Faculty of Dentistry, University of Oslo, Oslo, Norway.
Oral Health Centre of Expertise, Rogaland, Stavanger, Norway.
BMC Oral Health. 2023 Jun 22;23(1):415. doi: 10.1186/s12903-023-03061-4.
Educating dentists in treatment methods for dental anxiety would increase the patients' access to treatments that are important to their oral health. However, to avoid adverse effects on comorbid symptoms, involvement by a psychologist has been considered necessary. The objective of the present paper was to evaluate whether a dentist could implement systematized treatments for dental anxiety without an increase in comorbid symptoms of anxiety, depression or PTSD.
A two-arm parallel randomised controlled trial was set in a general dental practice. Eighty-two patients with self-reported dental anxiety either completed treatment with dentist-administered cognitive behavioural therapy (D-CBT, n = 36), or received dental treatment while sedated with midazolam combined with the systemized communication technique "The Four Habits Model" (Four Habits/midazolam, n = 41). Dental anxiety and comorbid symptoms were measured pre-treatment (n = 96), post-treatment (n = 77) and one-year after treatment (n = 52).
An Intention-To-Treat analysis indicated reduced dental anxiety scores by the Modified Dental Anxiety Scale (median MDAS: 5.0 (-1,16)). The median scores on the Hospital Index of Anxiety and Depression (HADS-A/D) and the PTSD checklist for DSM-IV (PCL) were reduced as follows: HADS-A: 1 (-11, 11)/HADS-D: 0 (-7, 10)/PCL: 1 (-17,37). No between-group differences were found.
The study findings support that a general dental practitioner may treat dental anxiety with Four Habits/Midazolam or D-CBT without causing adverse effects on symptoms of anxiety, depression or PTSD. Establishing a best practice for treatment of patients with dental anxiety in general dental practice should be a shared ambition for clinicians, researchers, and educators.
The trial was approved by REC (Norwegian regional committee for medical and health research ethics) with ID number 2017/97 in March 2017, and it is registered in clinicaltrials.gov 26/09/2017 with identifier: NCT03293342.
对牙医进行牙科焦虑症治疗方法的教育，将增加患者获得对其口腔健康至关重要的治疗的机会。然而，为了避免对共病症状产生不利影响，人们认为有必要让心理学家参与进来。本文的目的是评估牙医是否可以实施系统化的牙科焦虑症治疗，而不会增加焦虑、抑郁或创伤后应激障碍的共病症状。
在一家普通牙科诊所进行了一项双臂平行随机对照试验。82 名自我报告有牙科焦虑症的患者，要么接受牙医实施的认知行为疗法（D-CBT，n=36）治疗，要么在咪达唑仑镇静下接受系统沟通技术“四习惯模式”（Four Habits/midazolam，n=41）治疗。在治疗前（n=96）、治疗后（n=77）和治疗后一年（n=52）测量牙科焦虑症和共病症状。
意向治疗分析表明，改良牙科焦虑量表（MDAS）的评分降低（中位数 MDAS：5.0（-1，16））。医院焦虑和抑郁量表（HADS-A/D）和创伤后应激障碍检查表 DSM-IV（PCL）的中位数评分降低如下：HADS-A：1（-11，11）/HADS-D：0（-7，10）/PCL：1（-17，37）。两组间无差异。
研究结果支持，普通牙医可以使用 Four Habits/Midazolam 或 D-CBT 治疗牙科焦虑症，而不会对焦虑、抑郁或创伤后应激障碍的症状产生不良影响。在普通牙科实践中为牙科焦虑症患者建立最佳治疗实践应该是临床医生、研究人员和教育工作者的共同目标。
该试验于 2017 年 3 月获得挪威医学和卫生研究伦理委员会（REC）批准，注册号为 2017/97，并于 2017 年 9 月 26 日在 clinicaltrials.gov 注册，标识符为：NCT03293342。
