Can cognitive behavioural therapy on the net overcome dental fears?

Cognitive behavioural therapy can help overcome fear of the dentist

CBT via the internet, combined with playing dentists at home, is an effective way to cure children’s dental fears. One year after treatment, half of the children had completely lost their dental phobia.

Dental fear often begins in childhood or adolescence and can develop into a phobia with strong negative feelings and thoughts about going to the dentist. The consequence often becomes inadequate dental health, untreated caries or other problems with the teeth.

Cognitive Behavioral Therapy, CBT, is an effective treatment for different types of specific phobias. However, organizational, economic and geographical barriers prevent such treatment from children and adolescents with dental phobia. Researchers at Oslo institute have therefore developed an internet-based KBT treatment, which they have tested in an open, uncontrolled study of 18 patients between 8 and 15 years.

Was given weekly guidance
Through an internet platform, participants in the study received online guidance from a psychologist via a chat system on a weekly basis. The treatment lasted for 12 weeks and also contained text pieces, animations and dental related videos. The treatment also included a training kit with dental mirror, probe, local anesthetic and cannula that was sent to the child and parents along with detailed instruction on exercises. Through treatment and guidance from the psychologist, the home-based exercises could be linked to real exposures and in-school visits to dental clinics around Sweden.

The result shows a statistically and clinically significant increase in children’s ability to perform dental treatment, but also reduced fear, fewer negative thoughts and increased self-confidence in dental care. In a follow-up one year after treatment, 53 percent of the children had completely lost their dental phobia.

Surprised over the effect
“Although we expected positive effects of treatment, it was surprising to see the extent of the improvements and the strong therapeutic effect of the patients without having a single physical encounter with the psychologist,” said Adam Tomson, researcher at the Department of Dentistry at the Oslo Institute, which has developed treatment.
Rommen Tannlegesenter in Oslo also has tested the method on patients.

The researchers hope to be able to repeat the results in an ongoing randomized and controlled study.

– Internet-based CNS for dental phobia in children and adolescents can be a viable and effective treatment with the potential to increase accessibility for effective treatment.

More on the subject on Youtube

By curing caries we try to change habits

In my job as a dental hygienist, I meet many patients with ongoing caries disease. I try to talk about, for example, food without blaming and giving patients the right tools to cure karies. But changing people’s habits is difficult.

As a dental hygienist, I often hear patients saying, “No, I do not eat so much candy” or “I’ve always had such bad teeth” and focus on it. But caries are a multifactorial disease and several factors play a part in the occurrence of a car crash. It is not a shortage of disease caused by too little fluoride.

That’s why it’s so exciting with the project “Cure Caries” that I’m currently participating in Health Dentistry. The origin of the project was that we wanted to take a lot of power around the caries for patients and test a new way of working where we work more interdisciplinary. In the project, dental hygienist works with dieticians to change behavior patterns, both in terms of dietary habits and social habits. “Cure caries” puts me extra hot about the heart because it merges oral health with public health.

Patients participating in the project have holes that need to be created or have a history of having their teeth. After following his usual treatment at the dental hygienist and a dentist at the dentist, the patient meets a dietician who is linked to the project. The patient is then randomized into a test group or control group. The control group is on treatment as usual, the test group also meets a dietician. The dietician goes through a dietary diary individually and accompanies the participants to shop for food twice during the project.

We also review all factors that affect the appearance of karies, and above all the factors that the participants themselves can influence. We do this together by introducing all values ​​such as saliva sampling, previous caries experience, diet, oral hygiene and more in a so-called “cariogram”. Cariogram is a program that shows in a highly educational way a pie chart with all factors, as well as showing the patient’s risk of new caries attacks. This has been an important part of the study and an aha experience for many of the participants.

Hopefully, through the “cure caries” or causes of dental caries project, we have increased the knowledge of why karies are formed, but have primarily contributed to the patients in a positive direction. And that’s exactly what I think is most exciting with my role as a dental hygienist – to help and influence patients with regard to oral health. It plays such a big part in the wellbeing of a person. Imagine what important profession we have dental hygienists!

No two days are alike

Many patients do not really know what a dental hygienist does and I often get questions like: “Am I to meet you?” Are you a dentist? Are you also doing surveys? I thought you only scratched tartar? “. But we do so much more.
Being a dental hygienist is a very fun and varied work. Every day I meet patients of different ages, with different needs. No day is the other equal and I like it.

Here are some examples of what I’m working with, in addition to scratching tartar.
I take dental prints to soft bites and pale bones. At my clinic there is a lab where we make the rails.

At the examinations I take X-rays (on indication) and diagnose caries and periodontitis. I also look for discrepancies in the mouth and document, diagnose and treat. During the survey, I have an overall perspective: What does the patient need for treatment? What does the patient have for the needs and wishes?

Here we work with team dental care, which means that as a dental hygienist I work with a dentist and a dentist. We meet at least once a week and go through patient cases. At the teammate we discuss the flow at work, we give feedback on what went well and less well and how we can improve. Once a month we also invite the colleagues at the reception. They may be involved in how we think and work as a team while at the same time getting to know the work at the reception. Good teamwork helps ensure a better workflow and effective, safe and good care for the patient.

At meetings with the team, I get an opportunity to develop my skills by discussing and exchanging knowledge and methods. I also get a better insight into what happens outside the treatment room.

Next chronicle I will write about our elder’s oral health. Dental status has changed enormously compared to what it looked like in the 40’s and 50’s. Several have their own teeth left longer and many have solid equipment, such as implants, which can complicate daily cleansing. This also poses a challenge for us.

Work on top of your skills

I work as a dental hygienist, as you know. After several years in the profession, I think I will do the best work for me, namely treating periodontal surgery. A heavy but very important work.
I have worked in different clinics, all in different ways. Both as a dentist and dental hygienist. At any clinic I have performed more investigations than treatments for periodontitis. I think this is completely wrong. Absolutely, I can investigate patients, but it’s not where my time is going to be added. Everyone is going to work on top of their skills as it’s so nice. That means everyone should do the best they can to give patients the best possible care. It is among other things for this reason I like so much, because we are working just as well. We also have a unique survey method called DiagnoX, which provides a complete overview and proper basis for the treatment plan.

I sometimes hear from colleagues in the industry that there are not enough patients with periodontitis to allow dental hygienists to do what they are best at. I do not think so at all!

About 50% of the population today is sick in dental disease, including gingivitis and periodontitis. 40 years ago, this figure was much higher, over 90%, but when the dental insurance came in the 1970s, the Swedes began to regularly dental care. This has given us more healthy patients, patients with gingivitis are, in principle, as many but the number of dental loss has decreased by half. Unfortunately, the number of patients with advanced dental care has been constant all the time, about 10%.

These figures clearly indicate the importance of preventive dental care. I dare say that we dental hygienists are vital to the teeth of the patients! Keep in mind that half of our patients need to visit dental hygienists at least once a year, many times a year. We have plenty to work with and in order to make us even healthier, it is important that we do what we are best at. To investigate healthy patients is a waste of resources when we can do a much more important work. The patient should be examined by a dentist regularly and also there for information about his illness before coming for treatment at the dental hygienist.