Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Dental Hospital, Great Maze Pond, London, SE1 9RT, UK.
Professor of Psychology as applied to Dentistry/Honorary Consultant/Dean of Research Governance, Ethics and Integrity, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.
BMC Oral Health. 2023 Jul 31;23(1):531. doi: 10.1186/s12903-023-03095-8.
People with dental phobia often present with more active dental caries and fewer teeth. Minimally Intervention oral Healthcare offers a possible solution to address the high care needs of this group. The aim was to determine this patient group's eligibility and willingness to participate and the effect of MIOC, compared to treatment as usual (TAU), on their oral health outcomes for planning a future randomised controlled trial (RCT). Minimum intervention oral healthcare (MIOC) comprises of four interlinked domains. In the first domain, we identified and diagnosed the disease status and participants' anxiety status (≥ 19 MDAS). In the second domain, an individualised prevention-based personalised care plan was designed. During this process, patients with dental phobia were exposed to the dental environment in a stepped manner ('graded exposure') and had their urgent care provided with conscious sedation. In the 3 domain, we took a minimally invasive operative approach to restore teeth while preserving tooth substance and limiting the use of fear-provoking stimuli (e.g., rotary instruments) when possible. At the review and the recall appointment(s) (4 domain), the patients' oral health care behaviours, disease risk/susceptibility and fear levels were re-assessed.
This two-arm randomised feasibility trial (N = 44) allocated participants to the experimental arm (MIOC) or the control arm (treatment as usual [TAU]). The primary outcomes were the eligibility and willingness to participate and feasibility to conduct a trial of MIOC for people with dental phobia. The secondary outcomes were oral health status, oral health related quality of life and care completion. A written and verbal consent for participation and dental care provision were obtained.
Forty-four people diagnosed with dental phobia were allocated randomly to the two study arms. At the six-month recall after completed care, the outcome of each study arm was assessed. It was feasible to conduct a clinical trial (eligibility rate [56%], completion rate [81%], declined to participate [12%]). The intervention group showed improvements in all health care outcomes, and oral health related quality of life.
A clinical trial of MIOC vs TAU in people with dental phobia is feasible. Preliminary findings suggest that patients in the MIOC arm are more likely to successfully complete their course of treatment. The study was 'retrospectively registered' on 02/05/2018 (ISRCT15294714) with the International Standard Randomised Controlled Trial (ISRCT).
患有牙科恐惧症的人通常会出现更多的龋齿和更少的牙齿。微创口腔保健提供了一种可能的解决方案，可以满足这群人的高护理需求。本研究旨在确定该患者群体的参与资格和意愿，并比较 MIOC 与常规治疗 (TAU) 对其口腔健康结果的影响，以为未来的随机对照试验 (RCT) 做规划。微创口腔保健 (MIOC) 由四个相互关联的领域组成。在第一个领域，我们确定并诊断了疾病状况和参与者的焦虑状况（≥19 项 MDAS）。在第二个领域，设计了个体化的基于预防的个性化护理计划。在此过程中，牙科恐惧症患者以渐进的方式（“分级暴露”）暴露于牙科环境中，并在有意识的镇静下提供紧急护理。在第三个领域，我们采取微创手术方法来修复牙齿，同时保留牙本质并尽可能限制使用引起恐惧的刺激物（例如旋转器械）。在复查和（多次）复诊预约（第四个领域）中，重新评估患者的口腔保健行为、疾病风险/易感性和恐惧水平。
这项双臂随机可行性试验（N=44）将参与者随机分配到实验组（MIOC）或对照组（常规治疗 [TAU]）。主要结果是确定 MIOC 治疗牙科恐惧症患者的参与资格和意愿以及可行性。次要结果是口腔健康状况、口腔健康相关生活质量和护理完成情况。获得了参与和提供牙科护理的书面和口头同意。
44 名被诊断为牙科恐惧症的患者被随机分配到两个研究组。在完成护理后的六个月复诊时，评估了每个研究组的结果。开展 MIOC 临床试验是可行的（参与率[56%]，完成率[81%]，拒绝参与[12%]）。干预组在所有保健结果和口腔健康相关生活质量方面均有所改善。
MIOC 与 TAU 治疗牙科恐惧症的临床试验是可行的。初步结果表明，MIOC 组的患者更有可能成功完成疗程。该研究于 2018 年 5 月 2 日（ISRCT15294714）在国际标准随机对照试验 (ISRCT) 注册。
