Title: Development of a guided self-help Cognitive Behavioural Therapy resource for the reduction of dental anxiety in young people aged 11-16 years.
Funder: Department of Health (England)

Abstract: Background - importance of reducing dental anxiety in young people Dental anxiety is common with just under half of children reporting some dental anxiety and 10-20% reporting high levels of dental anxiety (Taani, El-Qaderi et al. 2005; Dogan, Seydaoglu et al. 2006). Dental anxiety has major implications for young people and their parents. Young people with high levels of dental anxiety have more decayed and extracted teeth than less anxious children (Townend, Dimigen et al. 2000; Versloot, Veerkamp et al. 2004; Nicolas, Bessadet et al. 2010) and avoidance may result in increased unmet need for dental care (Berggren and Odont 2001). Up to 1 in 5 young people report not visiting the dentist regularly because of fear (Taani 2002) with fear being a significant barrier to completion of dental treatment (McGoldrick, Levitt et al. 2001). There are also long term implications, with evidence that anxiety can intensify (Kendell 1992; Salloum, Sulkowski et al. 2009) and anxious children are more likely to be symptomatic, rather than proactive users of dental services in adulthood (Poulton, Waldie et al. 2001). Dental anxiety in young people also has a significant impact on dental services. Providing treatment for anxious patients is time consuming, costly, demanding and a cause of occupational stress for dentists (Moore and Brodsgaard 2001). These factors result in patients being referred to secondary care services, having to wait longer for dental treatment and increased costs to the NHS (Harris, Pender et al. 2008). Traditionally, dental anxiety in young people has been managed using pharmacological techniques including inhalational sedation (laughing gas) and general anaesthesia (GA). However, such approaches are costly and only manage rather than reduce dental anxiety (Koroluk 2000). The cost per case for inhalational sedation or GA for dental treatment has been estimated at £273 and £720 respectively (National Institute for Health and Clinical Excellence 2010). Therefore, over recent years greater effort has been directed towards behaviour management and psychological interventions such as Cognitive Behavioural Therapy (CBT), which can reduce patient’s anxiety in the long-term and prevent dependence on pharmacological methods (Levitt, McGoldrick et al. 2000; Bankole, Aderinokun et al. 2002). Through the reduction of dental anxiety in young people, the consequences of dental anxiety, including high levels of unmet need, failure to complete courses of treatment and symptomatic attendance, can be alleviated. Aims: To develop the first guided self-help CBT resource for young people and their parents for the reduction of dental anxiety and undertake a feasibility study to inform a future pilot trial. Plan: The project will be in two phases. Phase one will involve young people (aged 11-16 years) and their parents in the development of a guided self-help CBT resource to reduce dental anxiety. The second phase will be a feasibility study to assess whether a pilot trial can be conducted to evaluate the clinical and cost-effectiveness of the guided self-help CBT resource compared to alternative pharmacological approaches to dental anxiety. The feasibility study will identify the: a) most appropriate measure of dental anxiety, the primary outcome measure for a trial b) profile of dentally anxious young people who could potentially be helped by a guided self-help CBT resource c) perceptions of primary dental care team members of such a resource and their willingness to recruit participants to a trial d) retention and completion rates and acceptability of the resource to patients and parents e) availability of information required to evaluate the cost-effectiveness of a guided self-help CBT resource.


Research activity codes: 5.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH