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There is certainly no shortage of literature surrounding the incidence of dental anxiety, the causes of dental anxiety and management strategies. Similarly, much research has been undertaken to investigate the relationship between socioeconomic position and dental disease rates. Both anxiety and a lower socioeconomic position have been linked with poorer oral health-related quality of life. We know that early childhood dental experiences can set the tone for a patient's attitudes towards, and relationships with, dentists and dental treatments. The aim of this review was to investigate whether children from a lower socioeconomic position are more likely to become dentally anxious. It aims to explore whether the treatment of children from lower socioeconomic backgrounds is different to their more affluent peers and, if so, whether this might impact how these individuals go on to perceive dentists and dental treatment. As dentists we must provide appropriate treatment and aim for the best dental health outcomes, whilst also considering the patient holistically. With children, this should involve fostering positive relationships and dental experiences where possible, to set them up for a positive and healthy dental future which is as anxiety free as possible. [ABSTRACT FROM AUTHOR]

This document is a journal scan that provides a synopsis of articles from the last twelve months. One article discusses the use of oral benzodiazepines for managing dental anxiety in the UK, highlighting a lack of confidence and clear guidance among dentists. Another article explores the sedation of pediatric dental outpatients using oral midazolam versus intranasal dexmedetomidine plus oral midazolam, finding that the combination treatment is more effective. The document also mentions the dangers of the recreational use of nitrous oxide and the need for clearer guidelines on its use. Finally, there is an article on the comparison of oropharyngeal oxygen pooling and suctioning during dental office-based anesthesia. It is important to critically evaluate articles from different countries due to variations in definitions and practices. This document is a collection of reviews on various topics related to dentistry and oral surgery. The first review discusses the perioperative management of oral antithrombotics in dentistry and oral surgery, focusing on factors considered when developing a management plan for patients on these medications. The second review explores the impact of bitewing radiographs on treatment planning for carious primary molars, finding that they play an important role in treatment decisions. The third review examines the feasibility of minimum intervention oral healthcare for individuals with dental phobia, showing positive outcomes for patients receiving this approach. Lastly, a systematic review and meta-analysis evaluates the use of virtual reality as a distraction method for managing dental phobia in children, [Extracted from the article]

Introduction: Dental Cognitive BehaviourTherapy (dental CBT) is a talking therapy for adults and children aimed to reduce a patient's anxiety specifically related to dentistry. The Modified Dental Anxiety Score (MDAS) allows an objective measurement of the patient's level of anxiety pre and post CBT. Aims: The objective was to assess the effectiveness of the CBT service within Birmingham Community Healthcare NHS Foundation Trust (BCHC) Community Dental Services (CDS). The aims were to assess the number of patients with a pre- and post-CBT MDAS recorded, the success of CBT and the anxiety management modalities used to facilitate treatment. Methods: A retrospective analysis of internal CBT referrals between January 2018 to December 2022. Results: 135 referrals were identified. 56% had a pre-MDAS score, of these 85% were between 20 to 25, indicating high anxiety (>19). Post-CBT MDAS scores reduced to between 5 to 14 for 85% of patients (indicating low I moderate anxiety). After having CBT 45% of patients had dental treatment with local anaesthetic (LA) alone and 35% with inhalation sedation (IHS). Conclusions: CBT is effective in the treatment of dental anxiety and therefore allows patients to receive treatment from their general dental practitioners (GDP) and step down from general anaesthetic (GA) / intravenous sedation (IVS). [ABSTRACT FROM AUTHOR]

Conscious sedation using midazolam can be an effective primary care dental treatment modality for patients with both dental anxiety and additional needs. This retrospective service evaluation aims to assess the efficacy of conscious sedation with midazolam in a new special care primary dental service, by identifying whether midazolam provided operating conditions sufficient to allow planned dental treatment to be completed. Individual electronic records of patients treated with conscious sedation with midazolam by the West Dorset Special Care Primary Care Dental Service during the first nine months were examined. Efficacy of midazolam was evaluated using patient sedation scores and operating conditions. Planned treatment was successfully completed in 37 out of the 41 appointments (90%). Four patients were unable to have treatment carried out for reasons including cannulation refusal, suboptimal co-operation and vomiting. This study demonstrates that delivering dentist-led conscious sedation with midazolam in a primary care setting is a highly effective, costefficient alternative to general anaesthesia for a range of patients with anxiety and I or additional needs, and has significant potential to reduce wait times. However, the technique requires appropriately trained staff, careful patient selection together with suitable premises and equipment in line with evidence-based national policy and guidelines. [ABSTRACT FROM AUTHOR]

