For many people, a routine dentist appointment can evoke feelings of distress, fear and nervousness. 

This has led a group of Temple University Maurice H. Kornberg School of Dentistry researchers to explore the origins of dental anxiety and identify ways to alleviate it.  

Their findings were published by Frontiers in Oral Health in the article “A mixed methods exploration of the origin of dental anxiety and coping strategies among participants in a behavioral intervention for dental anxiety.” The project was funded by a grant from the National Institute of Dental and Craniofacial Research. 

The research team, including Amid Ismail, Elizabeth Konneker, Eugene M. Dunne and Marisol Tellez, evaluated patient-reported experiences during their project. 

The researchers found that a cognitive behavior therapy (CBT)-based dental anxiety intervention reduced the use of avoidant coping strategies, which may in turn reduce patient fears. 

‘“The overall message of the research is understanding just how common dental anxiety is,” said Konneker, lead author of the paper. “Having a resource of some kind that normalizes dental anxiety and being able to provide people with the tools that makes them feel better at the dentist is important.” 

Konneker and the research team identified three origins for dental anxiety: a traumatic dental visit in childhood, a traumatic dental event in adulthood and anxiety that has always been present. They identified several frequently mentioned experiences that may contribute to a patient’s dental anxiety, which include loss of control, trust in providers and fear of pain. 

The paper notes that the prevalence of dental anxiety among dental patients is typically reported to be around 19% for adults and 24% for children and adolescents in the U.S.  

The study used data from a clinical trial led by Tellez, associate dean for research and chair of the Department of Oral Health Sciences at Kornberg. The trial tested an hourlong online CBT-based intervention to treat dental school patients experiencing dental anxiety. 

“We wanted to test the efficacy of that online program,” Tellez said. “Any patient who endured high dental anxiety and came to a scheduled dental appointment was recruited into the study. They would go through the intervention before their appointment.” 

Study participants were randomized to one of three groups after baseline assessments: to view the invention with a trained staff member present in the room, to view the same intervention but in the presence of psychology-trained personnel, or to watch a time- and attention-matched control video. 

Konneker explained how researchers used the Anxiety and Related Disorders Interview Schedule (ADIS) to collect qualitative data from 499 clinical trial participants. The ADIS is a semi-structured interview designed to assess a patient’s level of distress directly before and during a dental appointment. 

During the process, patients described when they first experienced anxiety. They were asked to report what coping mechanisms they used during dental appointments at the baseline semi-structured interview, as well as one month and three months post intervention. 

The researchers identified 30 coping mechanisms that participants utilized before and during their appointments. Some of these mechanisms included avoidant coping strategies such as listening to music, reading, fidgeting or squeezing something. 

The patients were assessed with the Modified Dental Anxiety Scale (MDAS), which is a measure of dental anxiety severity and the Fear Questionnaire Blood-Injury Injection Subscale (FQBII), which features five items that specifically relate to the fear of seeing blood, injury or receiving an injection.  

“Participants who reported avoidant coping strategies tended to have a higher MDAS and a higher FQBII,” Konneker said. “That just means they reported being more fearful of the sight of blood and the prospect of seeing an injection, things that you can associate with a routine dental appointment.” 

Dunne, an assistant professor at Kornberg, said the paper does a nice job of capturing the patients’ voices. “For patients who were in the intervention, we saw them report over time a reduction in using avoidant coping strategies and it seems as though they were replaced with coping thoughts,” he said. 

“In the interviews, they spontaneously reported that they were using some of those skills that we taught in the intervention. We didn’t ask them directly, ‘Did you use these skills?’ We just said tell us how you are dealing with it. To have them freely associate using the skills was nice to see.”