UCLA

Introduction and Objective:

Dental anxiety poses a significant barrier to treatment compliance, the use of dental services and ability to maintain an adequate oral health quality of life. Dental anxiety prevalence is high with approximately 10-20% occurrence in the population of the United States and despite the significant advancements in dental materials and technology, dental anxiety levels have remained relatively stable since the mid-1900s (Sohn & Amid, 2005; Locker, Liddell, & Shapiro, 1999; (Smith & Heaton, 2003). There exists a strong association between dental anxiety, poorer oral health status and oral health quality of life (Kumar et al., 2009; Armfield, Stewart, & Spencer, 2007; Mcgrath & Bedi, 2004; Berggren & Gunnell, 1984). The aim of this study is to conduct comparative effectiveness research to find out which dental anxiety interventions have shown to be more effective in decreasing dental anxiety in adult dental patients.

Methods: The research hypothesis was that cognitive behavioral therapy applied to adult dental patients with dental anxiety is more effective in reducing dental anxiety than other intervention modalities focused on reducing dental anxiety. Search for systematic reviews, randomized clinical trials, and cohort studies were done using PubMed, the Cochrane Library, and Emabase databases. The relevance of the identified systematic review, clinical trials, and cohort studies to the study and PICOTS question was assessed using the inclusion and exclusion criteria. The quality of the evidence and clinical relevance analysis achieved using validated and reliable instruments by two independent readers and all disagreements resolved by discussion after establishing the inter-rater reliability of the two readers. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) was utilized to assess the quality and clinical relevance of six systematic reviews. The CONsolidated Standards of Reporting Trials (CONSORT 2010) instrument was utilized to evaluate the quality and clinical relevance of clinical trials. The Strengthening the reporting of Observational Studies in Epidemiology (STROBE) instrument was utilized to evaluate the quality and clinical relevance of cohort studies. Acceptable sampling was done using established cutoff scores. Meta-analysis could not be done due to heterogeneity of available data.

Results: Two out of six systematic reviews, four out of fifty-nine randomized control trials, and four out of fifteen cohort studies were considered high-quality studies. So out of eighty studies, ten were included.

Conclusions:

A quantitative and qualitative consensus could not be formed due to heterogeneity of data and study design; however, multiple qualitative consensuses could be formed. For example, atraumatic restorative treatment (ART) can lower anxiety more than conventional treatment, lavender scent is effective in reducing state anxiety but not anticipatory anxiety, auricular acupuncture is more effective than placebo sham acupuncture in reducing dental anxiety, and either type of acupuncture is more effective than no acupuncture. Furthermore, premedication with the anxiolytic valium and systematic desensitization have both shown to be effective in reducing dental anxiety, while brief relaxation and music distraction are both effective in reducing dental anxiety as well, though brief relaxation is more effective in patients with high dental anxiety. We can neither accept nor reject our hypothesis because while cognitive behavioral therapy was shown to be effective in one study, and related cognitive therapy and psychological intervention was shown to be effective in two other studies, these were not demonstrated to be more effective than other anxiety treatments shown to be effective in studies where cognitive behavioral therapy was not compared. Thus, since cognitive behavioral therapy was not compared to other intervention types shown to be effective, we cannot conclude whether cognitive behavioral therapy is or is not more effective in treating dental anxiety. To do so, a high-quality study comparing the intervention modalities shown to be effective in all the high-quality studies in our bibliome is needed.