The SAAD Digest provides abstracts of speakers at the annual symposium. The topics covered include incorporating remimazolam into dental care, the impact of childhood sexual abuse on dental care, the use of conscious sedation for dental procedures, the effects of illicit drugs on sedation, and the new NHS England Clinical Guide for Dental Anxiety Management. The abstracts provide insights into these topics from various perspectives, including dental professionals, survivors of childhood sexual abuse, and medical experts. The symposium aims to enhance support for patients and increase awareness of their individual needs. [Extracted from the article]

As dementia advances patients exhibit behavioural and personality changes that can make it hard for them to co-operate with dental treatment without sedation or general anaesthesia. This can lead to a difficult decision process for the clinician about whether sedation or general anaesthesia is in the patient's best interest. Pre-operative, peri-operative and post-operative considerations are required. Factors such as frailty and co-morbidities can indicate the risk of negative outcomes during and post treatment. Certain drugs such as antihypertensives or anticoagulants may need to be adjusted pre-operatively. During treatment with either sedation or general anaesthesia, reduced and titrated drug doses should be given. When sedating patients, they may not co-operate with monitoring equipment like pulse oximetry and alternative techniques such as capnography may be more appropriate. No studies have shown that intravenous agents show any links to further cognitive decline in a patient with dementia when used for sedation. General anaesthesia has an increased risk of postoperative morbidity and delirium especially in the elderly. Liaison with a comprehensive geriatric assessment team can be useful when planning sedation or general anaesthesia and can help to improve patient safety at every stage. [ABSTRACT FROM AUTHOR]

The provision of sedation is key in providing treatment to many patients who experience anxiety towards dental treatment. There are various methods of conscious sedation that can be used. These all act to reduce patient anxiety and discomfort to allow necessary treatment to be carried out, whilst helping the patient have a positive dental experience. The chosen technique is determined on an individual basis by patient assessment and suitability. There is no one method for all. With anxious children, inhalation sedation is a well reported technique which may be used to overcome anxiousness and has proved effective in many cases. There are various factors that should be considered when planning and carrying out inhalation sedation to increase the chance of successful treatment for any patient. These factors will be discussed here in relation to children, although they may not be inappropriate for patients of older ages. With children in particular, successful treatment and co-operative patients go hand in hand. The majority of factors which influence the patient's co-operative ability, in turn impact the practitioner's ability successfully to deliver treatment. [ABSTRACT FROM AUTHOR]

Dental anxiety is a common barrier to dental care and oral health, both globally and nationally, yet its aetiology is still not fully understood. Without a sound understanding of the different pathways to anxiety acquisition, successful long-term treatment and management can be difficult. This essay aims to provide an overview of the proposed theories and supporting evidence to give an insight into the complex and multiple factors involved in the development of dental anxiety. Influencing factors can loosely be divided into those which are exogenous and include external sources; and those which are of an endogenous nature, usually as a result of a central nervous system imbalance or genetic influences. Understanding the interaction and influence of these factors during anxiety acquisition is crucial to treatment planning and the ultimate success of anxiety management. [ABSTRACT FROM AUTHOR]

Pregnant dental patients require special consideration regarding the management of pain and anxiety. Some modalities, routinely used for anxiolysis and analgesia in the dental setting, are contraindicated or should only be used with caution during pregnancy. Furthermore, patient anxiety levels are often heightened at this time, negatively impacting pain perception and compounding constraints on pharmacological intervention. We aim to describe the methods for controlling pain and anxiety, which are appropriate to use in pregnant patients, and summarise the appropriate timing of dental treatment during pregnancy. We also emphasise the importance of an accurate and up-to-date medical history, which includes pregnancy status, to prevent safety incidents occurring in this patient cohort. Finally, we suggest an approach for mitigating harm in the event of inadvertently treating a pregnant patient under intravenous sedation, or other unintentional exposure to drugs best avoided during pregnancy. We discuss the role of the UK Teratology Information Service in providing evidence-based information on foetal risk, following pharmacological and other potentially toxic pregnancy exposures. [ABSTRACT FROM AUTHOR]

