SAAD Symposium explores advancements in dental sedation and dental anxiety management.

Correction to: SAAD Symposium explores advancements in dental sedation and dental anxiety management.

Introduction: Dental anxiety is a common problem faced by dental practitioners worldwide. Generally, the management of dental anxiety can be classified as pharmacological and non-pharmacological approaches, in multiple studies and reports available on this subject.Aims and objectives: This paper will provide a general overview of the pharmacological and nonpharmacological strategies in the management of dental anxiety, supported by dental literature. This would help dental practitioners understand the benefits and limitations of the different methods of treating their anxious patients.Methodology: This is a narrative review and a summary of the different approaches and methods available in the management of dental anxiety. Relevant articles were searched from the online databases of PubMed, ScienceDirect, and Google Scholar, and the keywords used to identify the papers were ‘Dental Anxiety’, ‘Pharmacological’, and ‘Non-pharmacological’.Conclusion: Appropriate management of dental anxiety is crucial to ensure a successful dental procedure. The choice of the anxiety management must be based on the complete understanding of the particular patient, identifying the source of anxiety, and working hand-in-hand with the patient for better oral health care.

Dental anxiety is a common phenomenon in the general population and may be more prevalent in people with learning disabilities. There is growing interest in the use of cognitive behaviour therapy (CBT) approaches, including within dental anxiety management. However, relatively little is known regarding the application of CBT approaches in dental anxiety management for patients with learning disabilities. This paper outlines details of the implementation of a CBT-based dental anxiety pathway for patients with learning disabilities treated in a special care dental service in England. The pathway is modelled on the utilisation of skills from the dental team (dental nurses and dentists) to deliver a combination of talking sessions, desensitisation and positive affirmation in five distinct stages. Early feedback from service users following implementation of this pathway indicates successful acceptance of dental care with a decreased use of sedative adjuncts.

Dental anxiety is a barrier to attendance. Dental non-attenders may seek emergency care and may prefer to receive anxiety management measures for treatment required. Little is known about the preferences of these dental non-attenders for different anxiety management techniques. Understanding such preferences may inform management pathways, improve experiences, alleviate anxieties and encourage a more regular attendance pattern. As such, the aim of this study was to gain a greater understanding of the dental anxiety of patients attending a dental access centre for emergency dental treatment and to ascertain preferences for different anxiety management techniques. Cross-sectional study involving self-completed questionnaires and clinical observation. NHS Dental Access Centre, York, UK. Two hundred participants not registered with a general dental practitioner, aged 18 years or over, experiencing pain and self-referred were recruited on a consecutive sampling basis. Participants completed a questionnaire eliciting demographic and dental history details, dental anxiety and preferences for dental anxiety management options. Correlation of the modified dental anxiety scale with preference for different dental anxiety management techniques. No significant predictive factors were found that explained preferring local anaesthetic to sedation, or general anaesthesia for restorations or extractions. Those highly anxious were less likely to consider tell-show-do techniques (p=0.001) or watching explanatory videos (p=0.004) to be helpful for overcoming their anxieties than the low or moderate anxiety groups. People attending access centres may represent a group who are unwilling to explore non-pharmacological methods to overcome their anxieties. This supports the need for sedation to provide treatment. Future work may include exploring in more depth the thoughts and opinions of this group of patients to improve understanding of their complex dental attitudes. From this, more effective strategies may be developed to encourage regular dental attendance.

The aim of this study was to determine the effect of using of psychological management techniques on the level of anxiety in Nigerian children during dental management. The Short Form of the Dental Anxiety Survey Schedule was administered to 81 children who were attending a suburban dental clinic for the first time. This schedule was re-administered again two weeks later when they came for a follow up visit. The age of the patients was recorded. The types as well as number of psychological techniques employed during treatment were also noted. The overall mean dental anxiety level of the children decrease from an average of 15.23 +/- 5.03 before treatment to 13.40 + 4.13 after treatment (p < 0.001). However, the mean dental anxiety score in children in whom no psychological technique was employed during treatment increased after treatment. On the other hand, there was also a statistically significant decrease in the mean dental anxiety level of children treated using either a single psychological technique or combined psychological techniques after treatment. Better results were obtained when combined psychological techniques where used than when only a single technique was used. It was concluded that psychological techniques used in the management of dental anxiety in children are highly effective in decreasing dental anxiety levels. Better results are obtained when a number of techniques are combined effectively.

