Dental anxiety treatment by a dentist in primary care: A 1-year follow-up study

In an earlier randomized controlled trial of dental anxiety treatments (n = 96) we compared the effects of dentist-administered cognitive behavioural therapy (D-CBT) and dental treatment supplemented with the Four Habits communication model plus midazolam sedation. Both treatments, applied in a general dental practice, were associated with a clinically relevant decrease in dental anxiety. In this follow-up study, 52 of the 82 treatment completers responded to an online questionnaire 1 year post-treatment. Reduction in dental anxiety persisted for both treatment groups. From baseline to 1 year post-treatment the Modified Dental Anxiety Scale was reduced by 7.8 [SD: 4.4; Cohen's d effect size: 1.2 (CI: 0.8-1.7)] and 7.8 [SD: 4.2; Cohen's d: 1.4 (0.9-1.8)] in the D-CBT and Four Habits/midazolam groups, respectively. Most patients (74% for D-CBT, 80% for Four Habits/midazolam) continued with dental treatment. Nine patients in the D-CBT and seven in the Four Habits/midazolam groups received additional CBT treatment from a psychologist/dentist team. Both methods tested should be accessible to interested dentists who receive adequate training. Effective first-line treatments for dental anxiety in general dental practice can generate more accessible care pathways for patients with dental anxiety. Evidence-based dental anxiety treatment programmes should be included in the dental curriculum and established as best practice for dentists.