There is no shortage of research regarding the success of techniques that can be used to manage dental anxiety. There is, however, an absence of conversation around the feasibility and practicality of anxiety management in NHS primary dental practices. With the pressures and limitations of time, equipment and funding, managing dental anxiety in adults may be more difficult than suggested in the literature. As a fifth year dental student, I felt I had a reasonable level of experience in managing dentally anxious patients. With the use of distraction, enhancing the patient's control and relaxation techniques, I was able to coach patients through their dental treatment. There is, however, a cohort of patients who require additional management, often through the use of conscious sedation for their anxiety. It is often at this stage that patients require a referral to secondary or tertiary care settings, begging the question, can dental anxiety in adults be feasibly managed in NHS primary practice or not?. Using anecdotal evidence from a salaried community dental practitioner, as well as evidence based articles, this paper will explore which, if any, methods of anxiety management are compatible with the structure of the NHS primary care setting. [ABSTRACT FROM AUTHOR]

Conscious sedation in dentistry is a crucial tool to help patients to accept difficult procedures and relieve anxiety. During sedation, the dental team monitors the welfare of the patient. Pulse oximetry and watching the patient are currently the widely accepted methods of assessing the patients breathing. The chief risk to a patient during conscious sedation is depression of their breathing due to the effects of the sedative medication. It has been suggested that capnography monitoring allows for earlier detection of reduced breathing. The use of capnography monitoring for conscious sedation in dentistry is not currently required in the United Kingdom. In other countries the use of capnography for monitoring during procedural sedation is recommended by their guidelines and standards. This article aims to provide an introduction to capnography, its current areas of standard use, the relevant legislation in other countries and what the future may hold. [ABSTRACT FROM AUTHOR]

Inhalation sedation with nitrous oxide is a popular method in the management of dental anxiety. It differs from other forms of sedation as it is seen to induce a psycho-pharmacological state. This term helps describe the balance between the pharmacology of the drug itself, and the behavioural techniques implemented as a result of patient suggestibility, which can increase the extent of anxiolysis and co-operation. The effects can be amplified if clinicians exploit the pharmacology of nitrous oxide through methods that reinforce feelings of relaxation and wellbeing, which is in contrast to intravenous sedation which produces a sedative state regardless of adjuncts. Guidance recommends the use of semi-hypnotic suggestion, and studies have shown potential uses in the long-term management of dental anxiety. There is also emerging evidence of the uses of behavioural techniques in dentistry, and its benefits in comparison to inhalation sedation. The effect of nitrous oxide is no substitute for the persuasive ability of the operator, with evidence suggesting psychology may have a larger effect during inhalation sedation delivery than was previously thought. [ABSTRACT FROM AUTHOR]

Introduction The study aimed to explore the attitudes of adults with dental anxiety towards changes made in dental practices following the onset of COVID-19 and identify any triggers of their anxiety. Materials and methods A cross-sectional survey study design was employed. An online questionnaire assessed respondents'anxiety levels since the onset of the pandemic compared to before, and identified any triggers of their anxiety. Descriptive statistics and thematic analysis were performed. Results The majority of adults with dental anxiety noticed an increase in their dental anxiety levels since the onset of the COVID-19 pandemic. One of the main reasons for the increase has been due to the risk of transmission of COVID-19. Measures which most respondents felt anxious about were the extra PPE, use of teledentistry and having to wait outside the building before an appointment. Discussion The study provides a novel insight into the impact of COVID-19 on dentally anxious adults, a topic which has not been previously studied in the UK population. The main limitation is the small sample size, to ensure the findings were generalisable to a wider population, a larger-scale study would have to be conducted. Conclusion The study gives insight into the attitudes of dentally anxious adults during the COVID-19 pandemic and can be used to inform patient care. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has led to increased levels of generalised anxiety particularly in certain population groups. Dentists may see these anxieties being expressed specifically as dental anxiety, fear, or phobia. Many of the traditional strategies and techniques used to manage anxious patients have been compromised as a result of the precautions put in place to mitigate the transmission of C0VID-19.The pandemic has caused widespread disruption to conscious sedation and general anaesthetic services used to manage patients with moderate to severe dental anxiety. Furthermore, the need for advanced personal protective equipment has challenged the effectiveness of non-pharmacological anxiolytic techniques such as iatrosedation and hypnosis. Dentists need to be aware of how the management options for anxious patients undergoing dental treatment have been affected by the pandemic to enable them to make appropriate, informed decisions regarding the management of anxious patients. The pandemic has also allowed us to recognise the value of digital technologies in assessing patients with dental anxiety and could also represent a stimulus for changing attitudes regarding the use of general anaesthesia in managing patients with dental anxiety. [ABSTRACT FROM AUTHOR]

