PAINLESS DENTISTRY

A computerized video tool designed to reduce fear of dental injections has the potential to help patients stop avoiding dental care due to fear, according to a new study in a supplement of the Journal of Dental Research (May 20, 2013).

A quarter of adults report a clinically significant fear of dental injections, and 1 in 20 say they avoid dental treatment due to such fears, according to the study authors, from the University of Washington School of Dentistry.

"While systematic desensitization is the most common therapeutic method for treating specific phobias such as fear of dental injections, lack of access to trained therapists, as well as dentists’ lack of training and time in providing such a therapy, means that most fearful individuals are not able to receive the therapy needed to be able to receive necessary dental treatment," the researchers wrote.

To address this issue, they turned to a computerized treatment approach: computer-assisted relaxation learning (CARL), which uses systematic desensitization to reduce dental injection fear. Through a series of two- to four-minute video segments, CARL introduces cognitive and physical coping strategies. The patient is then shown a model successfully managing anxiety while being presented with increasingly invasive aspects of a dental injection.

This dentist-blind, parallel-group study, conducted in eight U.S. sites, compared CARL with an informational pamphlet in reducing fear of dental injections. It is the first randomized control trial of a computerized treatment for dental injection fear, according to the authors. Previous research has shown that CARL effectively reduced dental injection fear after program completion and at one-year follow-up.

The researchers used newspaper ads to recruit people who reported fear and avoidance of dental injections. The ads ran in the communities of eight participating dental practices from February 2008 through June 2010. After arriving at the assigned dental office, participants received study information from a dental staff member, then completed three surveys about anxiety and fears regarding dentists and needles on a computer.

A total of 68 participants completed the study. Half viewed the CARL videos and half were given pamphlets with information about patient comfort, topical and local anesthetics, and postoperative pain management. Of the 34 CARL participants, 12 (35.3%) subsequently got injections, while 6 (17.6%) of those who read the pamphlets received injections.

Only 26% of participants who completed the study returned for an optional dental injection. Due to the small overall proportion of participants who got injections, the study was not able to fully assess the primary outcome of self-reported anxiety during injection and so did not achieve statistical significance, the researchers noted.

However, participants who viewed CARL reported significantly greater reduction in self-reported general and injection-specific dental anxiety measures compared with control patients (p < 0.001). While twice as many people who saw the video subsequently opted to get a dental injection, it was not statistically significant.

"CARL … was successful in reducing self-reported dental fear related to dental injections compared with an informational standard of care," the researchers concluded. "Since CARL does not require involvement by trained therapists or special training for dentists, it may increase access to this therapeutic approach to a wider proportion of the population, improving access to dental care and better oral health."