Behavioral interventions may reduce dental anxiety and increase acceptance of dental treatment in dentally fearful adults
Open accessAbstract
Article title and bibliographic information Psychological treatment of dental anxiety among adults: a systematic review. Wide Bowman U, Carlsson V, Westin M, Hakeberg M. Eur J Oral Sci 2013; 121(3 Pt 2):225-34. Reviewer Lisa J. Heaton, PhD Purpose/Question Are behavioral and cognitive-behavioral treatments for dental anxiety more effective in decreasing dental anxiety compared to receiving information about dental care, completing dental treatment under sedation or general anesthesia, or placebo/no treatment in dentally fearful adults? Source of funding Information not available Type of study/Design Systematic review with meta-analysis of data Level of evidence Level 2: Limited-quality, patient-oriented evidence Strength of recommendation grade Grade B: Inconsistent or limited-quality patient-oriented evidence. © 2013 Elsevier Inc. All rights reserved.
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Claims the paper makes
2 of 12 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured
- Interpretationnone given
Behavioral interventions might lower dental anxiety in adults with dental fear.
“Behavioral interventions may reduce dental anxiety and increase acceptance of dental treatment in dentally fearful adults”
Quote in the paperSubstantial claim - Interpretationreasoning
Variation in how behavioral interventions are defined is a major source of inconsistency among studies of dental anxiety.
“A key to the inconsistencies across studies of behavioral interventions for dental anxiety lies in the definition of such interventions.”
Quote in the paperSubstantial claim - Interpretationreasoning
The poor quality of the reviewed studies is probably due, at least partly, to when they were published.
“The low quality of the studies evaluated by the authors likely comes, at least in part, through the timing of their publication.”
Quote in the paperNot a substantial claim - Interpretationnone given
Behavioral interventions might improve acceptance of dental treatment among adults with dental fear.
“Behavioral interventions may reduce dental anxiety and increase acceptance of dental treatment in dentally fearful adults”
Quote in the paperSubstantial claim
- May combine two claims. 8
- Classified as probably not a substantial claim. 6
May combine two claims.
PremisecitationWide acceptance of RCT standardization began only in 1996, with the original CONSORT statement and its revision five years afterward.
“The standardization in RCTs did not begin to gain wide acceptance until 1996 with the original CONSORT statement6 and its revision 5 years later.7”
Quote in the paperSubstantial claim1 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationMore than 10% of adults have severe dental anxiety, a rate consistently reported in studies over recent decades.
“Studies across the last several decades have consistently found prevalence rates for severe dental anxiety at more than 10% of the adult population.2,3”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [2] Gatchel, 1983, The prevalence of dental fear and avoidance: a recent survey study, J Am Dent Assoc source
- cites [3] Humphris, 2013, UK population norms for the modified dental anxiety scale with percentile calculator: adult dental health survey 2009 results, BMC Oral Health source
The paper’s Abstract > Results reports that 11.6% of participants had high dental anxiety, supporting a rate above 10% in its UK adult survey. The cited paper does not establish that studies across several decades consistently found rates above 10%; its comparison with a 2008 survey concerns mean anxiety scores, not severe-anxiety prevalence. (LLM, conf=0.86)
Experimental — accuracy not yet measured
May combine two claims.
FindingreasoningThe reviewed paper included 10 studies, 8 of which appeared in 2001 or earlier and therefore lacked some CONSORT items now expected in RCTs.
“Eight of the 10 studies from the current paper were published in or before 2001 and thus did not contain all of the CONSORT items required of RCTs today.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationKvale and colleagues and Gordon and colleagues also found comparable heterogeneity in the studies they reviewed.
“Reviews by Kvale and colleagues9 and Gordon and colleagues5 reported similar heterogeneity in the studies they evaluated.”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe recently published RCT on a self-paced computerized cognitive-behavioral intervention for dental injection phobia followed the CONSORT checklist, unlike many studies in the current meta-analysis.
“Unlike many of the studies reviewed in the current meta-analysis, this paper followed the CONSORT checklist, including all of the necessary components that Wide Boman and colleagues1 were unable to report on in the papers reviewed.”
Quote in the paperNot a substantial claim0 of 2 sources checkedMay combine two claims.
PremisecitationPeople with severe dental anxiety frequently avoid dental care, and this avoidance can have major consequences for oral and general health.
“As severe dental anxiety often leads to avoidance of dental treatment that, in turn, can have a substantial impact on oral and overall health,4”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [4] Schuller, 2003, Are there differences in oral health and oral health behavior between individuals with high and low dental fear?, Community Dent Oral Epidemiol source
Classified as probably not a substantial claim. May combine two claims.
InterpretationcitationThe systematic review and meta-analysis by Wide Boman and colleagues identifies strengths of behavioral interventions for severe dental anxiety while also emphasizing the need for better RCTs and greater consistency across interventions.
“In summary, Wide Boman and colleagues’ systematic review and meta-analysis points out strengths of behavioral interventions for the treatment of severe dental anxiety, but highlights needs for high-quality RCTs and consistency across interventions.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] Wide Boman, 2013, Psychological treatment of dental anxiety among adults: a systematic review, Eur J Oral Sci source
May combine two claims.
