Abstract
Dental phobia is relatively common among adults and often associated with poorer oral health as a consequence of delaying dental treatment until advanced disease has caused intolerable symptoms. The increased rates of active disease may also have an impact on oral health-related quality of life (OHR QoL).
Minimum intervention oral healthcare (MIOC) combines four key domains: detection and diagnosis, prevention and control of oral disease, minimally invasive (MI) operative interventions and review/recall. Team delivery and patient-focused care are the underpinning tenets to these four domains. The MIOC approach offers advantages to both patients with dental phobia and the oral healthcare team involved in their long-term management. This paper presents an adaptation of MIOC for patients with dental phobia, which is founded on a comprehensive assessment approach followed by the provision of dental care with behavioural management techniques in combination with conscious sedation. This approach has the potential to provide a comprehensive personalised patient management pathway for delivering better oral health for this vulnerable patient group in a primary care setting.
Key points
-
People with dental phobia often present with a poorer oral health status which compromises their oral health-related quality of life.
-
An outline of the application of the minimum intervention oral healthcare (MIOC) framework for patients with dental phobia is described, which has the potential to be particularly beneficial for the oral healthcare of this group of patients.
-
An assessment tool is presented which provides an overview of important points for a practitioner to consider when assessing patients with dental phobia using MIOC.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Hill K B, Chadwick B L, Freeman R, O'Sullivan I, Murray J J. Adult Dental Health Survey 2009: Relationships between dental attendance patterns, oral health behaviour and the current barriers to dental care. Br Dent J 2013; 214: 25-32.
LeBeau R T, Glenn D, Liao B et al. Specific phobia: a review of DSM-IV specific phobia and preliminary recommendations for DSMV. Depress Anxiety 2010; 27: 148-167.
Cohen S M, Fiske J, Newton J T. The impact of dental anxiety on daily living. Br Dent J 2000; 189: 385-390.
Heidari E, Banerjee A, Newton J T. Oral health status of non-phobic and dentally phobic individuals; A secondary analysis of the 2009 Adult Dental Health Survey. Br Dent J 2015; 219: 1-9.
Heidari E, Andiappan M, Banerjee A, Newton J T. The oral health of individuals with dental phobia: A multivariate analysis of the Adult Dental Health Survey, 2009. Br Dent J 2017; 222: 595-604.
Weinstein P, Milgrom P, Ratener P, Morrison K. Patient dental values and their relationship to oral health status, dentist perceptions and quality of care. Community Dent Oral Epidemiol 1979; 7: 121-127.
O'Toole S, Pennington M, Varma S, Bartlett D W. The treatment need and associated cost of erosive tooth wear rehabilitation-a service evaluation within an NHS dental hospital. Br Dent J 2018; 224: 957-961.
Heidari E, Banerjee A, Newton J T. Survey of treatment policies under conscious sedation at centres dealing with people with high levels of dental anxiety across the United Kingdom. Br Dent J 2018; 224: 632-636.
Heidari E, Newton J T, Andiappan M, Banerjee A. The impact of dental phobia on care planning: a vignette study. Br Dent J 2019; 226: 581-587.
Banerjee A, Doméjean S. The Contemporary Approach to Tooth Preservation: Minimum Intervention (MI) Caries Management in General Practice. Prim Dent J 2013; 2: 30-37.
Frencken J E. Atraumatic restorative treatment and minimal intervention dentistry. Br Dent J 2017; 223: 183-189.
Banerjee A. Minimum intervention (MI) oral healthcare delivery implementation - overcoming the hurdles. Prim Dent J 2017; 6: 28-33.
Newsome P R H, Wright G H. Patient Management: A review of patient satisfaction: 2. Dental patient satisfaction: an appraisal of recent literature. Br Dent J 2011; 186: 166-170.
Newton T, Asimakopoulou K, Daly B, Scambler S, Scott S. The management of dental anxiety: Time for a sense of proportion? Br Dent J 2012; 213: 271-274.
Milgrom P, Newton J T, Boyle C, Heaton L J, Donaldson N. The effects of dental anxiety and irregular attendance on referral for dental treatment under sedation within the National Health Service in London. Community Dent Oral Epidemiol 2010; 38: 453-459.
Kvale G, Berggren U, Milgrom P. Dental fear in adults: A meta-analysis of behavioural interventions. Community Dent Oral Epidemiol 2004; 32: 250-264.
The Scottish Dental Clinical Effectiveness Programme. Conscious Sedation in Dentistry: Dental Clinical Guidance (Third Edition). 2017. Available at (accessed September 2020).
