Dental Anxiety
Conditions
Brief summary
Dental and health anxiety are common and potentially distressing problems, for both patients and health care providers. Anxiety has been identified as a barrier to regular dental visits and as an important target for enhancement of oral health-related quality of life. possible groups, (1) high dental anxiety and (2) low dental anxiety. The study aimed to develop and evaluate a computerized cognitive-behavioral therapy dental anxiety intervention (C-CBT) that could be easily implemented in dental healthcare settings. A cognitive-behavioral protocol based on psychoeducation, exposure to feared dental procedures, and cognitive restructuring was developed. A randomized controlled trial was conducted (N=151) to test its efficacy. Consenting adult dental patients who met inclusion (e.g., high dental anxiety) and exclusion criteria were randomized to one of two groups, (1) immediate treatment (IT) (n=74) or (2) a waitlist control (WL) (n=77).
Detailed description
Analyses of covariance (ANCOVAs) based on intention to treat analyses were used to compare the two groups on dental anxiety, fear, avoidance, and overall severity of dental phobia. Baseline scores on these outcomes were entered into the analyses as covariates.
Interventions
BEHAVIORALComputerized Dental Anxiety Treatment
The Computerized Dental Anxiety Treatment Program consists of treatment modules that are be delivered through a computer. The modules use Cognitive Behavioral Therapy (CBT) to assist the participant in preparing a personal plan for managing his/her dental anxiety. The program incorporates a range of CBT techniques, including cognitive restructuring, exposure, and motivational interviewing.
Sponsors
Pennsylvania Department of Health
Temple University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* high dental anxiety * fluent in spoken and written English
Exclusion criteria
* unable to provide written, informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Modified Dental Anxiety Scale | Change from one week before dentist appointment to 1 month after dentist appointment | The Modified Dental Anxiety Scale a five-item self-report measure that assesses fear of dental procedures, including drilling, scaling and polishing (i.e., cleaning), and local anesthetic injections. Sample items include, If you went to your dentist for treatment tomorrow, how would you feel? and If you were about to have your tooth drilled, how would you feel? Items are rated on a five-point Likert-type scale ranging from 1 (not anxious) to 5 (extremely anxious). Scale 0-25. We considered patients who scored \> 19 on the MDAS at baseline or endorsed at least two MDAS items \> 4 to have high dental anxiety. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Clinical Severity Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV | Change from one week before dental appointment to one-month after dental appointment | The Anxiety Disorders Interview Schedule for DSM-IV is a semi-structured diagnostic interview for assessing DSM-IV criteria for current anxiety, depressive, somatoform, and substance use disorders. For the present investigation, only the specific phobia module of the ADIS-IV was administered to assess the presence and severity of a current diagnosis of dental phobia. Various aspects of dental phobia were assessed using the specific phobia module of the ADIS-IV. Interviewers assessed participants' anxiety and avoidance of dental procedures on scales that ranged from 0 (none) to 8 (very severe). They also rated patients' overall distress and impairment due to their dental phobia symptoms and assigned a clinician's severity rating (CSR) that also ranged from 0 (none) to 8 (very severe); a CSR \> 4 indicated that the participant met criteria for diagnosis of dental phobia. |
| Change in Fear Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV | Change from one week before appointment to one month after appointment | The Anxiety Disorders Interview Schedule for DSM-IV is a semi-structured diagnostic interview for assessing DSM-IV criteria for current anxiety, depressive, somatoform, and substance use disorders. For the present investigation, only the specific phobia module of the ADIS-IV was administered to assess the presence and severity of a current diagnosis of dental phobia. Various aspects of dental phobia were assessed using the specific phobia module of the ADIS-IV. Interviewers assessed participants' anxiety and avoidance of dental procedures on scales that ranged from 0 (none) to 8 (very severe). They also rated patients' overall distress and impairment due to their dental phobia symptoms and assigned a clinician's severity rating (CSR) that also ranged from 0 (none) to 8 (very severe); a CSR \> 4 indicated that the participant met criteria for diagnosis of dental phobia. |
| Change in Avoidance Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV | Change from one week before appointment to one month after appointment | The Anxiety Disorders Interview Schedule for DSM-IV is a semi-structured diagnostic interview for assessing DSM-IV criteria for current anxiety, depressive, somatoform, and substance use disorders. For the present investigation, only the specific phobia module of the ADIS-IV was administered to assess the presence and severity of a current diagnosis of dental phobia. Various aspects of dental phobia were assessed using the specific phobia module of the ADIS-IV. Interviewers assessed participants' anxiety and avoidance of dental procedures on scales that ranged from 0 (none) to 8 (very severe). They also rated patients' overall distress and impairment due to their dental phobia symptoms and assigned a clinician's severity rating (CSR) that also ranged from 0 (none) to 8 (very severe); a CSR \> 4 indicated that the participant met criteria for diagnosis of dental phobia. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Immediate Treatment Before the intervention, participants completed self-report questionnaires and a telephone diagnostic interview. Participants in the immediate treatment group were asked to come in 1.5 hours before a previously scheduled dental appointment to complete the computerized cognitive-behavioral therapy dental anxiety intervention (C-CBT).
