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CBT may replace sedation for dental phobias. But first, define “sedation”

Cognitive behavior therapy can help overcome fear of the dentist

Our Review Summary

The release focuses on a paper published in the British Dental Journal  that evaluated the effect of cognitive behavioural therapy (CBT) on patients with dental phobia or related fears concerning dentistry. The release reports that CBT allowed many patients with dental phobia to receive dental care without relying on sedation, and that CBT and sedation complement each other as ways of helping patients with dental phobia address their dental health needs. The release did a good job describing benefits but was very vague on what researchers meant by the term “sedation” and the types of procedures most feared by those with phobias. In addition, the release didn’t delve into any of the limitations of this study, which was essentially a case series — considered a very low level of evidence.

 

Why This Matters

dentalA lot of research has been done on dental anxiety — and it’s very common. Most such studies find that at least 10 percent (and as many as 20 percent) of people have dental anxiety or dental phobia. These fears make people less likely to see a dentist, and put them at greater risk of oral health problems — which can, in turn, have significant impacts on an individual’s quality of life. (Anyone who has ever had a toothache will agree with us.) In short, identifying ways to help people deal with dental anxiety and phobias has the potential to improve the quality of life for a great many people. In addition, there have been many studies (reported in a meta-analysis and systematic review) that have demonstrated the usefulness of CBT in preventing the need for sedation in these patients. As sedation carries certain risks and does not address any underlying issues leading to dental phobia, CBT could be a positive alternative for many patients.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

The release does not address cost at all. This is not entirely surprising, since the study was done in the United Kingdom, which has a universal health care system. However, the journal article on which the release is based does address cost, at least in terms of the cost to the health care system itself. The article says that the CBT sessions to address dental fears had “an average cost of £810 per patient.” (The cost in British pounds converts to about $1,212.) The article also says, “While initially expensive the evidence suggests that patients can then receive dental treatment without sedation thus potentially reducing long-term costs.” For patients in the United States, the cost would likely be significant — particularly since the researchers report that patients needed an average of five CBT sessions before being able to receive dental care without sedation (and it’s not clear whether health insurance would cover such sessions).

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The benefit here is the ability of a patient to receive dental care without sedation — which carries its own costs and health risks. The release states that 79% of patients who participated in the study “went on to have dental treatment without the need for sedation.” Only 6% of patients had treatment under sedation. The remaining 15% either dropped out of CBT or were removed from the study because they were identified as having other psychological problems that required treatment. Of the patients who completed the CBT (i.e., didn’t drop out and weren’t removed from the study), 93% went on to have dental treatment without sedation.

Does the news release adequately explain/quantify the harms of the intervention?

Satisfactory

The release does not address risks, but CBT carries few risks (if any). In addition, the release states that in this study, patients who needed additional therapy beyond CBT for mental health issues were referred for more assistance.

Does the news release seem to grasp the quality of the evidence?

Not Satisfactory

The release does a relatively thorough job of describing the study itself — the number of patients (130), the degree of dental fear, the methods used to test and score dental phobia. etc. What’s missing in the release (but not in the published study results) is that the most common fear among patients with dental phobias are fear of dental injections and the dental drill.

In addition, an important limitation to the research not mentioned in the release is that this was essentially a case series — a very low level of evidence. There was no comparison or control group, which would’ve made the findings more robust. And the study only looked at patients with dental fears who are willing to take advantage of CBT services. Do the results apply to the community of people with dental phobias so severe that they would not take part in a study that required them to follow-up with dental treatment? For severe phobias, avoidance is key.

A final issue is that the patient outcomes were gathered post-therapy via patient questionnaires. Service evaluations are not as reliable as actual clinical trials.

Does the news release commit disease-mongering?

Satisfactory

No disease mongering here.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

The release does not explicitly name the funding source for the research, only that the clinic where CBT was provided is run by the King’s College London Dental Institute Health Psychology Service at Guy’s and St Thomas’ NHS Foundation Trust.

Does the news release compare the new approach with existing alternatives?

Not Satisfactory

The primary alternative to CBT is sedation, which the release addresses.

But we expected the news release to go into more detail about the types of sedation and dental procedures the study authors were referring to. For example, prior to dental treatment — which can range from a basic cleaning or filling for a cavity, to more involved surgical procedures — patients might be given an anti-anxiety medication to make them more relaxed. In some cases, patients require intravenous sedation. Since the release doesn’t describe what the authors mean by sedation, it’s a very imprecise comparison.

Does the news release establish the availability of the treatment/test/product/procedure?

Satisfactory

The release makes clear that CBT and sedation are both available to patients with dental fears in the U.K. The release would have been stronger if it had noted, as the journal article does, that: “Some barriers to the broader dissemination of CBT for people with dental phobia seem to remain, e.g. there is a lack of training and a skilled workforce to deliver the techniques.”

Does the news release establish the true novelty of the approach?

Not Satisfactory

This study is not the first to address CBT as a treatment for dental anxiety. A quick search identified related research dating back at least as far as 1992, and as recent as 2013. The release would have been stronger if it had explained how the new U.K. study fit into the broader body of work on this subject.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Satisfactory

The release is cautious in its use of language, and is very careful to acknowledge the limitations of CBT in addressing dental phobia. For example, the first sentence of the release states that CBT “could help many people with dental phobia.” It does not say that CBT will help or that it could help all people with dental phobia.

Total Score: 5 of 10 Satisfactory

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