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Is Fear Stopping You From Seeing Your Dentist?

Other patients, according to Konneker, provide “vivid descriptors of the sound or smell of the drill, and they’ll talk about how it disturbs them.” “A lot of folks just don’t enjoy the experience of people being so near their mouth for so long, because it is so personal,” she explains.

Konneker has been screening patients to see if they are qualified for and interested in participating in a $2.59 million NIH-funded study run by Temple’s Maurice H. Kornberg School of Dentistry academics.

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The goal was to see if a cognitive behavioral intervention, provided through a series of films right before an appointment, may alleviate this prevalent type of anxiety that keeps patients from receiving necessary care.

According to a meta-analysis of thirty-one studies published in 2021, an estimated 15% of people worldwide experience dental anxiety, with women experiencing it more commonly than males. Another study, which included 308 US patients and was published in 2017, discovered that 19% of patients had moderate to high dental anxiety, which was high enough to benefit from anxiety-reduction methods during treatment. Fear of the dentist experience, a previous terrible experience, the cost of treatment, a gag reflex, and fear of bad news were the most often cited reasons.

When patients miss or cancel visits due to fear, it creates a domino effect, according to Eugene Dunne, a psychologist and assistant professor in the Department of Oral Health Sciences at the Kornberg School of Dentistry. “We think about it in terms of the fear avoidance cycle associated with dental anxiety—that anxiety and dread can lead to postponement or avoidance of dental care,” he explains.

“As a result, when you do ultimately go to seek dental care, it might be emergency care, and more invasive treatment is going to be needed,” he explains. “Thus, what they experience is more pain and more issues when they’re actually at the dentist. So as a result, that cycle continues because it’s being reinforced.”

Furthermore, the repercussions do not end with tooth and gum injuries. Stained and missing teeth might make it difficult to get a job or engage in social situations where smiling helps to create rapport.

According to a poll of more than 5,000 Americans done in 2021 by the CareQuest Institute for Oral Health,a nonprofit organization in Boston, Massachusetts, 12% of US adults who reported not securing a job in the previous year due to dental problems also acknowledged experiencing dental phobia. When compared to White individuals, Hispanic, Black, and Asian adults were more likely to report dread.

Meanwhile, nervous patients face a therapeutic gap, according to Marisol Tellez Merchan, associate dean for research at the Kornberg School of Dentistry.

To treat anxiety symptoms, psychologists and other mental health experts have developed a variety of techniques, including cognitive behavioral therapy. Yet, those professionals are not the same as the dentists who care for patients in their offices. Tellez claims that psychologists are rarely on the faculty of dental schools.

Dentists Need to Learn to Tackle Anxious Patients

“I think that the training in behavioral sciences in dental school has always been very minimal,” Tellez says. At most, she notes, “dentists in general practice may have received some training regarding relaxation techniques and breathing exercises.”

According to Tellez, the patients served by the teachers and students at Temple University’s dentistry clinics are largely Black and Hispanic, with roughly half covered by Medicaid and nearly a fourth without any insurance coverage. People may have to travel for up to an hour to receive care. According to her, Temple, which also has tuition revenue, is frequently the cheapest alternative, with sliding-scale fees for uninsured persons.

Dunne and Tellez, the study’s co-principal investigators, are part of a tiny group of researchers throughout the country who are creating therapies to help patients. Temple’s study combines the skills of dentists and psychologists to investigate if exposing patients to their concerns in advance through a series of videos—a psychological strategy known as exposure therapy—can help them overcome their fears and ratchet down their angst.

The current study, which seeks to enroll 450 patients, analyses patients’ anxiety before the intervention, immediately following the dentist session, and for the next several months, as well as how well they keep appointments.

“I hope that we can see a reduction in anxiety and fear,” Tellez says. “I want to see that somehow that reduction led them to maybe miss fewer appointments during the course of the next twelve months. And that overall, they are more satisfied with the dental experience that is being provided at the school.”

Face Your Anxiety

Dunne explains that the computer-based strategy used by Temple researchers in their study, which has previously been validated12, involves many cognitive behavioral approaches, including exposure therapy. He claims that this cognitive behavioral method has been utilized to treat various fears, such as flying phobia.

Dunne explains that the goal is to work with the patient to create a “hierarchy of terror.” If the most intense fear is flying at 30,000 feet, the patient gradually works up to that scenario through a series of exposure sessions. He suggests that they begin by holding a plush facsimile of an airplane or seeing a cartoon of a plane flying.

They concentrate on establishing coping skills, such as deep breathing methods and more constructive thoughts, at each degree of exposure.

According to Dunne, the technique teaches patients to be present with their anxiety even as it rises, so they may experience weathering it and coming out on the other side: “Facing that dread, letting that anxiety peak, employing those abilities to face that anxiety.”

In the Temple study, participants chose three treatments from a list of six that cause them the most anxiety: cleanings, x-rays, cavity fillings, root canals, injections, or tooth extractions. The patients are then shown a series of movies on the three procedures, beginning with the least feared.

For example, in numerous root canal videos, the process is portrayed from several viewpoints, beginning at a greater distance from the patient actor in the chair and eventually getting closer. The narrator’s running commentary throughout the treatment recommends strategies for the patient to change their thinking about pain, lack of control, and other fears to more peaceful, coping thoughts.

The last root canal video is shot from the patient’s perspective, who is sitting in the chair and looking up at the dentist. The film depicts the patient’s internal monologue and tries to reframe it.

In one scene, the patient worries that the dentist will make a mistake, but then tells himself that a mistake is exceedingly unlikely and that the root canal will relieve his pain considerably more likely.

The study, which had enrolled 376 patients by early December 2022, had divided individuals into three groups to be tracked. In one group, participants complete the intervention before their appointment with the assistance of a graduate-level psychologist. The intervention is provided by a dental assistant who has undergone some cognitive behavioral training in the second group. Participants in the final group, the control group, instead viewed a nature video.

The anxiety level of participants is examined immediately following the dentist session, as well as one month and three months later. Their appointments are also tracked for the first year to see how many appointments patients’ book, whether they keep them, and any changes in patterns, according to Tellez. Upon completing all of the exams, participants will receive a total of $175 in gift cards.

The researchers hope that the trial, the results of which Tellez expects to publish in 2024, will demonstrate that a dental assistant can deliver the intervention to patients right before their consultation. Tellez believes that dental assistants would be appropriate for the job because they are already involved in patient education.

Although the trial is only being conducted in English, the researchers are preparing training manuals, and the intervention has been translated into Spanish to better reach Hispanic patients, she says. The goal is to disseminate the intervention to more dental schools and clinics, although this would necessitate extra money.

Reference :

  1. Strategies to manage patients with dental anxiety and dental phobia: literature review – (https:pubmed.ncbi.nlm.nih.gov/27022303/)

Source: Medindia

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