Background: Information on the pattern of dental anxiety management in Nigeria is currently not available. Aim: The study was designed to determine the awareness and frequency of application of dental anxiety assessment questionnaires as well as the current pattern in the management of dental anxiety in Nigeria. Methods: The cross-sectional study was conducted using structured questionnaires distributed among dental residents and house officers in Nigerian dental schools. Information requested included demographic variables, frequency of presentation of dental anxiety, awareness and frequency of application of dental anxiety questionnaires. The respondents were also asked to rate the frequency of application of the outlined dental anxiety management techniques on a 5-point Likert scale. The median score and the range for each technique was determined and compared between the male and female respondents. Results: A total of 96 questionaires were sent out to dental surgeons of all grades. Response was obtained from 86 giving a response rate of 90%. Only 23 (26.7%) respondents were aware of dental anxiety questionnaires while only 13 (15.1%) have seen the instrument applied. The percentage of patients with dental anxiety was estimated by the respondents to be

Background: Children experience dental anxiety during their first dental visit, which affects the quality of dental treatment and gives rise to behaviour management problems. Clay, origami and building blocks have been effective in alleviating hospitalization anxiety in pediatric patients. These successful techniques in hospitalized pediatric patients have seldom been used in the dental set up. Therefore, the aim of this study is to assess and compare the efficacy of clay therapy, origami and building blocks in the management of dental anxiety in children aged 6-10 years. Methods: Sixty children aged 6-10 years, with no previous dentist exposure, with Frankl’s behaviour rating 2 or 3 having dental caries with international caries detection and assessment system (ICDAS) score 3 requiring restorations without local anesthesia were selected and divided into four groups. Group 1 – clay therapy; group 2 - building blocks; group 3 – origami; and group 4 – tell show do. Pulse rate, facial image scale (FIS) and face, leg, activity, cry, consolability (FLACC) behaviour scales were used to quantify anxious behaviour. Operator compliance and parent acceptance was rated on the Likert scale. Results: The results showed lower mean pulse rates, lower FIS and FLACC scores, and better operator compliance and parental acceptance in clay therapy, origami and building blocks groups than in the conventional tell-show-do group. The most significant reduction in all the parameters was seen in the clay therapy group. Conclusions: Clay therapy, origami and building blocks can be used as an effective means to reduce dental anxiety in children.

Audiovisual distraction, a non-pharmacological intervention, has been used to manage dental anxiety in prior clinical trials. Synthesize the available evidences to evaluate the efficacy of audiovisual distraction techniques on the management of dental anxiety in children. Electronic databases (PubMed, Cochrane Central Register of Controlled Trials, and Embase) were searched. We included randomized controlled trials (RCTs), and methodological quality of included trials was assessed using the Cochrane Collaboration's criteria. Information on reported anxiety, pain, behaviors, vital signs (including blood pressure, oxygen saturation, and pulse rate), and children satisfaction was analyzed. Nine studies were included for a systematic review, and none of them had low risk of bias. Significant differences in anxiety were found. According to the study, a majority of results indicated a significant difference in pain and behavior between the audiovisual and control group. Three studies reported children in the audiovisual group preferred usage of an audiovisual device for future dental visits. No significant differences could be found regarding blood pressure. There is some low-quality evidence suggesting that the usage of audiovisual distraction during dental treatment may relieve children's dental anxiety.

The purpose of this article is to provide a concise summary of the scientific literature in the form of a narrative review to highlight areas where the use of clinical hypnosis is supported by scientific evidence in dentistry. A literature review was carried out to identify relevant peer-reviewed articles on PubMed, written in French or in English, with time limitation from 2000 to May 2023, and updated in December 2024. Articles had to be systematic reviews or meta-analysis linked with the management of dental anxiety and acute dental pain, as well as chronic orofacial pain. Twelve articles were selected for analysis, with 8 on dental anxiety, 3 on temporomandibular disorders, and 1 on burning mouth syndrome. Several literature reviews and meta-analyses published on the subject support the use of hypnosis in several clinical contexts, including local anesthesia, dental extraction and dental anxiety in adults and children. Evidence is also presented to improve the condition of patients suffering from pain associated with temporomandibular disorders. However, the literature remains somewhat fragmented because of the diversity of hypnosis techniques applied, and the different dental procedures or conditions explored. Hypnosis can have a considerable impact in the management of dental anxiety and acute dental pain. It also seems promising for the management of orofacial pain, but further research would be necessary. This research highlights that the available evidence is sufficient to encourage the integration of evidence-based hypnosis training to improve the management of acute stress and pain in dental practice.

