Dental Treatment under Sedation

Raadal, Magne

doi:10.1002/9781118499825.ch11

Cited by 2 publications

(2 citation statements)

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“…Standard therapeutics for fear frequently used by dental providers, such as anxiolytics and more substantial sedation, are offered out of compassion and may permit treatment completion in the short term, but they do nothing to reduce patients' subsequent anxiety or avoidance [7]. Thus, these interventions counterproductively perpetuate the fear → avoidance → dental‐problem → acute‐treatment → fear cycle [8].…”

Section: Introductionmentioning

confidence: 99%

Leveraging technology to increase the disseminability of evidence‐based treatment of dental fear: An uncontrolled pilot study

Heyman,

Daly,

Slep

et al. 2023

J Public Health Dent

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ObjectivesU.S. and global estimates indicate that over 30% of adults fear receiving dental care, including over 20% who have visited a dentist in the last year, leading to avoidance and degraded oral and systemic health. Although evidence‐based cognitive‐behavioral treatments for dental fear (CBT‐DF) exist, they have little impact on the millions who seek dental care annually because they are not disseminable (6 h of in‐chair time, delivered only in person at a few sites). We developed a disseminable CBT‐DF stepped‐care treatment comprising (Step 1) a mobile‐health application and, for those who remain fearful, (Step 2) a 1‐h, one‐on‐one psychological treatment session that allows practice during exposure to the patient's most‐feared stimuli. We hypothesized that the treatment would (a) be rated highly on usability and credibility and (b) result in clinically consequential (i.e., lowering fear into the 0–3 “no/low fear” zone) and statistically significant changes in global dental fear.MethodRacially/ethnically diverse patients (N = 48) with moderate to severe dental fear were recruited; all completed Step 1, and n = 16 completed Step 2.ResultsAs hypothesized, users found the stepped‐care treatment highly usable, credible, and helpful. Critically, this stepped‐care approach produced reductions in patients' dental fear that were both clinically consequential (with half no longer fearful) and statistically significant (d = 1.11).ConclusionsThis usable, credible, stepped‐care approach to dental fear treatment holds promise for liberating evidence‐based CBT‐DF from specialty clinics, allowing broad dissemination.

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Section: Introductionmentioning

confidence: 99%

Leveraging technology to increase the disseminability of evidence‐based treatment of dental fear: An uncontrolled pilot study

Heyman,

Daly,

Slep

et al. 2023

J Public Health Dent

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“…Furthermore, it is not due to lack of impact, as dental fear has demonstrable impacts on public health. As summarized by the US Surgeon General’s report (US Department of Health and Human Services 2000, p. iii), dental fear leads to “needless pain and suffering, causing devastating complications to an individual’s well-being, with financial and social costs that significantly diminish quality of life and burden American society.” Finally, it is not due to competing evidence-based standard practice, as standard treatment involves receiving intravenous (IV) sedation or anxiolytics (e.g., Milgrom et al 2013), both of which are contraindicated because they do nothing to reduce subsequent anxiety or treatment avoidance (e.g., Wannemueller et al 2011), lead to continued dental health problems (Jöhren et al 2000; Thom et al 2000; Raadal 2013), and perpetuate a pattern of patient fear → avoidance → dental problems. Clearly, the challenge at present is not how to treat dental fear to reduce the financial and human suffering burden to public health but how to disseminate and implement EBIs in a way that recognizes the rewards and barriers in the US health care system.…”

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confidence: 99%

Dentist-Perceived Barriers and Attractors to Cognitive-Behavioral Treatment Provided by Mental Health Providers in Dental Practices

et al. 2018

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Over 1 in 5 dental patients report moderate to severe dental fear. Although the efficacy of cognitive-behavioral treatment (CBT) for dental fear has been examined in over 20 randomized controlled trials-with 2 meta-analyses finding strong average effect sizes ( d > 1)-CBT has received almost no dissemination beyond the specialty clinics that tested it. The challenge, then, is not how to treat dental fear but how to disseminate and implement such an evidence-based treatment in a way that recognizes the rewards and barriers in the US health care system. This mixed-method study investigated the potential of disseminating CBT through care from a mental health provider from within the dental home, a practice known as evidence-based collaborative care (EBCC). Two preadoption studies were conducted with practicing dentists drawn from a self-organized Practice-Based Research Network in the New York City metropolitan area. The first comprised 3 focus groups ( N = 17), and the second involved the administration of a survey ( N = 46). Focus group participants agreed that CBT for dental fear is worthy of consideration but identified several concerns regarding its appeal, feasibility, and application in community dental practices. Survey participants indicated endorsement of factors promoting the use of EBCC as a mechanism for CBT dissemination, with no factors receiving less than 50% support. Taken together, these findings indicate that EBCC may be a useful framework through which an evidence-based treatment for dental fear treatment can be delivered.

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Dental Treatment under Sedation

Cited by 2 publications

References 13 publications

Leveraging technology to increase the disseminability of evidence‐based treatment of dental fear: An uncontrolled pilot study

Leveraging technology to increase the disseminability of evidence‐based treatment of dental fear: An uncontrolled pilot study

Dentist-Perceived Barriers and Attractors to Cognitive-Behavioral Treatment Provided by Mental Health Providers in Dental Practices

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