The article discusses the role of Dental Care Professionals (DCPs) in providing psychological support to patients with dental anxiety. It highlights the importance of emotional support and rapport-building in managing anxiety during dental procedures. The author shares their experience of completing a Cognitive Behavioral Therapy (CBT) course to enhance their skills in anxiety management. The article also emphasizes the evolving role of dental nurses and the increasing recognition of their contributions to the dental team. The author concludes by expressing optimism about the future of the dental nurse profession and encouraging more young people to consider it as a career. [Extracted from the article]

Dental anxiety is a frequent problem in the general population, representing a primary barrier to oral health. Given the wide aetiological nature of the condition and different forms with which it may present, assessment tools are crucial for effective diagnoses and management. This essay aims to provide an overview of the different assessment scales that exist in general practice, their reliability and an insight into the novel tools being developed, as our understanding of dental anxiety and its management progresses. [ABSTRACT FROM AUTHOR]

Epilepsy is a common neurological disorder that affects 0.5-1% of the population with a rising incidence. Epileptic patients are more likely to suffer from co-morbidities of anxiety and depression and are more likely to have poorer oral health. Conscious sedation is a way of reducing anxiety and stress related to dental treatment and reducing the risk of a patient having an epileptic fit whilst in the dental chair. This summary looks at the considerations that need to be taken to ensure safety for treatment with conscious sedation of the epileptic patient and common anti-epileptic drugs used. Patient management is considered, as well as treatment of status epilepticus-a medical emergency. [ABSTRACT FROM AUTHOR]

A 13 year-old male patient with type I diabetes mellitus was referred to Community Dental Services for restoration of carious LR6. The patient's main complaint was a broken tooth in the lower right quadrant. He confirmed anxiety associated with needles and apprehension towards dental treatment. Examination and radiographs showed multiple carious lesions and an incidental finding of hypodontia associated with the lower right quadrant and third permanent molars. Treatment was successfully carried out under local anaesthetic and inhalation sedation, with a quadrant-based approach, including direct restorations and indirect pulp-capping of the lower-right first molar. [ABSTRACT FROM AUTHOR]

Introduction The General Dental Council (GDC) expects dental professionals to manage patients' dental anxiety and pain appropriately. Conscious sedation (CS) offers a safe alternative to general anaesthesia for patients who are unable to tolerate routine dental care. Current guidelines [Intercollegiate Advisory Committee for Sedation in Dentistry (IACSD), NHS England and Scottish Dental Effectiveness Clinical Programme (SDCEP)] recommend high-quality documentation of patient assessments including sedation history and airway assessment before undertaking CS. Alm To ensure high standards of record-keeping for pre-sedation assessments to allow safe provision of CS. Methods A clinical audit, where written patients' records were examined against the standard, contributed to an action plan detailing improvement to the current practice. After implementing the action plan from the first cycle, a second audit was undertaken to ensure compliance. Results In the second audit cycle, although only 11 (27%) records used the stamp checklist (one of the recommendations from the first cycle), the documentation of the airway assessment showed a slight improvement (64% to 73 %), whereas the documentation of a sedation history improved greatly (39% to 80%). Conclusion The results demonstrated the need to increase awareness of high quality record keeping through repeated clinical audit cycles/spirals involving the stakeholders in the suggested improvement plans. [ABSTRACT FROM AUTHOR]

Pain and anxiety associated with dentistry are important and prevalent factors, Current methods that can aid in the reduction of pain and anxiety include the use of differing medications, which have a host of potential side effects and invasive methods of delivery. One area that has had less attention in the dental literature is the valence (pleasantness to unpleasantness) associated with differing stimuli, and how these may be utilised to alleviate anxiety and/or pain. The aim of this article is to describe how valence, in particular pleasantness, utilising olfactory, auditory, visual and more recently somatosensory stimuli, may be used to reduce dental anxiety and/or pain. With this knowledge, it is hoped that the information may provide a platform for clinicians to base their audio, visual, etc. tools to help contribute to any potential analgesic/anxiolytic effects on patients undergoing various dental treatments. Furthermore, pleasant stimuli may open the avenue to provide for novel pain and anxiolytic management strategies, benefiting both patients and practitioners. [ABSTRACT FROM AUTHOR]

