Management of children's dental anxiety

Overcoming challenges in the delivery of psychological interventions to reduce dental anxiety

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Overcoming challenges in the delivery of psychological interventions to reduce dental anxiety

Whilst there is substantial evidence to support the use of CBT in the treatment of anxiety there are a number of barriers which may prevent dentally anxious children receiving evidence-based psychological interventions. Referring dentally anxious children to psychological services can be problematic due to costs and long waiting lists associated with this type of therapy . Dentists themselves, however, may feel reluctant to employ a variety of psychological techniques in their practice. Indeed, only one fifth of General Dental Practitioners report feeling confident providing restorative care to dentally anxious children and just under half of paediatric dentists believe there is not sufficient information on techniques for managing children’s dental anxiety . there is certainly support for argument dentists would benefit from additional training in this area... implications for dental education..etc... Helen.....

It is also important to consider how evidence based interventions are delivered to dentally anxious children and there is a need for these interventions to be adapted and integrated into everyday clinical practice. A promising method of delivering evidence-based psychological interventions, without intensive practitioner input, is by using an assisted self-help approach. Assisted self-help has been found to produce superior results over unsupported (pure) self-help approaches . The greater availability of self-help treatment in primary care and community settings may have the potential to provide cost effective, accessible and appropriate treatment for a range of problems and psychological therapies . Interventions include a range of media-based treatment approaches (e.g. video, workbooks/manuals and audiotapes) and a meta analysis of the effectiveness of these approaches revealed that problems such as fears are particularly amenable to self-help treatments . Indeed, research has revealed that Computerised Cognitive Behavioural Therapy (CCBT) programmes may be as effective as therapist-led cognitive behaviour therapy in the treatment of phobias . However, no age-appropriate self-help programmes currently exist for children with dental anxiety/phobia.
It should be recognised, however, that some patients will require more intensive or flexible approaches than those which can be delivered via a self-help format or by the dental team alone. Indeed, referral to a psychologist is recommended for patients who present with complex problems or have high levels of dental anxiety/extreme phobic reactions which would require the application of complicated cognitive-behavioural strategies .

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