Dental Phobia

Of the phobias in this review, fear of routine dentistry has probably received the greatest attention from theories of cognitive processing. Many people are unable to tolerate routine treatment that might save them from ill-health requiring even more alarming treatment such as extractions. Around a third of adults in an early survey were so afraid of dental treatment they would prefer to have it conducted while they were in a state of oblivion (Lindsay, Humphris & Barnby, 1987). It is possible to conduct dental treatment for patients under sedation or general anaesthesia, which would have that effect, but evidence suggests that those interventions, unlike successful psychological preparation, would not enable patients to accept dentistry while fully conscious (Thom, Sartory & Joehren, 2000).

Around 40 % of people with dental phobia have other clinically significant psychological problems such as depression or anxiety (Roy-Byrne etal., 1994). Furthermore, those people have a higher degree of impairment than those with no comorbidity. This is not surprising because more than a third of patients, unselected for dental phobia, are in continual pain when they decide to visit dentists (Green et al, 1997). Those with a phobia of treatment would probably be in more pain because of greater dental disease (Berggren, 1993). Most patients who are too fearful to tolerate dentistry are afraid of experiencing pain that they believe can occur without warning during treatment and they are afraid that they lack control over this (DeJongh et al., 1995; Lindsay & Jackson, 1993). Cognitive interventions would have to address those expectations.

A clinically significant outcome to psychological treatment must enable patients to accept routine dental care without exceptional measures such as sedation. Furthermore, because patients would have to undergo regular dental inspections and treatment, if necessary, for the rest of their lives, it would be desirable for psychological treatment to promote acceptance of dentistry for several visits. Evidence would have to be dentists' records of treatment because patients' reports of this are probably highly inaccurate (Eddie, 1984).

The studies of phobic patients in Table 20.1 show that exposure to video displays of patients receiving dentistry can reduce anxiety under test conditions. That has enabled subjects to accept one invasive dental procedure according to verifiable records in three studies (Bernstein & Kleinknecht, 1982; Harrison, Berggren & Carlsson, 1989; Jerremalm, Jansson & Oest, 1986). The studies that have tested cognitive therapy (De Jongh et al., 1995; Ning & Liddell, 1991) provide no evidence that the patients were more able to accept dental treatment even though improvements in anxiety on standard measures were recorded. Hypnosis, which is popular among dentists, has been examined in very few controlled studies. Moore et al. (1996) compared hypnotherapy plus graded exposure to dentistry, systematic desensitisation, group therapy and a waiting-list control group. The subjects in all treatments showed a greater reduction in anxiety than the control group but half those who received hypnosis failed to complete the study. Significantly fewer in the desensitisation group, around 8 %, failed to seek dental treatment.

No study has identified subjects with the comorbid disorders or pain that have been recorded in dental phobics. Impairment in daily living is also overlooked in all studies even though quality of life has been noted in dental phobics who avoid treatment and who have poor dental health (Berggren, 1993).

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