Needle injections of local anaesthetics during dental procedures are known to cause anxiety in patients, especially in paediatric patients. Dental fear and anxiety are well-known barriers to accessing oral health care, with the fear of needle injections being one of the many causative factors. In more severe cases, patients may present with dental phobia and needle phobia, possibly resulting in them postponing or avoiding their dental appointments altogether. These pose challenges for the dental practitioner. The pain associated with local anaesthetics is attributed to factors relating to the patient, local anaesthetic, and injection technique. The pain is predictable as they are planned procedures, therefore dental practitioners should strive to prevent or at least minimise iatrogenic pain and thus discomfort. Various traditional and newer techniques can be employed to assist dental practitioners in minimising discomfort and pain from the needle injections of local anaesthetics, such as desensitisation of the injection site. Continued prioritisation and further research would be beneficial for improving understanding and awareness of the techniques available to achieve a tailored approach to treatment. [ABSTRACT FROM AUTHOR]

Alm: To evaluate the rate of completion of the Modified Child Dental Anxiety Scale (MCDAS-f) in a paediatric specialist unit with secondary consideration of its application in comparing the pharmacological agents utilised with the total and component MCDAS-f scores. Method: Retrospective data was collected from patients aged between 8-15 years accessing treatment under local anaesthetic only (October 2018) and with the addition of inhalation sedation, Intravenous sedation and general anaesthetic (October December 2018). The data collected included patient demographic, the total and component MCDAS-f scores recorded, the pharmacological management chosen and the clinical outcome. Results: 156 patient records in total were analysed. The MCDAS-f was recorded for 14.1% (n=22) with a median total score of 23. Both the rate of completion and median scores were comparable across the different pharmacological managements. Where the MCDAS-f was completed 86.3% (n=19) underwent successful treatment compared to 85.19% (n=114) where it was not. Conclusion: The service evaluation gave insight into current practice. Inclusion of a question pertinent to IV sedation in a modified MCDAS-f form may be of benefit. Evaluation of a greater number of cases would, however, be required to entirely understand the value of the MCDAS-f in treatment planning. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to assess the prevalence of dental anxiety and the preferred pharmacological management techniques among psychiatric patients with different types of depression and who had acute dental pain. Methods: A descriptive study carried out from November 2017 to January 2018.The participants were recruited from the Department of Psychiatry in the Holy City of Makkah in the western region of Saudi Arabia. The study complied with the 'Strengthening the Reporting of Observational Studies in Epidemiology'(STROBE) Guidelines. The International Classification of Diseases (ICD-10) was used to classify the types of depression. The study questionnaires were given to willing participants in the form of closed-ended questions. A chi-squared test was used to assess relationships between categorical variables. One-way ANOVA was used to compare means between more than two groups. Results: Seventy patients were included in the study (50% response rate).The mean age was 42 (SD=14.9).Thirty-two male (46%) and 38 female (54%) participants were recruited. Thirty-four of the participants (49%) reported having dental anxiety. Twentyeight (40%) of the participants belonged to the group of unspecified depressive episodes, of whom 50% reported having dental anxiety. Twenty-nine participants (41%) preferred to receive dental treatments under local anaesthesia, while 24 participants (34%) preferred to receive dental treatments under local anaesthesia combined with different types of conscious sedation techniques, while 17 participants (25%) preferred to receive dental treatments under local anaesthesia and general anaesthesia (GA). Conclusions: It is not unusual for psychiatric patients suffering from depression to have dental anxiety preventing them from accessing dental services. The majority of the participants preferred dental treatment to be carried out under local anaesthesia with conscious sedation or GA. [ABSTRACT FROM AUTHOR]

