A Temple University study reports that a one-hour online cognitive behavioral therapy (CBT) program reduced dental patients’ use of avoidance coping strategies—a change the researchers say may help reduce dental fear.
The findings, published in the journal Frontiers in Oral Health, were funded by the National Institute of Dental and Craniofacial Research and based on data from a randomized clinical trial led by Marisol Tellez of Temple University’s Maurice H. Kornberg School of Dentistry.
The research team included Amid Ismail, Elizabeth Konneker, Eugene M. Dunne, and Tellez. A total of 499 trial participants provided patient-reported experiences for analysis.
Dental anxiety is common. The paper notes that the prevalence of dental anxiety in the United States is estimated to be approximately 19% among adults and 24% among children and adolescents.
According to the study’s lead author, Connek, the team aimed to measure the prevalence of dental anxiety and identify practical tools to help patients feel better about visiting the dentist.
Researchers identified three main sources of dental anxiety: traumatic dental visits in childhood, traumatic dental events in adulthood, and persistent generalized anxiety. Common triggers cited by patients included loss of control, distrust of caregivers, and fear of pain.
The trial tested a brief online intervention based on cognitive behavioral therapy (CBT) administered before dental appointments to patients reporting high levels of dental anxiety.
After a baseline assessment, participants were randomly assigned to three groups: one group watched the intervention in the presence of a trained staff member in the room, one group watched the intervention in the presence of a psychology-trained staff member, and one group watched a control video matched for time and attention.
Researchers collected qualitative data using the Anxiety and Related Disorders Interview Scale (ADIS) at baseline and at one and three months.
Participants described when they first felt anxious and listed the coping strategies they used before and during their dental visit.
The research team identified 30 coping mechanisms. Many of these were avoidance strategies, such as listening to music, reading, fidgeting, or squeezing objects.
The researchers also measured patients’ anxiety using the Modified Dental Anxiety Scale (MDAS) and assessed their fear of blood, injuries, and injections using the FQ-BII.
Konneker noted that participants who relied on avoidance strategies tended to have higher MDAS and FQ-BII scores, indicating a greater fear of blood and injections (common aspects of daily dental care).
Patients who received the CBT intervention reported a decrease in their use of avoidance coping strategies over time. Instead, they described using coping thoughts and skills consistent with the program.
“Patients spontaneously indicated that they were using the skills we taught,” said Dunne, an assistant professor on the team. “We didn’t ask them directly; they came up with it. That was encouraging.”
The authors concluded that a brief online CBT intervention can reduce avoidance behaviors associated with dental anxiety. If replicated more widely, such programs could help dental practices improve patient comfort and attendance.