A Narrative Review on the Existing Platforms and Future Challenges

“…Following the same concept, VR can serve as an effective non-pharmacologic analgesic for dental pain [45]. Several studies reported that VR reduced their awareness of dental pain and that they were so absorbed in the VR that they did not think often about their pain [46][47][48]. The patient's inability to see the dental practitioner and instruments may be one advantage of VR.…”

Safe intravenous sedation for oral surgery in a primary care setting

“…Non-pharmacological behavioural management techniques can include simple strategies such as rapport building, enhancing sense of control, cognitive distraction, systematic desensitisation, and provision of procedural, sensory and coping information. [21][22][23] The use of cognitive behavioural therapy (CBT) is a well-established therapy for people with dental anxiety, and has a wide base of evidence for efficacy and effectiveness, maintaining positive effects over time. 22,24,25 Once sedation assessment has been undertaken, and the sedation technique has been decided upon, the justification for this should be documented in the patient's notes.…”

“…A high BmI can result in increased risk of sedation-related complications due to increased adipose tissue surrounding the airway leading to reduced patency, increased metabolic demands, associated comorbidities and increased challenges in managing the airway should complications arise. 21…”