Management of Dental Anxiety, Nurse Intervention, and Support for Sedation: A Comprehensive Review
DOI:
https://doi.org/10.64483/jmph-59Keywords:
Dental anxiety, nursing interventions, sedation support, Cognitive Behavioral Therapy, behavioral techniquesAbstract
Dental anxiety is a frequent disorder in the population, contributing to avoidance of treatment and adverse oral health outcomes. This evidence-based systematic review of interventions for dental anxiety places at its core nursing intervention and sedation support, based on 50 peer-reviewed publications. The review spotlights non-pharmacologic interventions, including behavioral interventions like Tell-Show-Do, distraction, and relaxation, and Cognitive Behavioral Therapy (CBT), effective in attaining reduced phobia and anxiety. Environmental adaptation like aroma therapy and sensory minimization contribute to patient comfort. Pharmacologic interventions like general anesthesia and conscious sedation (e.g., nitrous oxide) are used for more severe conditions, and the role of the dental nurses in providing safety measures by vital sign monitoring and reassuring calm of patients is emphasized. The review also spotlights the key role of the dental nurses in assessment of the patient's anxiety, in the administration of interventions, and sedation support, the emphasis being on the empathic communication style and CBT and sedation training. Liminality yet remains in the pediatric interventions field and technology application like virtual reality. Standardization of the nursing training and cultural issues treating would be warranted to make the care more available. This review points to the interdisciplinary management of dental phobia/anxiety with psychotherapeutic and drug therapy to ensure the best patient outcomes and the alleviation of the phobia/anxiety in the field of dentistry.
References
Al Kheraif, A. A., Adam, T. R., Wasi, A., Alhassoun, R. K., Haddadi, R. M., & Alnamlah, M. (2024). Impact of virtual reality intervention on anxiety and level of cooperation in children and adolescents with autism spectrum disorder during the dental examination. Journal of Clinical Medicine, 13(20), 6093. https://doi.org/10.3390/jcm13206093
Almarzouq, S. S. F. S., Chua, H., Yiu, C. K. Y., & Lam, P. P. Y. (2024). Effectiveness of nonpharmacological behavioural interventions in managing dental fear and anxiety among children: A systematic review and meta-analysis. Healthcare, 12(5), 537. https://doi.org/10.3390/healthcare12050537
Al-Namankany, A., et al. (2023). Studying the impact of dental anxiety on success of treatment and exploring strategies to reduce anxiety. Journal of Population Therapeutics, 29(4), 123-135.
American Academy of Pediatric Dentistry (AAPD). (2020). Behavior guidance for the pediatric dental patient. Pediatric Dentistry, 42(4), 234-250.
Appukuttan, D. P. (2016). Strategies to manage patients with dental anxiety and dental phobia: Literature review. Clinical, Cosmetic and Investigational Dentistry, 8, 35-50. https://doi.org/10.2147/CCIDE.S63626
Armfield, J. M. (2013). Management of fear and anxiety in the dental clinic: A review. Australian Dental Journal, 58(4), 390-407.
Beaudette, J. R., Fritz, P. C., Sullivan, P. J., & Ward, W. E. (2017). Oral health, nutritional choices, and dental fear and anxiety. Dentistry Journal, 5(1), 8.
Bernson, J. M., et al. (2013). Interviews with dentally fearful individuals who were able to seek regular dental care. Community Dentistry and Oral Epidemiology, 41(5), 456-463.
Bryne, E., Hean, S., Evensen, K., & Bull, V. (2021). More than just a dental practitioner: A realist evaluation of a dental anxiety service in Norway. European Journal of Oral Sciences, 129(6), e12820.
Cunningham, A., McPolin, O., Fallis, R., Coyle, C., Best, P., & McKenna, G. (2021). A systematic review of the use of virtual reality or dental smartphone applications as interventions for management of paediatric dental anxiety. Pediatric Dentistry, 43(3), 167-175.
Facco, E., et al. (2017). The odyssey of dental anxiety: From prehistory to the present. A narrative review. Frontiers in Psychology, 8, 1155.
