In order to deliver dental care for people with dental phobia, it is important to adapt an approach where prevention of oral diseases and preservation of teeth (when possible) is provided as part of the dental care plans.Dr Ellie Heidari from King’s
17 February 2020
How cognitive behavioural therapy (CBT) is helping many people overcome their fear of visiting the dentist
For some people the thought of going to the dentist is terrifying. Psychologists at King’s College London’s Faculty of Dentistry, Oral & Craniofacial Sciences and Guy’s and St Thomas’ NHS Trust have been working over the last 10 years to find out more about dental phobia to help people conquer their fear.
For many patients a bad experience at the dentist can leave them with a life-long phobia which could result in avoidance of check-ups for many years. Anxiety about visiting the dentist is common and becomes a phobia when it has a marked impact on someone’s well-being; people with dental phobias typically avoid going to the dentist and end up experiencing more dental pain, poorer oral health and a detrimental effect on their quality of life.
In recent years researchers at King’s set out to discover more about dental phobia. By analysing data from a national survey, they found that 1 in 10 adults in the United Kingdom were so scared of going to the dentist that they could be called ‘phobic’. They also found that those with dental phobia experienced both short-term and long-term problems in their everyday life – for example pain, difficulty eating and embarrassment about the appearance of their teeth.
The team were interested in why people with dental phobia experience more dental disease than those who are less fearful of visiting a dentist. In a study published in the British Dental Journal, they set out to test whether the presence of dental phobia modifies the proposed care plan for a patient, compared to a similar non-phobic patient.
The results found that treatment plans offered were influenced by the patients’ dental needs, and not the presence of absence of dental phobia. It highlighted that it is still important to consider patients’ anxiety and its management in the treatment plan to ensure the best possible care options are available.
CBT for dental phobia
Cognitive Behavioural Therapy (CBT) is a short-term talking therapy that can help manage fears by changing thoughts and behaviours. Typically lasting 6-10 sessions, CBT has been shown to help with a range of psychological problems, most notably for depression and anxiety-related disorders. It has now been shown to be successful in reducing dental anxiety and increasing dental attendance.
Psychologists working with dental patients at King’s have developed the UK’s first dedicated cognitive behavioural therapy service for individuals with dental phobia. They have produced a training model which has been rolled out in many locations across the UK.
People with dental phobia are most commonly given sedation to allow them to become relaxed enough to have dental treatment performed. However, this does not help them to overcome their fear in the long term.Tim Newton, Professor of Psychology as Applied to Dentistry
“The primary goal of our CBT service is to enable patients to receive dental treatment without the need for sedation by working with each individual patient to set goals according to their priorities.”
Over a period of six to ten weeks, psychologists help prepare dental patients by explaining every step of the treatment and gradually introducing them to the dental clinic environment.
A study has shown the success of the programme. Nine-tenths (93%) of dental phobic patients who completed a course of CBT then went on to have dental treatment without the need for sedation. Now operating for over 10 years, the team have developed training resources on the service. This has enabled other dental teams across the UK to set up CBT sessions for patients with dental phobia in their areas, through training provided by King’s.
Eileen Byrne, 65 from Coventry, avoided going to the dentist for three years after a traumatic experience. The retired personal assistant said: “I was always really nervous, so much so that I didn’t sit in the waiting room. I used to wait outside until they called me in.
“The sessions at Guy’s Hospital helped me to think about positive things and gave me the confidence to sign up with a dentist closer to home.”
Virtual reality technology
Researchers from King’s and Guy’s and St Thomas’ are now exploring whether virtual reality technology could help treat people with dental phobia. Patients who have been successfully treated with traditional CBT at Guy’s Hospital have helped develop the study, which involves wearing a virtual reality headset to simulate the dental clinic environment.
Virtual reality is already used to help people with a fear of flying or heights and so far, feedback for the dental phobia is encouraging.Dr Jennifer Hare, lead health psychologist in dental services at Guy’s and St Thomas’
If successful, the hope is that the use of virtual reality for dental phobia may increase access to services and support more people to overcome their fears.