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Study reveals best way to treat dental phobia- CBT



Well-known member
Oct 20, 2009
Thu, 1 Sep, 2011

Dentistry.co.uk News
31st August 2011

People with severe dental phobia may be able to overcome their anxieties with a single session of cognitive behavioural therapy (CBT), research published in the latest issue of the British Dental Journal (BDJ) suggests.

The authors of the study, based on an initial pilot of 60 patients who relied on having intravenous sedation before they could undergo dental treatment, concluded that the benefits were of such significance that they advise dental providers to implement this approach now rather than wait to pursue further research.

They point out that patients benefit from not being exposed to the health risks associated with repeated intravenous sedation; and this approach saves money for the NHS.

The initial cohort of 60 patients had all attended a specialist dental clinic in Sheffield for people with severe dental phobia.

Half the group were offered CBT, with 21 patients accepting the treatment. Twenty of these went on to have dental treatment without having to be sedated.

An audit of these patients a decade later found that of the 19 patients located who had had CBT, none had returned to sedation in the intervening 10-year period.

The benefits of having CBT for severe dental phobia appear to endure over time, the authors of A joint approach to treating dental phobia: A re-evaluation of a collaboration between community dental services and specialist psychotherapy services ten years on, conclude.

The latest 10-yearly survey on adult dental health published earlier this year by the NHS Information Centre suggests that as many as 12% of people may experience extreme dental anxiety.

Professor Damien Walmsley, the BDA's scientific adviser, said:'Dental phobia is a serious problem because it deters some people from ever going to the dentist, except when they are in severe pain.

'At this stage, they may require more invasive treatment than might be the case if they went to the dentist regularly. Sadly, this cycle of anxiety, non-attendance and pain is often repeated in the children of those with dental phobia, perpetuating the problem and feeding another generation of oral health problems.

'CBT is one of a range of techniques than can be used to make the experience comfortable for patients who feel especially anxious about having dental treatment, and the results of this study look promising for those who experience severe dental phobia.

'All dentists are highly-skilled, caring health professionals who are trained to put patients at ease. Many also undertake additional training in techniques, such as hypnosis, and acupuncture, and of course, CBT.'
I am sure it can work for many people (especially those who have generalised anxiety about lots of things rather than fear based on real previous negative experiences) but you still need to find a nice dentist to go forward.
You wouldn't let just any builder build your new house so why would you let just any dentist work on your teeth and assume the outcome will always be of equal quality and the experience similar; when it is a fact that the skills and techniques and chairside manner of dentists vary widely even when trained in the same country.
I agree with you......

the closing sentence in the article gave it lost credibility IMHO. Some cause phobia, some make it worse, some actually have the capacity to deal with it.

'All dentists are highly-skilled, caring health professionals who are trained to put patients at ease. '
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Perhaps I am missing something but I am very confused by the claims of “a single session” of CBT to cure anxiety as apart from that opening sentence, the article does not state that the patients attended one session only. It actually implies (IMO) that the CBT treatment was an ongoing collaboration between dental and psychotherapy services????

Having undergone CBT treatment for dental phobia, I can attest that it can and does work BUT it is not a magic switch that makes the anxiety disappear rather you are taught to learn and adopt coping techniques, to recognise the fearful stimulus and not allow it to take over. I attended CBT sessions for three months to get to a point where I would describe myself as “nervous but able to cope”, rather than “terrified” of dentistry.

The intake of volunteers is also significant to the success of this study. These were patients who were already registered and presumably would have attended at least one, if not regularly, a specialist, phobic-friendly dental practice. So although dependant on sedation for treatment, they will at least be used to the dental environment and have built up a relationship with a sympathetic dentist, unlike a “cold” phobic patient who may not have visited a dentist for 20+ years with no recent experience on which they can base an element of positive thinking. Of those who volunteered for the process, we have no idea how many were at the stage where sedation may have been needed for some treatments but not others and who may have already significantly reduced the anxiety they felt as new patients. Of the 9 who refused CBT (and the 30 who were not in that group), was this because their anxieties were so high that they could not face the possibility of undergoing treatment without sedation and therefore did not believe in the CBT process?

My experience of CBT – and having also studied basic psychology courses – is that cooperation of the patient is vital – i.e. you have to want it to work and want to overcome the phobia and be willing to put in a lot of work to do this. I couldn’t have undertaken the treatment and obtained the results I did when I was at the total avoidance stage and it is unlikely to yield results for those who go to the dentist under severe duress and not for themselves but my worry is that this article implies it is quick and easy to overcome dental phobia using this kind of therapy and it will work on all phobic patients. Don’t get me wrong, I applaud any attempt to bring therapies like CBT to the fore and think they should be more widely available to those suffering from dental phobia or any anxiety really. I think that identifying and challenging the root of the anxiety has far more longterm effectiveness than treating the resulting anxiety with medication but I think this kind of study does no favours with the potentially skewed results and outlandish claims. It may well serve to make those who have tried and failed to overcome their phobia “in a single session” feel worse about their situation. It certainly has served to pour some water on what I considered to be great achievements in a longer time-frame.

Above all, a good sympathetic denstist is invaluable whether fully co-invested in the treatment or not but willing to listen and build on the progress the patient is making elsewhere. As already stated, the claim that “all dentists are highly-skilled, caring health professionals who are trained to put patients at ease.” Is known by patients and dentists alike on this form and beyond to be a load of codswallop and like RP, it is this overarching attitude to the article that makes me sceptical of the claims no matter how much truth and substance may actually lie behind the study.
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