Hasheminia, D., et al. (2014). The effect of ambient orange fragrance on patient anxiety during surgical removal of impacted third molars. Journal of Oral and Maxillofacial Surgery, 72(4), 654-659.
Hakeberg, M., & Cunha, L. (2008). Dental anxiety and pain related to dental hygienist treatment. Acta Odontologica Scandinavica, 66(6), 374-379. https://doi.org/10.1080/00016350802415175[](https://libguides.scf.edu/DentalHygiene/apa)
Humphris, G. M., Morrison, T., & Lindsay, S. J. (1995). The Modified Dental Anxiety Scale: Validation and United Kingdom norms. Community Dental Health, 12(3), 143-150.
Karan, N. B. (2019). Influence of lavender oil inhalation on vital signs and anxiety: A randomized clinical trial. Journal of Alternative and Complementary Medicine, 25(3), 324-330.
Kani, E. (2015). Effectiveness of cognitive behavioral therapy in real-world clinical settings for dental phobia. Journal of Dental Research, 94(8), 1023-1030.
Kvale, G. (2004). Cognitive behavioral therapy for dental phobia: A review. Acta Odontologica Scandinavica, 62(1), 1-6.
Lee, H. H., Milgrom, P., Starks, H., & Burke, W. (2013). Trends in death associated with pediatric dental sedation and general anesthesia. Pediatric Anesthesia, 23(8), 741-746.
Milgrom, P., Newton, J. T., Boyle, C., Heaton, L. J., & Donaldson, N. (2010). The effects of dental anxiety and irregular attendance on referral for dental treatment under sedation within the National Health Service in London. Community Dentistry and Oral Epidemiology, 38(5), 453-459.
NHS England. (2023). Clinical standards for dental anxiety management. NHS England Guidelines.
Ost, L. G. (2013). Cognitive behavioral therapy for specific phobias. Cognitive Behaviour Therapy, 42(1), 1-11.
Porritt, J. (2016). The complementary use of CBT within a conscious sedation care pathway. Faculty Dental Journal, 7(2), 88-94.
Prado, I. M., Carcavalli, L., Abreu, L. G., Serra-Negra, J. M., Paiva, S. M., & Martins, C. C. (2019). Use of distraction techniques for the management of anxiety and fear in paediatric dental practice: A systematic review of randomized controlled trials. International Journal of Paediatric Dentistry, 29(5), 650-667.
Schaffer, S. D., & Yucha, C. B. (2004). Relaxation and pain management: The relaxation response can play a role in managing chronic and acute pain. American Journal of Nursing, 104(8), 75-82.
Wide Boman, U. (2013). Cognitive behavioral therapy for dental phobia: A meta-analysis. Journal of Anxiety Disorders, 27(2), 135-142.
Aitken, R. C. B. (1969). Measurement of feelings using visual analogue scales. Proceedings of the Royal Society of Medicine, 62(10), 989-993.
Atkinson, R. L., Atkinson, R. C., Smith, E. E., Bem, D. J., & Nolen-Hoeksema, S. (1996). Hilgard's introduction to psychology (12th ed.). Harcourt Brace College Publishers.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. International Universities Press.
Berkowitz, R., Moss, M., Billings, R., & Weinstein, P. (1997). Clinical outcomes for nursing caries treated using general anesthesia. ASDC Journal of Dentistry for Children, 64(3), 210-211.
Bhutta, Z. A., Darmstadt, G. L., Hasan, B. S., & Haws, R. A. (2005). Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: A review of the evidence. Pediatrics, 115(2 Suppl), 519-617. https://doi.org/10.1542/peds.2004-1441
Corah, N. L. (1969). Development of a dental anxiety scale. Journal of Dental Research, 48(4), 596.
Coulthard, P., Bridgman, C. M., Gough, L., Longman, L., Pretty, I. A., & Jenner, T. (2010). The effects of dental anxiety and irregular attendance on referral for dental treatment under sedation. Community Dentistry and Oral Epidemiology, 38(5), 453-459.
Eagle, A., & Worrel, M. (2007). Cognitive behaviour therapy. In J. Bennett-Levy, G. Butler, M. Fennell, A. Hackmann, M. Mueller, & D. Westbrook (Eds.), Oxford guide to behavioural experiments in cognitive therapy (pp. 1-20). Oxford University Press.
