Children's experiences following a CBT intervention to reduce dental anxiety: one year on.

Objective: To investigate children's ongoing experiences of dental care and use of strategies to manage their dental anxiety following cognitive behavioural therapy (CBT). Design: A child self-completed postal questionnaire. Settings: Hospital, community and general dental practice. Subjects: Questionnaires were sent to 44 children, aged 10­17 years who had been referred to specialist services due to their dental anxiety. Intervention: Children had all previously received a guided CBT self-help intervention to reduce their dental anxiety and, on completion of treatment, had been discharged to their referring dentist. Questionnaires were sent out 12­18 months later to ascertain dental attendance patterns and application of any strategies learnt from the previous CBT intervention. Results: 22 responses (50%) were received from 16 girls and six boys. Eighty-two percent had subsequently accessed follow-up care with a general dental practitioner and over half of these had undergone a dental procedure, other than a check-up. Ninety-one percent reported feeling less worried about dental visits, than previously, and described a change in cognition, behaviours, and feelings that allowed them to manage their anxiety better. Conclusions: CBT has positive immediate and longitudinal effects in reducing children's dental anxiety. The challenge of adopting this evidence-based approach within primary care settings remains.

Development and Testing of a Cognitive Behavioral Therapy Resource for Children's Dental Anxiety.

Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for dental anxiety; however, access to therapy is limited. The current study aimed to develop a self-help CBT resource for reducing dental anxiety in children, and to assess the feasibility of conducting a trial to evaluate the treatment efficacy and cost-effectiveness of such an intervention. A mixed methods design was employed. Within phase 1, a qualitative "person-based" approach informed the development of the self-help CBT resource. This also employed guidelines for the development and evaluation of complex interventions. Within phase 2, children, aged between 9 and 16 y, who had elevated self-reported dental anxiety and were attending a community dental service or dental hospital, were invited to use the CBT resource. Children completed questionnaires, which assessed their dental anxiety and health-related quality of life (HRQoL) prior to and following their use of the resource. Recruitment and completion rates were recorded. Acceptability of the CBT resource was explored using interviews and focus groups with children, parents/carers and dental professionals. For this analysis, the authors adhered to the Mixed Methods Appraisal Tool criteria. There were 24 families and 25 dental professionals participating in the development and qualitative evaluation of the CBT resource for children with dental anxiety. A total of 56 children agreed to trial the CBT resource (66% response rate) and 48 of these children completed the study (86% completion rate). There was a significant reduction in dental anxiety (mean score difference = 7.7, t = 7.9, df = 45, P < 0.001, Cohen's d ES = 1.2) and an increase in HRQoL following the use of the CBT resource (mean score difference = -0.03, t = 2.14, df = 46, P < 0.05, Cohen's d ES = 0.3). The self-help approach had high levels of acceptability to stakeholders. These findings provide preliminary evidence for the effectiveness and acceptability of the resource in reducing dental anxiety in children and support the further evaluation of this approach in a randomized control trial. Knowledge Transfer Statement: This study details the development of a guided self-help Cognitive Behavioral Therapy resource for the management of dental anxiety in children and provides preliminary evidence for the feasibility and acceptability of this approach with children aged between 9 and 16 y. The results of this study will inform the design of a definitive trial to examine the treatment- and cost-effectiveness of the resource for reducing dental anxiety in children.

Service evaluation of a nurse-led dental anxiety management service for adult patients.

Objective Evaluate patients' and professionals' experiences of a nurse-led dental anxiety management service (NDAMS).Design Service evaluation.Setting The NDAMS operates as part of the Sheffield Salaried Primary Dental Care Service.Subjects and methods Questionnaire survey of anxious patients and qualitative interviews with patients and professionals.Interventions Dental nurses delivered low-level psychological interventions as part of an integrated care pathway (ICP) for dental anxiety.Main outcome measures Dental anxiety and oral health-related quality of life (OHRQoL) questionnaires were completed by patients before and following NDAM.Results A total of 187 patients were assessed as suitable for NDAM (mean age = 33.7, 77% female) and 33 had completed it at the time of the service evaluation. Of those patients who had completed the intervention, significant improvements in dental anxiety and OHRQoL were reported. Professionals highlighted the importance of integrated working, adequate support and training, and assessing the suitability of patients for NDAM.Conclusion ICPs that combine pharmacological and psychological management approaches can help meet the needs of dentally anxious patients; however, early identification of patients most likely to benefit from psychological intervention should be a priority.

A service evaluation of patient pathways and care experiences of dentally anxious adult patients.

