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Tackling dental anxiety at its roots

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05 February 2021

Tackling dental anxiety at its roots

Senior Lecturer

Avoiding the dentist can lead to lifelong health problems. We’re helping children face their fears.

Did you dread visiting the dentist as a child? You’re not alone. Over 50% of children have some fear of dental appointments or treatment — and for a third, this is severe. It’s known as dental anxiety, and it’s a serious problem for patients and practitioners.

Dental anxiety is very distressing for children — making them feel anxious, upset, and like they have no control over their situation. This means they’re much more likely to miss or delay appointments, leading to worse oral health than other children.

So how do we break the cycle? As a health psychologist, I’ve used techniques based on Cognitive Behavioural Therapy (CBT) — a talking treatment that looks at practical ways to manage negative thoughts — to help people change the way they think and behave. I realised that a similar approach could be used to tackle dental anxiety at its roots.

The knock-on effects of dental anxiety

Left untreated, dental anxiety can persist — and worsen — into adulthood. People then face lifelong dental problems that affect their health and quality of life. 

It’s also linked to a reliance on pharmacological interventions like general anaesthetic and sedation, which do nothing to address the underlying issue.

These issues, along with missed appointments, have major financial implications, costing the NHS millions of pounds each year.

For dentists, a lack of training and resources in anxiety management means it’s difficult to know how to deal with the problem. Not only is this bad for patients, it causes significant stress for practitioners too.

With this in mind, our team set out to develop the first ever child-centred intervention for dental anxiety.

A child at a dental practice
Cognitive behavioural therapy (CBT) is used to tackle dental anxiety.

Resources and training

With input from young people, parents and dentists, we created a set of accessible CBT resources called Your Teeth — You Are in Control. These include a self-help booklet for children, plus supporting guides for parents or carers, and the dental team. 

The booklet contains simple CBT-based activities that young patients complete with their dentist. These help children understand their worries and make a plan for their treatment. 

For example, one activity looks at different coping strategies like asking questions or listening to music. It’s an effective way to open up communication, build trust, and give children a sense of control.

To underpin the resources, we designed a training programme to increase practitioners' understanding of dental anxiety and how to manage it. I also led the development of the Children's Experiences of Dental Anxiety Measure (CEDAM), which helps dentists recognise and respond to changes in patient anxiety.

Transforming care

When we tested the resources with real patients, we found a reduction in dental anxiety — and an improvement in quality of life. Importantly, they helped children living in areas of high deprivation, who are more likely to be referred to specialist services and face additional barriers to timely dental treatment. 

Now, Your Teeth — You Are in Control has been adopted by dental services across the UK, and is helping transform children’s care. It’s won awards for its focus on patient empowerment and has been translated into 10 different languages.

Dentists told us that the intervention improved their anxiety management skills and changed the way they work. It’s given them the tools to help anxious patients get the care they need, and reduced stress on the whole dental team. 

This led to five UK dental schools including the intervention in their undergraduate and postgraduate courses.

We’re already starting to see its economic potential too. In Sheffield alone, it’s reduced missed appointments by 10% — which could lead to a yearly saving of over £78,000. The resources could also cut costly general anaesthetic procedures by more than 50%.

We’re now planning to scale up the project as part of a larger trial. We hope the resources will then be rolled out across the NHS, so more young people can conquer their fears and get the care they deserve.

Publications

  • Development and Testing of a Cognitive Behavioural Therapy Resource for Children's Dental Anxiety, Porritt J, Rodd H, Morgan A, et al.. JDR Clin Trans Res. 2017;2(1):23-37. https://doi.org/10.1177/2380084416673798
  • ‘Children’s experiences following a CBT intervention to reduce dental anxiety: one year on.’ British Dental Journal, 225 (3), 247-251. Rodd, H., Kirby, J., Duffy, E., Porritt, J., Annie, M., Suneeta, P., ... Marshman, Z. (2018). https://doi.org/10.1038/sj.bdj.2018.540
  • ‘Evaluation of Self-Help Cognitive Behavioural Therapy for Children’s Dental Anxiety in General Dental Practice.’ Dentistry journal, 7 (2), e36. Bux, S., Porritt, J., & Marshman, Z. (2019). https://doi.org/10.3390/dj7020036
  • ‘Message to dentist’: Facilitating communication with dentally anxious children.’ Dentistry journal, 7 (3), e69. Rodd, H., Timms, L., Noble, F., Bux, S., Porritt, J., & Marshman, Z. (2019). https://doi.org/10.3390/dj7030069

Staff

Jenny Porritt, Senior psychology lecturer

Dr Jenny Porritt

Senior Lecturer in Health Psychology

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About this project

Explore the people and organisations behind this research, and find related publications by the research team.

Related courses

Our teaching is informed by research. Browse undergraduate and postgraduate courses with links to this research project, topic or team.

Get in touch

Find key contacts for enquiries about funding, partnerships, collaborations and doctoral degrees.

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