The C-CBT consisted of a single-session, one-hour computerized intervention that assisted the participant in building skills for managing his or her dental anxiety.
One month after the dental appointment, participants were contacted by phone and asked to complete follow-up assessments. | 74 |
| Waiting List Control Before their dental appointments, participants completed self-report questionnaires and a telephone diagnostic interview. Waiting list control participants attended their scheduled dental appointment without receiving the computerized cognitive-behavioral therapy dental anxiety intervention but were offered the opportunity to receive the same intervention following all of their study assessments.
One month after the dental appointment, participants were contacted by phone and asked to complete follow-up assessments. | 77 |
| Total | 151 |
Baseline characteristics
| Characteristic | Total | Waiting List Control | Immediate Treatment |
|---|---|---|---|
| ADIS Specific Phobia Avoidance Rating | 4.2 units on a scale STANDARD_DEVIATION 2.4 | 3.9 units on a scale STANDARD_DEVIATION 2.5 | 4.6 units on a scale STANDARD_DEVIATION 2.2 |
| ADIS Specific Phobia Clinical Severity Rating | 5.0 units on a scale STANDARD_DEVIATION 1.5 | 4.8 units on a scale STANDARD_DEVIATION 1.6 | 5.3 units on a scale STANDARD_DEVIATION 1.4 |
| ADIS Specific Phobia Fear Rating | 5.4 units on a scale STANDARD_DEVIATION 1.3 | 5.2 units on a scale STANDARD_DEVIATION 1.4 | 5.6 units on a scale STANDARD_DEVIATION 1.3 |
| Age, Continuous | 44.7 years STANDARD_DEVIATION 13.1 | 44.6 years STANDARD_DEVIATION 13.6 | 44.7 years STANDARD_DEVIATION 12.8 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 10 Participants | 5 Participants | 5 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 111 Participants | 58 Participants | 53 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 30 Participants | 14 Participants | 16 Participants |
| Gender Female | 93 Participants | 41 Participants | 52 Participants |
| Gender Male | 58 Participants | 36 Participants | 22 Participants |
| MDAS Baseline Score | 19.5 units on a scale STANDARD_DEVIATION 2.8 | 19.6 units on a scale STANDARD_DEVIATION 2.6 | 19.5 units on a scale STANDARD_DEVIATION 2.9 |
| Race/Ethnicity, Customized Asian | 4 participants | 2 participants | 2 participants |
| Race/Ethnicity, Customized Black or African American | 78 participants | 44 participants | 34 participants |
| Race/Ethnicity, Customized Not reported/missing | 22 participants | 10 participants | 12 participants |
| Race/Ethnicity, Customized Other | 9 participants | 3 participants | 6 participants |
| Race/Ethnicity, Customized White | 38 participants | 18 participants | 20 participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 74 | 0 / 77 |
| serious Total, serious adverse events | 0 / 74 | 0 / 77 |
Outcome results
Primary
Change in Modified Dental Anxiety Scale
The Modified Dental Anxiety Scale a five-item self-report measure that assesses fear of dental procedures, including drilling, scaling and polishing (i.e., cleaning), and local anesthetic injections. Sample items include, If you went to your dentist for treatment tomorrow, how would you feel? and If you were about to have your tooth drilled, how would you feel? Items are rated on a five-point Likert-type scale ranging from 1 (not anxious) to 5 (extremely anxious). Scale 0-25. We considered patients who scored \> 19 on the MDAS at baseline or endorsed at least two MDAS items \> 4 to have high dental anxiety.