InterpretationreasoningAlthough the variety of behavioral interventions for dental anxiety offers many treatment options, it also makes systematic testing of their effectiveness harder.
“While this diversity across behavioral interventions for dental anxiety provides numerous tools for treatment, it also reduces the ability to systematically test the effectiveness of such interventions.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Premiseown dataThe reviewed paper includes studies of behavioral therapies that vary widely in format and duration, such as six-session behavioral therapy, 10 weekly CBT sessions, a one-session cognitive treatment, a 30-minute videotaped intervention, six-session CBT/BT, one- versus five-session exposure, and a single 2.5-3.5 hour stress inoculation treatment.
“The current paper includes studies of a behavioral therapy conducted over “an average of six sessions” (p. 227); cognitive-behavioral therapy administered over 10 weekly sessions; a one-session cognitive treatment; a 30-minute videotaped behavioral intervention; CBT and BT conducted over six sessions; comparisons of one- and five-session exposure treatments;”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] Wide Boman, 2013, Psychological treatment of dental anxiety among adults: a systematic review, Eur J Oral Sci source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA recent systematic review by Gordon and colleagues reached conclusions that align with those of the reviewed authors.
“At least one recent systematic review arrived at conclusions similar to those of this paper’s authors.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5] Gordon, 2013, A critical review of approaches to the treatment of dental anxiety in adults, J Anxiety Disord source
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
A reported quality grade falls outside the stated rating scale
MinorThe stated rating scale has three categories: high, moderate, and low. The later claim that studies were graded "low to very low" introduces a grade not on that scale.
“an overall quality rating of high, moderate, or low was assigned to each paper”
“the authors graded the quality of all of the studies reviewed as low to very low.”
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The prevalence of dental fear and avoidance: a recent survey study
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Dental fear in adults: a meta-analysis of behavioral interventions
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A critical review of approaches to the treatment of dental anxiety in adults
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Psychological treatment of dental anxiety among adults: A systematic review
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Computerized Dental Injection Fear Treatment: A Randomized Clinical Trial
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Self-citation
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Cited by
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Strategies to manage patients with dental anxiety and dental phobia: literature review
Appukuttan, D. (2016) · Clinical, Cosmetic and Investigational Dentistry · doi:10.2147/ccide.s63626 · Cited by 616 · see citing works
“94,95 CBT treatment generally contains psychoeducation, graded exposure, cognitive restructuring, behavioral experiments, and relaxation, as well as self-assertiveness training.”
Non-pharmacological interventions for managing dental anxiety in children
Anthonappa, R. P., Ashley, P. F., Bonetti, D. L., Lombardo, G., & Riley, P. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012676 · Cited by 79 · see citing works
“This complex intervention requires the involvement of specific therapists (e.g. psychologists), who teach the patients to manage their anxiety by developing new skills (Getka 1992; Heaton 2013).”
BackgroundPsychological Intrusion – An Overlooked Aspect of Dental Fear
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“Recent reviews found that CBT and behaviour therapy had the most evidence of efficacy in the treatment of dental fear in adults (Gordon et al., 2013; Heaton, 2013), though even with this, care needs to be taken in the way patients are encouraged to challenge their negative thinking patterns as too…”
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“As with other reviews and meta-analyses of nonpharmacologic/behavioral techniques for managing DA, the lack of consistency of interventions makes true comparisons across studies difficult.(8)”
BackgroundSelf-citationClinical effectiveness of diaphragmatic breathing for dental anxiety in 7- to 13-year-old children
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Dental fear in adolescents' transition to early adulthood
Jaakkola, S. (2015) · UTUPub (University of Turku)
- Authors
- Heaton, L. J.
- Affiliations
- University of Washington (US)
- Corresponding author
- Heaton, Lisa J.
- ORCID
- Heaton, Lisa J.
- Venue
- Journal of Evidence-Based Dental Practice
- Publisher
- Elsevier BV
- Published
- 2013-12
- Volume
- 13
- Issue
- 4
- Pages
- 160-162
- ISSN
- 1532-3382 (ISSN-L)
- PMC
- PMC4109392
- OpenAlex
- W2056268993
- Semantic Scholar
- 17bab478a1101d877392ea9b0f9f360ff4ca905b
- Cited by
- 14
- References
- 13
- Citations by year
- 2026: 2 · 2023: 1 · 2022: 3 · 2021: 1 · 2020: 1 · 2018: 3 · 2017: 1 · 2016: 1 · 2015: 1
- FWCI
- 0.76
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Evidence Based Dental Practice (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Dental and Craniofacial Research (K23DE019202)
- Topics
- Health Sciences › Dentistry › Oral Surgery › Dental Anxiety and Anesthesia Techniques
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
- Keywords
- dental anxiety, behavioral interventions, cognitive behavioral therapy, treatment acceptance, sedation, general anesthesia
- MeSH terms
- Humans, Psychotherapy, Dental Anxiety
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