Treatment of Dental Phobia: Exposure and Desensitization

The dental phobia is the extreme form of the dental fear that prevents the patient from attending the treatment that the oral health requires, and the management of the phobia demands the skill that extends beyond the routine behaviour guidance. The systematic desensitization, the exposure therap...

The dental phobia is the extreme form of the dental fear that prevents the patient from attending the treatment that the oral health requires, and the management of the phobia demands the skill that extends beyond the routine behaviour guidance. The systematic desensitization, the exposure therapy, and the cognitive techniques form the core of the treatment that the specialist practice delivers, and the general practitioner who recognises the phobia and applies the first steps of the management creates the bridge that the referral crosses. This article reviews the diagnosis, the therapy, and the practice that serves the patient who carries the phobia rather than the fear.

The Diagnosis and the Distinction

The dental phobia is the diagnosis that the clinician makes when the fear reaches the intensity that paralyzes the patient, and the distinction between the fear and the phobia is the line that the treatment follows. The fear can be managed with the behaviour guidance and the reassurance, while the phobia requires the structured therapy that changes the response pattern that the patient has learned. The diagnostic interview and the self-report that the clinician administers or the specialist provides define the severity, and the history of the previous treatment that has failed or the trauma that the patient remembers is the information that the therapy uses.

The Systematic Desensitization

The systematic desensitization is the therapy that the clinician adapts from the psychotherapy, and the method follows the sequence of the gradual exposure that the patient controls. The first step is the construction of the hierarchy, and the patient lists the situations that provoke the anxiety in the order from the least to the most distressing. The patient learns the relaxation technique and then faces the first item of the hierarchy, and the clinician advances the exposure only when the patient reports the anxiety at the acceptable level. The repetition of this cycle moves the patient through the sequence until the dental visit and the treatment are the situation that the patient tolerates.

The Exposure Therapy

The exposure therapy is the direct form of the desensitization, and the clinician who uses it exposes the patient to the feared stimulus in a controlled and the supported setting. The exposure that the patient controls, where the patient decides the pace and the duration of the exposure, is the most effective form, because the patient who experiences the anxiety and survives the treatment without the harm learns the tolerance that the therapist cannot convey by words. The clinician who explains the method, supports the patient through the session, and celebrates the progress keeps the patient engaged in the therapy.

The Cognitive Techniques

The cognitive techniques that the clinician uses with the phobic patient address the thoughts that the anxiety generates, and the patient who learns to recognise and to restructure the catastrophic thought responds better to the exposure. The cognitive restructuring that follows the identification of the automatic thought replaces the fear with the realistic expectation, and the patient who enters the chair with the thought that the treatment is necessary and the safety is managed by the clinician tolerates the procedure. The patient who understands the purpose of the therapy and the steps that the clinician will follow reduces the unknown that the phobia exploits.

The Practice Adaptation

The practice that treats the phobic patient adapts the environment, the communication, and the scheduling to the needs of the patient, and the adaptation that the general practice can implement creates the bridge to the specialist care. The clinician who offers the longer appointment, the quiet room, and the presence of the support person removes the barriers that the phobia raises. The patient who arrives early, is guided through the process, and is not left alone in the waiting room perceives the practice as the safe environment.

The Referral and the Collaboration

The patient who exceeds the capacity of the practice requires the referral to the specialist, and the specialist who understands the method and the patient needs provides the therapy that the phobia demands. The referral that the general practitioner makes is the intervention that the practice can control, and the collaboration between the general and the specialist practice that treats the same patient ensures that the oral care continues while the therapy is underway.

The Home Care and the Hygiene

The patient who carries the phobia and the treatment needs the home hygiene that the anxiety does not prevent, and the routine that the clinician establishes protects the teeth that the treatment will eventually restore. A soft electric brush such as the BrushO allows the patient to clean the teeth at the low pressure, and the routine that the clinician designs for the patient with the anxiety keeps the oral care manageable during the therapy. The patient who maintains the hygiene during the treatment phase protects the teeth that the later care requires.

Clinical Key Points

- Distinguish the fear that the behaviour guidance manages from the phobia that the therapy requires.

- Construct the hierarchy of the exposures and advance only when the patient tolerates the current level.

- Use the cognitive techniques to address the catastrophic thought.

- Adapt the practice to the needs of the patient.

- Refer the patient to the specialist when the capacity of the practice is exceeded.

Conclusion

The dental phobia is the condition that the structured therapy treats, and the clinician who recognises the phobia and applies the desensitization and the exposure therapy gives the patient the treatment that the oral health demands. The general practice that supports the first steps and the specialist practice that delivers the therapy together restore the patient to the chair.