The main aim of the present study was to gain a better understanding of the management of dental anxiety reported by dental practitioners in western Switzerland. In 2013, an 18-item electronic questionnaire was sent to dental practitioners in the Swiss Romandy. A total of 140 (18.6%) questionnaires were included in the analysis. About four out of five practitioners (79.4%) involved with dental emergency service had at least one occurrence with dental phobic patients. The majority of the respondents stated that both dental anxiety and dental phobia increases stress in the dental practice with frequencies of 90.0% and 88.5%, respectively. Among the 119 respondents using anxiety reduction methods (85.0%), an overall of 51 (42.9%) reported using pharmacological methods while 89.9% (n = 107) used psychological methods. Female dentists were using psychological anxiety reduction methods three times more frequently than male dentists reaching borderline statistical significance (OR = 3.0, p = 0.0591). Out of 140 respondents, only 28 (20.1%) received education and training in dental anxiety reduction methods. The majority of these (66.4%; n = 83) stated that their education was inadequate and 55.8% (n = 77) requested further education and training. It can be concluded that more education and training of dental anxiety reduction methods are needed.

To examine the perceived importance and knowledge of the dental students' in their treatment of dental anxiety according to their year of study and to find out patients' perceived importance of the dental students' knowledge of dental anxiety according to their level on dental fear. Dental students (N=219) at the University of Turku and non-probability convenience sample of 100 of patients attending the Dental Teaching Clinic were given questionnaires with multiple choice and open-ended questions. Students were categorised into three groups according to the year of study (1-3, 4, 5). Patients were categorised into three groups using the established cut points for Modified Dental Anxiety Scale (no fear=5-9, low fear=10-18, high fear=19-25). The differences between groups were evaluated using cross-tabulations, chi squared and Fisher's exact tests. The open-ended questions were subjected to content analysis. Students' perceived importance of dental anxiety did not differ between three groups. Students with greater undergraduate education and clinical experience were more likely to have excellent or quite good knowledge (P<.001). Patients' perceived importance of dental students' knowledge of dental anxiety was greater in patients with high level of fear. The overlapping category that emerged from the open-ended question analysis was communication skills. This appeared to be important for patients with dental anxiety and for dental students in their management of dental anxiety. Clinical communication skills should be part of dental anxiety management teaching. Dental students should be able to gain sufficient knowledge and skills in treating dental anxiety before graduating.

This review aimed to find the most effective intervention for the management of dental anxiety among adults by way of a systematic review of Randomised controlled trials. Compared to European and US counterparts, the number of studies concerning the management of dental anxiety in the United Kingdom is limited. Several interventions have been reported with varying modes of action and duration. Two main groups of interventions: pharmacological and psychological/behavioural have been implemented. The pharmacological interventions employ the use of centrally acting sedatives whereas the psychological/behavioural interventions serve to change the behavioural and learning effects of dental anxiety. A third group operationally defined as “Complementary” for the purpose of this review consists of holistic therapies such as acupuncture, music distraction and aromatherapy for in the management of dental anxiety. Although reduction of dental anxiety before and after dental treatment has been recorded historically in the majority of trials, these have mainly investigated psychological/behavioural interventions. Exploring more recent trials, this study uncovers the benefits of complementary interventions for managing dental anxiety in adults and computer based variants of psychological/behavioural interventions. None compared the efficacy of one type or group against the other. Also, outcomes such as avoidance of dental treatment and economic implication of interventions were scarcely evaluated thus evidence on this remains inconclusive. The need for further investigation of these outcomes as well as those in Complementary Therapies is justified.

