Behavioural interventions could reduce dental anxiety and improve dental attendance in adults

PubMed and Psychlit were searched from 1966 to 2001. Reference lists from retrieved articles were also examined for more studies. Study authors were contacted for additional information where necessary.

For inclusion, an article had to satisfy the following criteria: the study sample should be adult subjects with documented high dental fear or avoidance; outcome measures should include at least self-reported changes in dental fear; outcomes should preferably include changes in dental behaviour or attendance post-treatment.

Studies were categorised into 3 behavioural interventions: behaviourally oriented approaches, cognitively oriented approaches and educational interventions. Attendance measures were grouped into <6 months, 6 months to 4 years after the intervention and longer term. The effect size (ES) for self-reported dental anxiety and for dental attendance post-treatment was calculated. Homogeneity tests were conducted.

The search identified 80 articles, of which 38 met the inclusion criteria. The calculated ES for self-reported anxiety after intervention indicated positive changes in 36 out of the 38 studies and no change in two. The overall ES was 1.78 [95% confidence interval (CI), 1.67-1.89]. The proportion of subjects with post-treatment dental visits in the first 6 months varied between 50 and 100%. The overall ES for attendance at dental visits, weighted by sample size, was 1.4 (95% CI, 1.27-1.58). The homogeneity analysis indicated that the studies could not be adequately described in one ES. The reported proportion of subjects with a dental visit between 6 months and 4 years post-treatment varied from 48 to 100%. The overall weighted ES for visiting the dentist, adjusted for drop-outs in the studies, was 1.17 (95% CI, 0.99-1.35).

Despite extensive heterogeneity, changes in self-reported anxiety represented a medium to large ES. Patients signing up for a behavioural intervention for dental fear can be expected to report a significant reduction in their fear, and this effect generally seems to be lasting. Mean long-term attendance (>4 years after treatment) was 77%.