Collado V, Faulks D, Nicolas E, Hennequin M. Conscious Sedation Procedures Using Intravenous Midazolam for Dental Care in Patients with Different Cognitive Profiles: A Prospective Study of Effectiveness and Safety. PLoS One 2013; 8: 1-11.
Newton J T, Asimakopoulou K. Minimally invasive dentistry: Enhancing oral health related behaviour through behaviour change techniques. Br Dent J 2017; 223: 147-150.
Asimakopoulou K, Newton J T. Success with motivational interviewing techniques in the dental clinic: A case for the use of iMI-GPS. Dent Update 2018; 45: 462-467.
Newton J T, Asimakopoulou K. Behavioural models for periodontal health and disease. Periodontol 2000 2018; 78: 201-211.
Banerjee A, Watson T F. Pickard's Guide to Minimally Invasive Operative Dentistry. 10th ed. Oxford: Oxford University Press, 2015.
Selwitz R H, Ismail A I, Pitts N B. Dental caries. Lancet 2007; 369: 51-59.
Featherstone J D B, Doméjean S. Minimal intervention dentistry: Part 1. from "compulsive" restorative dentistry to rational therapeutic strategies. Br Dent J 2012; 213: 441-445.
Innes N P T, Frencken J E, Bjørndal L et al. Managing Carious Lesions: Consensus Recommendations on Terminology. Adv Dent Res 2016; 28: 49-57.
van de Sande F H, Opdam N J, Da Rosa Rodolpho P A, Correa M B, Demarco F F, Cenci M S. Patient Risk Factors' Influence on Survival of Posterior Composites. J Dent Res 2013; DOI: 10.1177/0022034513484337.
Ericson D. What is minimally invasive dentistry? Oral Health Prev Dent 2004; 2 Suppl 1: 287-292.
Banerjee A, Frencken J E, Schwendicke F, Innes N P T. Contemporary operative caries management: Consensus recommendations on minimally invasive caries removal. Br Dent J 2017; 223: 215-222.
Dorri M, Martinez-Zapata M J, Walsh T, Marinho V C, Sheiham deceased A, Zaror C. Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries. Cochrane Database Syst Rev 2017; DOI: 10.1002/14651858.CD008072.pub2.
Green D, Mackenzie L, Banerjee A. Minimally invasive long-term management of direct restorations: The '5 Rs'. Dent Update 2015; 42: 413-426.
Astramskaitė I, Poškevičius L, Juodžbalys G. Factors determining tooth extraction anxiety and fear in adult dental patients: a systematic review. Int J Oral Maxillofac Surg 2016; 45: 1630-1643.
Mcgoldrick P, Levitt J, De Jongh A, Mason A, Evans D. Referrals to a secondary care dental clinic for anxious adult patients: implications for treatment. Br Dent J 2001; 191: 686-688.
Joda T, Gallucci G O, Wismeijer D, Zitzmann N U. Augmented and virtual reality in dental medicine: A systematic review. Comput Biol Med 2019; 108: 93-100.
Gujjar KR, van Wijk A, Kumar R, de Jongh A. Efficacy of virtual reality exposure therapy for the treatment of dental phobia in adults: A randomized controlled trial. J Anxiety Disord 2019; 62: 100-108.
Banerjee A. 'MI'opia or 20/20 vision? Br Dent J 2013; 214: 101-105.
Schwendicke F, Frencken J E, Bjørndal L et al. Managing Carious Lesions: Consensus Recommendations on Carious Tissue Removal. Adv Dent Res 2016; 28: 58-67.
Schwendicke F, Splieth C, Breschi L et al. Consensus statement: When to intervene in the caries process? Clin Oral Invest 2019; 23: 3691-3703.
Hurley S. Why re-invent the wheel if you've run out of road? Br Dent J 2020; 228: 755-756.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Heidari, E., Newton, J. & Banerjee, A. Minimum intervention oral healthcare for people with dental phobia: a patient management pathway. Br Dent J 229, 417–424 (2020). https://doi.org/10.1038/s41415-020-2178-2
Received:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41415-020-2178-2
This article is cited by
-
Impact of oral hygiene interventions on dental health in chemotherapy patients with malignant salivary gland tumors: A retrospective study
The Saudi Dental Journal (2025)
-
Could the minimum intervention oral care framework help improve the quality of oral health delivery and access to NHS primary dental care?
British Dental Journal (2024)
-
Minimum intervention oral care - incentivising preventive management of high-needs/high caries-risk patients using phased courses of treatment
British Dental Journal (2024)
-
Feasibility of minimum intervention oral healthcare delivery for individuals with dental phobia
BMC Oral Health (2023)
