Behavioural interventions could reduce dental anxiety and improve dental attendance in adults

Abstract

DATA SOURCES: PubMed and Psychlit were searched from 1966 to 2001. Reference lists from retrieved articles were also examined for more studies. Study authors were contacted for additional information where necessary.STUDY SELECTION: For inclusion, an article had to satisfy the following criteria: the study sample should be adult subjects with documented high dental fear or avoidance; outcome measures should include at least self-reported changes in dental fear; outcomes should preferably include changes in dental behaviour or attendance post-treatment.DATA EXTRACTION AND SYNTHESIS: Studies were categorised into 3 behavioural interventions: behaviourally oriented approaches, cognitively oriented approaches and educational interventions. Attendance measures were grouped into <6 months, 6 months to 4 years after the intervention and longer term. The effect size (ES) for self-reported dental anxiety and for dental attendance post-treatment was calculated. Homogeneity tests were conducted.RESULTS: The search identified 80 articles, of which 38 met the inclusion criteria. The calculated ES for self-reported anxiety after intervention indicated positive changes in 36 out of the 38 studies and no change in two. The overall ES was 1.78 [95% confidence interval (CI), 1.67-1.89]. The proportion of subjects with post-treatment dental visits in the first 6 months varied between 50 and 100%. The overall ES for attendance at dental visits, weighted by sample size, was 1.4 (95% CI, 1.27-1.58). The homogeneity analysis indicated that the studies could not be adequately described in one ES. The reported proportion of subjects with a dental visit between 6 months and 4 years post-treatment varied from 48 to 100%. The overall weighted ES for visiting the dentist, adjusted for drop-outs in the studies, was 1.17 (95% CI, 0.99-1.35).CONCLUSIONS: Despite extensive heterogeneity, changes in self-reported anxiety represented a medium to large ES. Patients signing up for a behavioural intervention for dental fear can be expected to report a significant reduction in their fear, and this effect generally seems to be lasting. Mean long-term attendance (>4 years after treatment) was 77%.