Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental Anxiety: Open Trial

Abstract

BackgroundCognitive behavioral therapy (CBT) is an evidence-based method for treating specific phobias, but access to treatment is difficult, especially for children and adolescents with dental anxiety. Psychologist-guided Internet-based CBT (ICBT) may be an effective way of increasing accessibility while maintaining treatment effects.ObjectiveThe aim of this study was to test the hypothesis that psychologist-guided ICBT improves school-aged children’s and adolescents’ ability to manage dental anxiety by (1) decreasing avoidance and affecting the phobia diagnosis and (2) decreasing the dental fear and increasing the target groups’ self-efficacy. The study also aimed to examine the feasibility and acceptability of this novel treatment.MethodsThis was an open, uncontrolled trial with assessments at baseline, posttreatment, and the 1-year follow-up. The study enrolled and treated 18 participants. The primary outcome was level of avoidance behaviors, as measured by the picture-guided behavioral avoidance test (PG-BAT). The secondary outcome was a diagnostic evaluation with the parents conducted by a psychologist. The specific phobia section of the structured interview Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) was used. Other outcome measures included level of dental anxiety and self-efficacy. The ICBT, which employed exposure therapy, comprised 12 modules of texts, animations, dentistry-related video clips, and an exercise package (including dental instruments). Participants accessed the treatment through an Internet-based treatment platform and received Web-based guidance from a psychologist. Treatment also included training at dental clinics. Feasibility and acceptability were assessed by measures of engagement, adherence, compliance, completed measures, patient and parent satisfaction scale, and staff acceptability.ResultsThe level of avoidance (according to the primary outcome measure PG-BAT) and dental anxiety decreased and self-efficacy increased significantly (P<.001), within-group effect sizes for both the primary outcome (Cohen d=1.5), and other outcomes were large in the range of 0.9 and 1.5. According to K-SADS-PL, 53% (8/15) of the participants were free from diagnosable dental anxiety at the 1-year follow-up. At the 1-year follow-up, improvements were maintained and clinically significant, with 60% (9/15) of participants who had been unable to manage intraoral injection of local anesthetics before ICBT reporting having accomplished this task at a dental clinic. The target group showed improvement in all the outcome measures. High levels of feasibility and acceptability were observed for the treatment.ConclusionsICBT is a promising and feasible treatment for dental anxiety in children and adolescents. Integrating it into routine pediatric dental care would increase access to an effective psychological treatment. The results of this open trial must be replicated in controlled studies.

Demystifying behaviour and dental anxiety in schoolchildren during endodontic treatment for primary teeth—controlled clinical trial

“…28 Dentists who perceive exacerbated anxiety or fear should direct such patients to effective psychological treatment to learn how to cope with anxiety. 29 This study has positive aspects that should be stressed. Behaviour was measured using a scale considered the gold standard for this purpose.…”

“…Soares (2017) found that experiences with dental caries increase the chance of dental anxiety in childhood and a greater number of decayed teeth or teeth indicated for extraction constitute a greater risk of developing high dental anxiety . Dentists who perceive exacerbated anxiety or fear should direct such patients to effective psychological treatment to learn how to cope with anxiety …”

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

“…Relaxation Learning (CARL), 41 Computerized-Cognitive Behavioral Therapy (C-CBT) 42 and psychologist guided internet-based Cognitive Behavioral Therapy (ICBT). 43 From a clinical dental practice perspective, it is important to establish whether there is sufficient evidence to justify the use of technology-based interventions for the treatment of dental anxiety. 30 Accordingly, the purpose of the present study was to systematically review the available studies that examined the effectiveness of technology-based interventions in alleviating moderate to severe dental anxiety.…”

“…53 For instance, in resource poor settings, where dentists are not available to devote time for treatment of dental anxiety, dental auxiliaries could be trained in administering technology-based interventions for treatment of dental anxiety. Accordingly, high quality trials are needed to determine the (relative) effectiveness of emerging interventions such as smart-phone based exposure treatment, 54 VR enhanced video exposure therapy, 55 VRET 50 and internet-based CBT 43 for treatment of dental anxiety.…”

O Emprego da Terapia Reiki no Tratamento Odontológico

“…Manifestações de ansiedade e medo dos indivíduos no decorrer das condutas odontológicas dificultam os tratamentos e podem levar ao desgaste físico e emocional dos cirurgiões dentistas. Os locais em que ocorrem os atendimentos odontológicos, seja em consultórios dentários ou em ambulatórios, também podem influenciar em manifestações adversas de cunho emocional nos pacientes, que devem ser evitadas (MARCOS et al, 2010;MORAIS, 2003;SINGH et al, 2000;SILVA et al, 2016;SHAHNAVAZ et al, 2018).…”