Dissemination of a Brief Dental Fear Intervention
Condition: Dental Fear
Study type: Interventional

Summary: 
      Despite the fact that several efficacious interventions for dental fear exist, it continues
      to be among the most common, and least addressed phobias among individuals. This reality is
      largely due to dissemination, or lack thereof. Research is needed on how to disseminate and
      implement such treatment in a way that recognizes the barriers to accessing and entering
      treatment for dental fear. Using a collaborative care approach, the investigators will pilot
      test, for feasibility and acceptability, a brief 2-step dental fear intervention. The first
      step will be an app intervention for moderate-to-severe dental that can be accessed by
      participants on a mobile device. The second step will consist of a one-hour face-to-face CBT
      intervention for participants delivered by a mental health professional at their dentist's
      office.
    

Detailed description: 
      Dental fear is among the most common individual phobias, and has devastating effects on oral
      and physical health, as well as emotional well-being. The behavioral avoidance associated
      with dental fear leads to neglect of prophylactic care, more dental emergencies, increased
      pain and suffering for individuals, and greater financial burdens, both for patients and
      society at large. Treatment remains inaccessible to the vast majority of fearful patients.
      Extremely efficacious brief evidence-based interventions for dental fear have not been
      administered outside of the specialty clinics in which they were developed. This is despite
      the ubiquitous nature of dental fear and its well-document impact on public health. Further,
      none of these existing treatment models can be easily incorporating into dental practices
      (due to issues of logistics, credentialed providers, time, financial costs, and disruptions
      of workflow).

      Research is needed on how to disseminate and implement such treatment in a way that
      recognizes the barriers to accessing and entering treatment for dental fear. The
      investigators propose to pilot test, for feasibility and acceptability, Dental FearLess, a
      brief, free, self-directed, computerized intervention for moderate-to-severe dental fear that
      can be implemented in the waiting room of dental offices. Patients reporting
      moderate-to-severe dental fear after completing Dental FearLess will be offered a follow-up
      1-hour session that covers the same content in person. Clearly, the challenge at present is
      not how to treat dental fear to reduce the financial and human suffering burden to public
      health, but how to disseminate and implement Evidence Based Interventions (EBIs) for dental
      fear in a way that recognizes the rewards and barriers in the U.S. healthcare system.

      Stepped-care interventions have demonstrated efficacy for other behavioral and emotional
      problems. The investigators aim to test whether such interventions are feasible and
      acceptable, for both dentists and patients, for dental fear. If the pilot evaluation shows
      promise, it can be tested in larger studies and, if effective, be more widely implemented in
      the normal course of dental practice. This could improve uptake and, ultimately, patient
      outcomes compared with existing psychosocial interventions for dental fear.
    

Intervention name(s): Dental FearLess app; In-Chair Treatment Protocol
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Dental FearLess, is a self-administered psychoeducational intervention that will be accessed by participants via their personal smart device (In other words, this is an online application in which investigators present information about dental procedures. The user selects the procedure on which they would like information and then views a brief video on the selected procedure. It uses evidence-based tools to help participants manage their thoughts, feelings, and behavior related to dental fear to reduce fear during encounters with dental professionals.; This session is a 1-hour-in-person Cognitive Behavioral Therapy (CBT) dental fear session by study staff at the dental office. Participants will practice managing their thoughts, behaviors, and/or feelings when exposed to stimuli that they report still fearing. After each practice situation, the mental health provider and participant discuss the disconfirmatory evidence generated by the situation.
Intervention model: Single Group Assignment
Intervention model description: Piloting dissemination and feasibility of a two-step dental fear treatment at private practices in a large metropolitan city.
Masking: None (Open Label)
Primary purpose: Treatment