More than 1 in 8 New Zealand (NZ) adults are dentally anxious, which can lead to avoiding dental care and a higher risk of poor oral health. However, little is known about how dentally anxious patients are identified and managed by NZ general dentists. This survey aimed to investigate how NZ dentists identify and manage dentally anxious patients. We conducted an email survey of NZ dentists in 2022, obtaining 212 responses. Along with demographic information, respondents were queried about whether they ask patients about past/current dental fears and their likely origin, how they assessed those fears, their usual management of dentally anxious patients, and how the management of dentally anxious patients could be improved. Almost three-quarters reported personally asking patients about past and/or current dental fears, and half enquired about bad life experiences that had led to those fears. Only 6 respondents (2.8%) reported using a formal dental anxiety/phobia assessment tool prior to treatment. For managing severely anxious adult dental patients, all dentists used at least 1 pharmacologic or psychological technique or referral to a colleague. The study identified several weaknesses among NZ dentists in identifying and managing dental anxiety patients. The use of formal dental anxiety/phobia assessment tools prior to treatment needs improvement. Addressing dental anxiety is a complex issue that requires a multipronged approach involving improved education, the development and implementation of better assessment tools, and a greater understanding of how dentists' current assessment and management of dental anxiety can be improved.

To evaluate dental anxiety from the dentist's perspective. A cross-sectional study was performed on a convenience sample. Data were gathered using questionnaires that included general information and specific questions concerning dentally anxious patients. Three hundred ten practicing dentists completed the survey. Participants estimated that 27% of their adolescent/adult patients and 35% of their child patients suffer from dental anxiety. Dentists reported devoting about a quarter of their weekly work hours to treating such patients. The most common anxiety management techniques used for adults and children alike were nitrous oxide and/or behavioural techniques (such as distraction, reinforcement, gradual exposure, and relaxation). Dentists generally agreed that it is their responsibility to help dentally anxious patients. Eighty-one percent expressed interest in taking part in dental anxiety management courses. The consensus was that treating dentally anxious patients involves long treatment times, insufficient payment, and frequent appointment cancellations. According to practicing dentists, over one-quarter of their patients suffer from dental anxiety. Most dentists perceive themselves as responsible for treating these patients and are willing to receive appropriate training. Incorporating behavioural and pharmacological management techniques in the undergraduate dental curriculum and expanding postgraduate training programmes in this field are important issues that can improve the well-being of both dentally anxious patients and their dentists.

Aims: The main aim of the present study was to gain a better understanding of the management of dental anxiety reported by dental practitioners in western Switzerland. Further aims included the assessment of their current strategies to treat dental anxiety and their need for further education. Materials and Methods: In 2013, an 18-item electronic questionnaire was created and sent to 726 dental practitioners identified from the of the Swiss Dental Association (SSO) database. A printed version of the questionnaire was sent by postal mail to a total of 28 dental practitioners where e-mail addresses were missing. Recipients were invited to reply by e-mail or postal mail, respectively. Up to three follow-up e-mails were sent. Results: A total of 143 dental practitioners responded to the survey. Following validation, 140 (18.6%) questionnaires were included in the analysis. About four out of five practitioners (79.4%) involved with dental emergency service in their past had at least one occurrence with dental phobic patients. The majority of the respondents stated that both dental anxiety and dental phobia increases stress in the dental practice with frequencies of 90.0% and 88.5%, respectively. Among the 119 respondents using anxiety reduction methods (85.0%), overall 51 (42.9%) reported to use pharmacological methods while the majority (89.9%; n=107) used psychological methods. Female dentists compared with their male colleagues were using psychological anxiety reduction methods three times more frequently than male dentists reaching borderline statistical significance (OR=3.0, p=0.0591). Out of 140 respondents, only 28 (20.1%) have received education and training in dental anxiety reduction methods. The majority of these (66.4%; n=83) stated that their education and training was inadequate and 55.8% (n=77) requested further education and training in these methods. Conclusions: Even though both female and male dentists reported to have experienced patients with dental phobia and increased stress levels when treating these patients, female dentists were more frequently using dental psychological anxiety reduction methods. In agreement with the requests from the respondents to this survey it can be concluded that more education and training of dental anxiety reduction methods are needed.