Time frame: Change from one week before dentist appointment to 1 month after dentist appointment
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Immediate Treatment | Change in Modified Dental Anxiety Scale | Baseline | 19.5 units on a scale | Standard Error 0.34 |
| Immediate Treatment | Change in Modified Dental Anxiety Scale | One month follow up | 15.4 units on a scale | Standard Error 0.74 |
| Waiting List Control | Change in Modified Dental Anxiety Scale | Baseline | 19.6 units on a scale | Standard Error 0.3 |
| Waiting List Control | Change in Modified Dental Anxiety Scale | One month follow up | 17.6 units on a scale | Standard Error 0.63 |
Comparison: Comparison of two groups at 1 month follow up with baseline value as the covariatep-value: <0.0595% CI: [0.74, 3.55]ANCOVA
Secondary
Change in Avoidance Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV
The Anxiety Disorders Interview Schedule for DSM-IV is a semi-structured diagnostic interview for assessing DSM-IV criteria for current anxiety, depressive, somatoform, and substance use disorders. For the present investigation, only the specific phobia module of the ADIS-IV was administered to assess the presence and severity of a current diagnosis of dental phobia. Various aspects of dental phobia were assessed using the specific phobia module of the ADIS-IV. Interviewers assessed participants' anxiety and avoidance of dental procedures on scales that ranged from 0 (none) to 8 (very severe). They also rated patients' overall distress and impairment due to their dental phobia symptoms and assigned a clinician's severity rating (CSR) that also ranged from 0 (none) to 8 (very severe); a CSR \> 4 indicated that the participant met criteria for diagnosis of dental phobia.
Time frame: Change from one week before appointment to one month after appointment
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Immediate Treatment | Change in Avoidance Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV | Baseline | 4.6 units on a scale | Standard Error 0.31 |
| Immediate Treatment | Change in Avoidance Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV | One month follow up | 1.3 units on a scale | Standard Error 0.31 |
| Waiting List Control | Change in Avoidance Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV | Baseline | 3.9 units on a scale | Standard Error 0.32 |
| Waiting List Control | Change in Avoidance Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV | One month follow up | 1.0 units on a scale | Standard Error 0.29 |
Comparison: Comparison of two groups at 1 month follow up with baseline value as the covariatep-value: <0.0595% CI: [0.01, 1.64]ANCOVA
Secondary
Change in Clinical Severity Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV
The Anxiety Disorders Interview Schedule for DSM-IV is a semi-structured diagnostic interview for assessing DSM-IV criteria for current anxiety, depressive, somatoform, and substance use disorders. For the present investigation, only the specific phobia module of the ADIS-IV was administered to assess the presence and severity of a current diagnosis of dental phobia. Various aspects of dental phobia were assessed using the specific phobia module of the ADIS-IV. Interviewers assessed participants' anxiety and avoidance of dental procedures on scales that ranged from 0 (none) to 8 (very severe). They also rated patients' overall distress and impairment due to their dental phobia symptoms and assigned a clinician's severity rating (CSR) that also ranged from 0 (none) to 8 (very severe); a CSR \> 4 indicated that the participant met criteria for diagnosis of dental phobia.
Time frame: Change from one week before dental appointment to one-month after dental appointment
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Immediate Treatment | Change in Clinical Severity Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV | Baseline | 5.3 units on a scale | Standard Error 0.19 |
| Immediate Treatment | Change in Clinical Severity Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV | One month follow up | 3.4 units on a scale | Standard Error 0.27 |
| Waiting List Control | Change in Clinical Severity Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV | Baseline | 4.8 units on a scale | Standard Error 0.2 |
| Waiting List Control | Change in Clinical Severity Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV | One month follow up | 4.0 units on a scale | Standard Error 0.23 |
Comparison: Comparison of two groups at 1 month follow up with baseline value as the covariatep-value: <0.0595% CI: [0.39, 1.57]ANCOVA
Secondary
Change in Fear Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV
The Anxiety Disorders Interview Schedule for DSM-IV is a semi-structured diagnostic interview for assessing DSM-IV criteria for current anxiety, depressive, somatoform, and substance use disorders. For the present investigation, only the specific phobia module of the ADIS-IV was administered to assess the presence and severity of a current diagnosis of dental phobia. Various aspects of dental phobia were assessed using the specific phobia module of the ADIS-IV. Interviewers assessed participants' anxiety and avoidance of dental procedures on scales that ranged from 0 (none) to 8 (very severe). They also rated patients' overall distress and impairment due to their dental phobia symptoms and assigned a clinician's severity rating (CSR) that also ranged from 0 (none) to 8 (very severe); a CSR \> 4 indicated that the participant met criteria for diagnosis of dental phobia.
Time frame: Change from one week before appointment to one month after appointment
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Immediate Treatment | Change in Fear Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV | Baseline | 5.6 units on a scale | Standard Error 0.17 |
| Immediate Treatment | Change in Fear Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV | One month follow up | 3.8 units on a scale | Standard Error 0.26 |
| Waiting List Control | Change in Fear Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV | Baseline | 5.2 units on a scale | Standard Error 0.17 |
| Waiting List Control | Change in Fear Rating for Specific Phobia Module of Anxiety Disorders Interview Schedule for DSM-IV | One month follow up | 4.8 units on a scale | Standard Error 0.23 |
Comparison: Comparison of two groups at 1 month follow up with baseline value as the covariatep-value: <0.0595% CI: [0.61, 1.85]ANCOVA