Are Technology-Based Interventions Effective in Reducing Dental Anxiety in Children and Adults? A Systematic Review.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of technology-based interventions for the treatment of dental anxiety in children and adults. DATA SOURCES: A systematic search using relevant keywords was conducted in PubMed-Medline, EMBASE, PsycINFO, CINAHL, Scopus, and The Cochrane Library. INCLUSION CRITERIA: Randomized controlled trials (RCTs) that compared technology-based interventions with inactive controls in the treatment of moderate to severe dental anxiety were included. RESULTS: A total of seven RCTs were included in the review. These studies investigated the effectiveness of video modeling, computerized cognitive behavioral therapy, virtual reality exposure therapy, and distraction with music and audiovisual video material. Six studies examining video modeling, computerized cognitive behavioral therapy, virtual reality exposure therapy, and distraction (audiovisual) showed significantly greater reductions in dental anxiety than inactive controls in both children and adults. None of the included studies followed Consolidated Standards of Reporting Trials guidelines completely or reported sufficient data, thereby precluding a possible meta-analysis. Four out of seven included studies were assessed to be at high risk of bias. CONCLUSIONS: A limited number of studies supported the effectiveness of technology-based interventions in the treatment of dental anxiety in children and adults. CLINICAL SIGNIFICANCE: The quality of the methods of studies on the effects of technology-based interventions allows only limited inferences on the effects of these interventions. However, within the limitations of the systematic review, the results converge to suggest that technology-based interventions may be useful as an adjunct to standard dental care. High-quality RCTs are needed to determine the (relative) effectiveness of these interventions. PROSPERO REGISTRATION NUMBER: CRD42017064810.

Efficacy of virtual reality exposure therapy for the treatment of dental phobia in adults: A randomized controlled trial.

BACKGROUND: Although Virtual Reality Exposure Therapy (VRET) has proven to be effective in the treatment of various subtypes of specific phobia, there is limited evidence of its role in the treatment of dental phobia. METHOD: A single-blind RCT was conducted among 30 randomized patients with dental phobia to either VRET or informational pamphlet (IP) condition. Primary outcome anxiety measures (VAS-A, MDAS and DFS) were evaluated at baseline, pre- and post-intervention, 1-week, 3-months and 6-months follow-up. Secondary outcome measures assessed were pre-post behavioral avoidance, temporal variations of heart rate and VR-experience during and post-VRET, and dental treatment acceptance in both conditions at 6-month follow-up. RESULTS: Intention to treat analysis, using a repeated measures MANOVA, revealed a multivariate interaction effect between time and condition (p = 0.015) for all primary outcome measures (all ps < 0.001). Only patients of the VRET condition showed a significant reduction in anxiety scores (mean reduction [s.d.]: VAS-A 44.4 [36.1]; MDAS 7.1 [5.4]; DFS 21.2 [13.1]) whereas the patients in the IP group did not (mean reduction [s.d.]: VAS-A -0.33 [7.7]; MDAS -0.33 [1.3]; DFS -1.9 [3.8]), F (15, 14) = 3.3, p = 0.015. CONCLUSIONS: VRET was found to be efficacious in the treatment of dental phobia.

Virtual Reality Exposure Therapy for the Treatment of Dental Phobia: A Controlled Feasibility Study.