Background: Conscious sedation may facilitate the provision of dental treatment for anxious children, negating the need for general anaesthesia. The undergraduate inhalation sedation clinic enables the student to meet the standards for registration as a dental professional, to apply theoretical learning, and to assess dental anxiety in their future practice. Aims: Evaluate utilisation of an undergraduate inhalation sedation clinic for child patients. Determine whether treatment planned is successfully delivered. Explore the use of behaviour rating and anxiety scales. Objectives: Inform the development of novel undergraduate curricula, patient pathways and outcomes. Method: Retrospective analysis of 50 consecutive case records for patients attending the undergraduate inhalation sedation clinic. Results: 62% (n=52) of appointments were attended. 90% (n=47) patients completed planned treatment. 6% (n=3) refused and were referred for general anaesthetic. MCDAS was completed 16% (n=8) at consultation. Anxiety was recorded as 86% (n=43) with a Frankl scale of (+) or (++) and 86% (n=43) received a Houpt score of >4. Conclusion: Provision of dental care to an anxious cohort of children enables undergraduate students to demonstrate compliance to the GDC document 'preparing for practice'. Utilisation of the clinic is suboptimal. Improved utilisation of MCDAS may improve patient pathways. [ABSTRACT FROM AUTHOR]

The SAAD Symposium and AGM, titled "Caring for an increasingly complex population - personal insights and personalised care," took place at the Royal Society of Medicine in London. The symposium featured lectures from various healthcare professionals on topics such as the effects of sedatives on patients, dental anxiety management, conscious sedation techniques, and the emotional challenges faced by survivors of child sexual abuse in dental settings. The event concluded with a discussion on the role of capnography in dental sedation. Overall, the symposium provided valuable insights and practical tips for healthcare professionals working with diverse patient populations. [Extracted from the article]

The SAAD Digest is a journal that focuses on providing education in pain and anxiety control for dental professionals. The editorial highlights the need for SAAD to address problems related to access to dental care, including the use of non-pharmacological techniques for anxiety management. The article also mentions statistics on dental health, such as the high number of dental abscesses and diagnoses of mouth cancer. The journal has made changes to its format and layout to improve readability, and it will now be published online with a single column of text. [Extracted from the article]

Background: Dental anxiety, fears and phobias are ubiquitous in the provision of dental care. Intravenous conscious sedation is a common management strategy for these conditions. A key element in managing risk with this strategy, is that the patient has to attend their appointment with an appropriate escort. Aims: To assess escorts' understanding of their responsibilities to the patient following dental treatment under intravenous sedation. Objectives of the audit were to identify the current level of patient safety under care of escorts and improve the information given to escorts if required. Methods: Cross-sectional survey and audit of 51 escorts of patients treated under midazolam-led sedation in the oral surgery division of Manchester Foundation Trust. Standards: 100% should have been informed of their duties and have thorough knowledge of post operative patient safety instruction. Results: 51 questionnaires were collected between 16th Oct 2017 - 24th Nov 2017.The 100% target was not met. Action plan: Provide the escort with another information sheet at the appointment and sign to confirm their responsibilities, before the patient is sedated. Improve the information sheet given to escorts. Implement a strategy to provide video information that can be sent to the escort to watch. Re-audit in 6 months. [ABSTRACT FROM AUTHOR]

Aims: To determine whether the use of visual mental imagery has any effect on patient relaxation during dental extraction oral surgery procedures. Methodology: Simple randomisation was used to select 43 patients treatment planned for dental extraction procedures, to take part in this trial. A standardised visual mental imagery technique involving patients being asked to look at a picture of a beach at sunset for one minute was conducted. Patients were guided by a standardised script. After the treatment, the patients completed an anonymous questionnaire on the technique. Results: In this study 60% of patients reported that the technique helped them feel more relaxed. Only 50% of all males reported that the technique made them feel more relaxed compared to 71 % of all females. 93% of patients would recommend this technique to another patient. Conclusion: Within the limitations of this study, the results show that the use of visual mental imagery does have a positive effect on patient's relaxation during dental extractions procedures.This technique has the potential to provide practitioners a non-pharmacological method to aid relaxation and help manage patient anxiety during dental extraction procedures. [ABSTRACT FROM AUTHOR]

Dental fear and anxiety (DFA), often recognised as one of the barriers to oral health, could impact a patient's dental health and social life. Current approaches for severe DFA often require the use of conscious sedation, general anesthesia and psychological therapies. New technological advances and scientific discoveries in the near future have the potential to open up a diverse range of possible treatment options for DFA. [ABSTRACT FROM AUTHOR]