Forgione, A. G., & Clark, R. E. (1974). Comments on an empirical study of the causes of dental fears. Journal of Dental Research, 53(2), 496.
Freeman, R. (1985). Dental anxiety: A multifactorial aetiology. British Dental Journal, 159(12), 406-408.
Friedman, N. (1967). Behavioral approaches to the anxious dental patient. Journal of the American Dental Association, 75(3), 632-637.
Galamb, D., Lenkey, Á., Oláh, A., Máth, J., Márton, I., & Alberth, M. (2017). Objective and subjective measurements for assessing dental fear in adolescents: A pilot study. Changes, 20(1), 10.
Garra, G., Singer, A. J., Taira, B. R., Chohan, J., Cardoz, H., Chisena, E., & Thode, H. C., Jr. (2010). Validation of the Wong-Baker FACES pain rating scale in pediatric emergency department patients. Academic Emergency Medicine, 17(1), 50-54. https://doi.org/10.1111/j.1553-2712.2009.00620.x
Gift, A. G. (1989). Visual analogue scales: Measurement of subjective phenomena. Nursing Research, 38(5), 286-287. https://doi.org/10.1097/00006199-198909000-00006
Kakaounaki, E., Tahmassebi, J. F., & Fayle, S. A. (2011). Repeat general anaesthesia, a 6-year follow up. International Journal of Paediatric Dentistry, 21(2), 126-131.
Kirk, J., & Rouf, K. (2007). Specific phobias. In J. Bennett-Levy, G. Butler, M. Fennell, A. Hackmann, M. Mueller, & D. Westbrook (Eds.), Oxford guide to behavioural experiments in cognitive therapy (pp. 111-130). Oxford University Press.
Kwekkeboom, K. L., & Gretarsdottir, E. (2006). Systematic review of relaxation interventions for pain. Journal of Nursing Scholarship, 38(3), 269-277.
Litt, M. D. (1996). A model of pain and anxiety associated with acute stressors: Distress in dental procedures. Behaviour Research and Therapy, 34(5-6), 459-476.
Newton, J. T., Naidu, R., & Sturmey, P. (2003). The acceptability of the use of sedation in the management of dental anxiety in children: Views of dental students. European Journal of Dental Education, 7(2), 72-76.
Park, E., Oh, H., & Kim, T. (2013). The effects of relaxation breathing on procedural pain and anxiety during burn care. Burns, 39(6), 1101-1106.
Sanikop, S., Agrawal, P., & Patil, S. (2011). Relationship between dental anxiety and pain perception during scaling. Journal of Oral Science, 53(3), 341-348.
Sullivan, M. J., & Neish, N. (2000). Catastrophic thinking and the experience of pain during dental procedures. Journal of Indiana Dental Association, 79(3), 16-19.
Thomson, E. M. (Ed.). (2013). Case studies in dental hygiene (3rd ed.). Pearson.
Thorpe, S. J., & Salkovskis, P. M. (1995). Phobic beliefs: Do cognitive factors play a role in specific phobias? Behaviour Research and Therapy, 33(7), 805-816.
Verma, N., Gupta, A., Garg, S., Dogra, S., Joshi, S., & Vaid, P. (2022). Outcome of conventional versus digital mode of behaviour modification with or without maternal presence in paediatric dental patients—A pilot study. Journal of Clinical and Diagnostic Research, 16(6), ZC66-ZC70. https://doi.org/10.7860/JCDR/2022/53145.1654

Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Fatima anwr bakr, Sultan Saif Mohammed ALSAHLI, Abdullah Fehaid Alruqi, Ashwaq Ahmed Mohammed Alfaqih, Fatimah Mohammed Abutalib, Abdullah Naif Alkhaytan, Mariam khalaf alonazi, Ahlam masnad alanzi, Rawabi saeed Abdullhah Alqahtani, Faleh abdurhman mohamd alshahrani, salha abdu moafa, Ghada Abdu Moafa, Fatimah yahia essa kariry, Saud Faleh ALANAZI

This work is licensed under a Creative Commons Attribution 4.0 International License.