BACKGROUND: Virtual reality exposure therapy (VRET) has been used to treat a variety of fears and phobias. AIM: To determine the feasibility (i.e. safety and efficacy) of using VRET to treat dental phobia. METHOD: Safety was evaluated by determining any adverse events or symptom exacerbation. Efficacy of VRET was evaluated by comparing the reduction in dental anxiety scores (measured 16 times within a 14-week study period, and at 6-month follow-up), and its behavioural effects with that of an informational pamphlet (IP) on ten randomized patients with dental phobia using a controlled multiple baseline design. Participants' heart rate response during VRET, and their experience post-VRET, were indexed. RESULTS: No personal adverse events or symptom exacerbation occurred. Visual analysis and post-hoc intention-to-treat analysis showed a significantly greater decrease in dental anxiety scores [higher PND (percentage of non-overlap data) scores of 100% and lower POD (percentage of overlap data) of 0%, Modified Dental Anxiety Scale, F (1,8) = 8.61, p = 0.019, and Dental Fear Scale, F (1,8) = 10.53, p = 0.012], and behavioural avoidance in the VRET compared with the IP group [d = 4.2 and -1.4, respectively). There was no increase in average heart rate during VRET. Of the nine treatment completers, six (four from the VRET group and two from the IP group) no longer had dental phobia at 6-month follow-up. Four of the five VRET participants, but none of the IP participants, scheduled a dental treatment appointment following the intervention. CONCLUSION: VRET is a feasible alternative for patients with dental phobia.

Virtual Reality Exposure Therapy for Treatment of Dental Phobia.

popularity as an effective treatment for anxiety disorders. The purpose of this article is to determine the applicability of VRET in the treatment of dental phobia of two patients. Two case examples of female dental patients, aged 56 and 24 years, who met the criteria for dental phobia according to the Phobia Checklist, illustrate the use of VRET in the dental setting. VRET that is used as a psychological treatment for dental fear and dental phobia can potentially be given by a non-specialist (for example dental assistant), thereby making it a cost-effective therapy for the treatment of dental phobia. Clinical relevance: This article is the first of its kind to demonstrate Virtual Reality Exposure Therapy (VRET) in the treatment of dental anxiety.

Apical plug technique in a calcified immature tooth: a case report.

Traumatic injury to an immature tooth may result in pulpal necrosis secondary to pulp canal obliteration, which makes the management of the tooth a clinical challenge for dentists. The present case report describes an innovative apical plug technique with mineral trioxide aggregate in a calcified immature tooth using an ultrasonic tip and long, thin, tapered fissure burs. The technique was proven to be successful clinically and radiographically at 2 years postobturation.

Foreign bodies in primary molars: a report of 2 cases.

Foreign bodies can be found in the pulps of primary teeth during routine oral examinations. These foreign bodies can result in painful complications. A detailed case history and clinical and radiographic examinations are necessary to come to a conclusion about the nature, size, and location of the foreign body, and to determine the difficulty involved in its removal. The purpose of this paper was to discuss 2 clinical cases and the management of foreign bodies found lodged in primary molars.

Modified distal shoe appliance--fabrication and clinical performance.

When the primary second molar is prematurely lost, mesial movement and migration of the permanent first molar often occurs. This is one of the most difficult problems of the developing dentition confronted by pediatric dentists. Use of a space maintainer that will guide the permanent first molar into its normal position is indicated. In cases with bilateral premature loss of primary molars, the conventional design of distal shoe poses a variety of problems and, therefore, necessitates a customized design for the eruption guidance of permanent first molars. The purpose of this case report is to discuss an innovative design of a distal shoe appliance, which was used with good clinical results.

Gingival health status of 2- to 15-year-old Benghazi children with type-I diabetes mellitus.

PURPOSE: The influence of diabetes on the risk of developing gingivitis has been the subject of much discussion in the literature. Most of the previous literature has focused on adults, with limited studies available on children. The purpose of this study was to evaluate and compare the plaque and gingival health status of diabetic children with healthy controls. METHODS: A comparative study was conducted between 72 children with type-I diabetes mellitus (average age=10.18±3.91-years-old) and 72 healthy controls (average age=10.8±2.78- years-old). Both groups were compared statistically regarding plaque and gingival indices using the t test for equality of means. RESULTS: The experimental group showed higher mean plaque and gingival scores vs the control group. A statistically significant difference (P<.01) in plaque and gingival scores were observed between the groups in the primary, mixed, and permanent dentition. CONCLUSIONS: Higher dental plaque levels and gingival scores were observed in the diabetic children vs the nondiabetic controls. Additional care for prevention of plaque accumulation and gingivitis should be highly recommended, particularly in diabetic youth.