OBJECTIVE: To investigate the current patient pathways used by dentally anxious adults in Sheffield and identify how the patient experience could be improved. DESIGN: Questionnaires gathered stakeholder perceptions of referral pathways and services for dentally anxious adult patients. Completed questionnaires were returned by 113 dentally anxious patients who had engaged with specialised dental services and 111 general dental practitioners (GDPs) (28% and 52% response rates). RESULTS: The recommendations for improving dental care experience of the anxious were: increased guidance and information to GDPs regarding available care pathways; improved availability of psychological services; and more opportunities and choice for patients in the long-term management of dental anxiety. CONCLUSIONS: The findings from the service evaluation suggest ways in which dental services could be developed to improve the care experiences of dentally anxious adult patients.

No sustainability without health equity.

This article suggests that opportunities to make strategic linkages between health, well-being and sustainable development are missed too often. There is a need for a more sophisticated understanding of the current landscape, which builds on the links between sustainable development, health, well-being and social justice. There is a need for a more sophisticated understanding of health economics to inform policy decisions, ensuring that the impact of mega-externalities (e.g. obesity) are considered and inform planning and policy decisions.

Psychosocial predictors of children's oral health-related quality of life during transition to secondary school.

PURPOSE: Dental conditions have the potential to impact negatively on children's oral health-related quality of life (OHRQoL). However, little attempt has been made to investigate how psychosocial variables and significant life events affect children's OHRQoL. This research aimed to explore how children's dental status, coping, and self-esteem influenced OHRQoL during transition to secondary school. METHODS: All patients were undergoing treatment at a UK Dental Hospital. Self-report questionnaires obtained psychosocial data on self-esteem, coping styles and OHRQoL and were completed by children 3 months prior to secondary school entry and 3 months following educational transition. Data were extracted from the clinical records of the paediatric patients who agreed to participate in the research. RESULTS: A total of 92 children aged between 10 and 11 years participated at baseline (43% response rate) and 71 of these children participated in the follow-up investigation (77% response rate). Multiple lagged regression analyses revealed that clinical variables and children's self-perception of their physical appearance were significant predictors of OHRQoL following transition to secondary school. CONCLUSIONS: Children who were satisfied with their physical appearance reported fewer impacts on their OHRQoL. The mechanisms through which this domain of self-esteem impacts on OHRQoL warrants further investigation.

Oral health-related quality of life of children in relation to dental appearance and educational transition.

BACKGROUND: A variety of inherited and acquired conditions affect the dentition. The aim of this research was to investigate the oral health-related quality of life (OHRQoL) of children in relation to the status of their permanent incisors, at a significant transitional stage in their childhood. METHOD: Two hundred and sixteen patients of the Charles Clifford Dental Hospital, Sheffield, aged between 10 and 11 years, were sent an OHRQoL questionnaire (CPQ11₋14) three months before secondary school entry. Participants were categorised, according to clinical status, as having a visible dental difference (abnormal incisor aesthetics and/or orthodontic malocclusion) or no visible difference. Follow-up questionnaires were issued three months after secondary school entry to obtain repeat psychosocial data. Analysis of variance tests investigated the impact of clinical variables, self-reported satisfaction with dental appearance and gender on OHRQoL during educational transition. RESULTS: Ninety-two children participated in the baseline study and 71 of these children completed the follow-up questionnaire (43% and 77% response rates, respectively). Visible dental differences and dissatisfaction with dental appearance were associated with worse OHRQoL at baseline and follow-up. CONCLUSIONS: Dental conditions which result in visible incisor differences are associated with higher levels of dissatisfaction with appearance and have potential to negatively impact on children's OHRQoL.

NHS dental professionals' evaluation of a child protection learning resource.

The aim of this survey was to evaluate the impact of an educational child protection resource which had been developed and made available, free of charge, to all NHS dental practices and salaried primary dental care services in England and concurrently published online. A postal questionnaire was sent to a random sample of 1000 NHS dental practices to assess whether the learning objectives of the educational resource had been met. A total of 467 questionnaires were completed (46.7% response rate). Almost two thirds of participants (63.4%) remembered receiving the Child Protection and Dental Team (CPDT) handbook or seeing the website and almost all of them had used (looked at or read) it and felt able to access it if needed. Of the 265 users, 76.2% felt it had improved their knowledge of child protection, 60.5% had adopted a child protection policy, 53.7% had identified a child protection lead and 25.8% had arranged further training as a result of using the educational resource. The findings from the evaluation indicated that the learning objectives of the CPDT educational resource had been met and highlighted ways in which the resource could be further improved to effectively meet the needs of dental professionals.