Exploring Dental Anxiety: A Combined Effort by Dentists and Psychologists

Clinical research on dental anxiety began in the early 1970s due to a growing number of highly anxious patients seeking dental care. A collaborative approach was adopted between dentists and psychologists after recognizing the need for a better understanding of these patients, as well as a need for better dental care strategies. This interdisciplinary collaboration has been the foundation of ongoing research and clinical work for the past 40 years.

The Early Role of Psychologists

Psychologists and dentists first connected at the Institute of Odontology to discuss dental fear and other clinical complications, such as stress-related muscular tension and dentist-patient interactions. At the time, dentists had limited treatment options for dentally fearful patients: sedation, general anesthesia, or “tell-show-do” techniques. However, these approaches did not effectively alleviate dental anxiety, as patients often returned with deteriorated oral health and providing care under general anesthesia increased risk and financial constraints.

Psychologists sought a suitable method to address dental anxiety and discovered Systematic Desensitization. This technique gradually exposes patients to increasingly threatening scenarios related to their phobia while maintaining a relaxed state, ultimately diminishing their anxiety. Psychologists adapted this method, using scenes involving dental care-related situations and began treating fearful patients.

Evolution of Treatment

After implementing this approach, clinicians saw remarkable results, with a small group of patients experiencing significant reductions in fear. With time, the therapy procedure underwent several modifications:

• Video recordings of dental-care situations were used to aid patient exposure, creating a virtual reality approach.
• Treatment sessions were shifted to dental-treatment rooms, increasing ecological validity and effectiveness.
• Patients gained control using a remote device to signal tension instead of raising a hand.
• Relaxation training used muscle relaxation techniques supported by biofeedback to monitor tension.
• The patient’s cognitive roots of dental anxiety were also addressed, exploring and challenging patients’ thoughts and beliefs.

The treatment method was further evaluated, comparing psychological treatment to treatment under general anesthesia. The results overwhelmingly favoured psychological treatment. A follow-up study two years later confirmed the sustained effect, with a significantly higher proportion of patients in the psychological treatment group receiving regular dental care. Systematic reviews of the method and similar behavioural/cognitive behavioural approaches have also shown moderate to good evidence of their clinical value. However, further well-designed clinical trials are needed to establish stronger evidence for long-term effectiveness.

Understanding the Cause of Dental Anxiety

In the field of dental anxiety, there are several ongoing issues that require more attention. One unresolved matter revolves around understanding the causes of this condition. While there appears to be a small genetic component, environmental factors remain significant. Differentiating between direct factors like negative dental experiences and indirect factors such as the influence of fearful family members has been attempted through comprehensive patient history. Research has attempted to determine whether these subgroups respond differently to treatments, hypothesizing that individuals with conditioned anxiety reactions would benefit more from relaxation-oriented approaches. However, results found no difference between relaxation-oriented treatment with cognitively oriented treatment in outcomes between patients with direct and indirect causes of their anxiety.

Dental anxiety is a multifaceted phenomenon involving physical, psychological, and social aspects. Its development occurs through various stages, each adding complexity to the condition and forming a changing foundation for the maintenance and progression of the fear. This complexity makes it difficult to attribute dental anxiety to a single remote cause, be it genetic or experiential.

The Future of Dental Anxiety Research

To understand the development and cause of dental anxiety, longitudinal data is needed. Long-term data collection would provide insight into the complex shaping of dental anxiety/avoidance, leading to improved prevention and treatment approaches. Additionally, understanding the dynamics of dental anxiety could contribute to generalized models for other anxiety conditions. Moreso, dental anxiety research should consider individual and public health perspectives, examining patient-centred factors like quality of life. Collaboration between dentists and psychologists remains essential in this research, which encompasses both clinical and epidemiological projects.

Going forward, it is crucial researchers continue to prioritize three fundamental outcomes for patients: the elimination of dental anxiety, the establishment of regular dental care, and the empowerment of patients with the ability to switch dentists or clinics as needed.