230 - Advances in Dental Fear Research: Treating the Fear before Treating the Teeth

Patient anxiety in the dental home negatively impacts the patient and the quality of dental care over a lifetime. Patient samples in both U.S. adults and children presenting for treatment indicate prevalences of clinically significant dental fear above 20%. Both the high prevalence of dental fear and its long-term ramifications in terms of disease experience, treatment options, and cost make it important that we better understand the mechanisms maintaining and exacerbating dental fear. In-chair anxiety is but an episode of a much longer trajectory that starts with childhood in-session distress, fear, and physiological pain and then coalesces into health-impacting dental anxiety. Only then, if no behavioral and/or psychological intervention is provided, the cycle ends with “pain.” Pain, in this inclusive sense, will result in suffering, loss of trust, and Pavlovian fear conditioning, and beliefs generalizing these consequences to all future dental encounters. Unless the patient is under pharmacologic management, these beliefs can impair a patient’s ability to tolerate and seek out future necessary dental treatments. Stimulus generalization may also allow fear conditioning to extend to other medical and dental procedural environments, often through adulthood, explaining, at least in part, the high prevalence of dental fear and phobias in adults. Therefore, treating fearful patients in the dental home requires learning about the etiology of dental fear, non-pharmacological behavior and pharmacologic therapy, and new interventions in digital app-based patient desensitization methods and minimally invasive dentistry (MID) to reduce and eliminate fear in the dental home and decrease the burden of dental disease.