T. Newton

The management of dental anxiety: time for a sense of proportion?

Dental anxiety and fear are common and potentially problematic, both for the patient and for the dental team in managing such patients. Furthermore, dental fear still presents a major barrier to the uptake of dental treatment. This article will take as its premise an assumption that anxiety manifests at different levels and that consequently management of dental anxiety involves both assessment and proportionate intervention. Methods for undertaking both assessment and management are outlined.

Acceptability of behaviour therapy for dental phobia

OBJECTIVE To determine how people with dental phobia rate the acceptability of behavioural therapy. METHODS One hundred and twenty individuals with dental phobia participated in a three-factor experimental vignette-based design. The three factors examined were dental treatment history, nature of intervention (intravenous sedation or behavioural therapy) and treatment outcome. There were eight different vignettes representing all combinations of the three experimental variables, and 15 participants completed each vignette. RESULTS Treatment outcome had a strong effect on rated acceptability (F = 115.76, P < 0.001). There was a weaker effect of treatment type (F = 5.49, P < 0.05) with behavioural therapy rated as more acceptable than intravenous sedation. Previous history of intravenous sedation was associated with a decreased perception that it is possible to overcome dental fear. CONCLUSIONS The perceptions of individuals with dental phobia of the acceptability of behavioural approaches to management are influenced by the perceived outcome of the treatment.

Summary of: estimating the need for dental sedation. 1. The Indicator of Sedation Need (IOSN) - a novel assessment tool.

While the control of pain and anxiety is fundamental to the practice of dentistry, the use of conscious sedation in dentistry is very variable among dentists. The need for conscious sedation could be considered by assessing and ranking a combination of information on patient anxiety, medical history and the complexity of the anticipated clinical treatment. By undertaking this systemtic assessment an indication of sedation need may be developed which would act as an aide to decision making and, potentially, referral management. Such a tool could also be used by commissioners who need to identify patients who need conscious sedation for dental treatment in order to plan, commission and deliver appropriate sedation services.

Summary of: Estimating the need for dental sedation. 2. Using IOSN as a health needs assessment tool

Aim This service evaluation assessed the need for sedation in a population of dental attenders (n = 607) in the North West of England.Methods Using the novel IOSN tool, three clinical domains of sedation need were assessed: treatment complexity, medical and behavioural indicators and patient reported anxiety using the Modified Dental Anxiety Scale.Results The findings suggest that 5% of the population are likely to require a course of treatment under sedation at some time. All three clinical domains contributed to the IOSN score and indication of treatment need. Females were 3.8 times more likely than males to be placed within the high need for sedation group. Factors such as age, deprivation and practice location were not associated with the need for sedation.Conclusions Primary care trusts (PCTs) need health needs assessment data in order to commission effectively and in line with World Class Commissioning guidelines. This study provides both an indicative figure of need as well as a tool by which individual PCTs can undertake local health needs assessment work. Caution should be taken with the figure as a total need within a population as the study has only included those patients that attended dental practices.