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Cited by 616Dental Anxiety and Anesthesia TechniquesAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesDental Radiography and Imaging

Strategies to manage patients with dental anxiety and dental phobia: literature review

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Appukuttan, Devapriya·2016·Clinical, Cosmetic and Investigational Dentistry
DOI 10.2147/ccide.s63626PMC PMC4790493
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Abstract

Dental anxiety and phobia result in avoidance of dental care. It is a frequently encountered problem in dental offices. Formulating acceptable evidence-based therapies for such patients is essential, or else they can be a considerable source of stress for the dentist. These patients need to be identified at the earliest opportunity and their concerns addressed. The initial interaction between the dentist and the patient can reveal the presence of anxiety, fear, and phobia. In such situations, subjective evaluation by interviews and self-reporting on fear and anxiety scales and objective assessment of blood pressure, pulse rate, pulse oximetry, finger temperature, and galvanic skin response can greatly enhance the diagnosis and enable categorization of these individuals as mildly, moderately, or highly anxious or dental phobics. Broadly, dental anxiety can be managed by psychotherapeutic interventions, pharmacological interventions, or a combination of both, depending on the level of dental anxiety, patient characteristics, and clinical situations. Psychotherapeutic interventions are either behaviorally or cognitively oriented. Pharmacologically, these patients can be managed using either sedation or general anesthesia. Behavior-modification therapies aim to change unacceptable behaviors through learning, and involve muscle relaxation and relaxation breathing, along with guided imagery and physiological monitoring using biofeedback, hypnosis, acupuncture, distraction, positive reinforcement, stop-signaling, and exposure-based treatments, such as systematic desensitization, "tell-show-do", and modeling. Cognitive strategies aim to alter and restructure the content of negative cognitions and enhance control over the negative thoughts. Cognitive behavior therapy is a combination of behavior therapy and cognitive therapy, and is currently the most accepted and successful psychological treatment for anxiety and phobia. In certain situations, where the patient is not able to respond to and cooperate well with psychotherapeutic interventions, is not willing to undergo these types of treatment, or is considered dental-phobic, pharmacological therapies such as sedation or general anesthesia should be sought.

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  • Scents, temperature, sounds, and other sensory impressions are crucial for whether a human being feels security and confidence in the environment or discomfort and threats.

    “Scents, temperature, sounds, and other sensory impressions are found to be crucial if a human being feels security and confidence in the environment, or the opposite, finds discomfort and threats (Fontaine et al., 2001; Appukuttan, 2016).”

    From The Oxytocinergic System as a Mediator of Anti-stress and Instorative Effects Induced by Nature: The Calm and Connection Theory (2021) · cites this paper as Appukuttan, 2016

    The dental office environment section says that smells, music, lighting, instrument sounds, and office temperature can affect patients’ comfort or anxiety. The Etiology of dental anxiety section also identifies sensory triggers of fear. These passages support the point in dental settings, but not the claim about human feelings of security and confidence in environments generally. (LLM, conf=0.87)

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Authors
Appukuttan, D.
Corresponding author
Appukuttan, Devapriya
ORCID
Appukuttan, Devapriya
Venue
Clinical, Cosmetic and Investigational Dentistry
Publisher
Informa UK Limited
Published
2016-03
Volume
8
Pages
35
ISSN
1179-1357 (ISSN-L)
DOI
10.2147/ccide.s63626
PMC
PMC4790493
OpenAlex
W2293431470
Cited by
616
References
14
Citations by year
2026: 73 · 2025: 91 · 2024: 84 · 2023: 77 · 2022: 90 · 2021: 84 · 2020: 44 · 2019: 34 · 2018: 17 · 2017: 15 · 2016: 4 · 2012: 1
FWCI
4.51
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Cosmetic and Investigational Dentistry (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
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 › Oral Surgery › Dental Radiography and Imaging
Keywords
dental anxiety, dental phobia, anxiety assessment, psychotherapeutic interventions, cognitive behavioral therapy, behavior modification therapy, sedation, general anesthesia, relaxation techniques, biofeedback, hypnosis, acupuncture, exposure therapy, tell-show-do

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