The aim of managing dental anxiety is to work towards eradicating the fear of the dentist, enabling the provision and maintenance of oral health. In order to understand the extent of the impact of oral health on overall health, a greater infiltration in the medical profession is needed in the future. Current practice in dentistry has favoured the use of a single-drug method of midazolam administration, however, despite its excellent properties compared with previously used agents, it is not always the ideal drug for intravenous sedation.The increase in the size of the elderly population and prevalence of bariatric patients has seen changes in clinical practice.The next 60 years of dentistry will surely see the development of increasingly effective sedation agents, such as remimazolam. It will be interesting to see if this new member of the benzodiazepine family will find a place in dentistry. Good quality evidenced-based research will need to be conducted to establish any potential in dentistry, in comparison with the safety and efficiency of midazolam, of any new drug with anxious dental patients. Other future changes in clinical practice will be reliant on sustainability plans, with the possible increase in provision of community hubs. [ABSTRACT FROM AUTHOR]

Dental anxiety (DA) can be considered as a universal phenomenon with a high prevalence worldwide; DA and pain are also the main causes for emergencies in the dental setting, so their prevention is an essential part of patient safety and overall quality of care. DA and its consequences are closely related to the fight-or-flight reaction and it seems reasonable to argue that the odyssey of DA began way back in the distant past, and has since probably evolved in parallel with the development of fight-or-flight reactions, implicit memory and knowledge, and ultimately consciousness. Basic emotions are related to survival functions in an inseparable psychosomatic unity that enable an immediate response to critical situations rather than generating knowledge, which is why many anxious patients are unaware of the cause of their anxiety. [ABSTRACT FROM AUTHOR]

Dental practitioners dealing with children and individuals with special needs can be supported by the provision of general anaesthesia for the most challenging patients in situations where other options are insufficient. The availability of general anaesthesia will further the aim of extending access to the widest range of dental care to the greatest number of patients regardless of disability, age or phobia. The objective is to ensure patients have a pain-free and healthy mouth, and any necessary treatment in the most appropriate setting related to their specific needs. A strictly individual and holistic approach is required when evaluating the risk versus benefit of proceeding with general anaesthesia for delivery of dental treatment particularly for children and special needs individuals. It is vitally important to consider and address all relevant factors specific to this particular group of patients including assessment of capacity, validity of consent, and any specific medical, social and behavioural issues. The other sedation modalities must be always taken into consideration. This article emphasises the crucial decision-making role of dentists in the referral process for dental treatment under general anaesthesia and the need for multidisciplinary co-operation between dental practitioners, community and hospital services. [ABSTRACT FROM AUTHOR]

This case report presents a Cognitive Behavioural Therapy (CBT) intervention provided fora 63-year-old male, who had experienced dental phobia for over 50-years. This gentleman initially received intravenous sedation (IVS) for 5-years within a Specialist Sedation and Special Care dental department, before being referred for the long-term management of his dental phobia, within the embedded specialist Dental Health Psychology Service in a London Dental Hospital. This brief report will consider aspects of the CBT intervention delivered in relation to assessment, case conceptualisation, course of treatment and outcomes; reflecting on the complementary aspects of sedation and CBT. Learning points will be identified for the role of CBT or CBT-based techniques within dental anxiety management settings. [ABSTRACT FROM AUTHOR]

The article presents a synopsis of articles of interest from the last twelve months to inspire further reading, including "the impact of dental phobia on patient consent," "Personal view."This may hurt": predictions in procedural disclosure may do harm," and "Enhancing a sedation score to include truly noxious stimulation: the Extended Observer's Assessment of Alertness and Sedation (EOAA/S)."

This article will explore the use of psychological approaches (specifically Cognitive Behavioural Therapy, CBT), for the management of people with dental phobia. While dental anxiety is common, it should be considered as a continuum, becoming a phobia when it meets the criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).' Specifically this means the phobia has a significant impact on an individual's wellbeing in areas of physiological, psychological or social functioning; with marked avoidance and experience of significant distress associated with encounters related to the dental setting. Recognised as one of the most common specific phobias,2 dental phobia is estimated to affect 11 % of the UK population.3 Consequently, increasing interest and attention on the application of CBT for dental phobia and the use of psychological approaches informed by the principles of CBT (i.e. Cognitive Behaviouraltechniques) for dental anxiety management, has led to an increase in the demand for both services and trained professionals within the dental care setting.To this end, it is important to note the distinction between CBT and CB-techniques; for individuals with mild-to-moderate dental anxiety, a range of psychological approaches may be employed, some of which draw on the principles of CBT (i.e. CB-techniques) but do not necessarily constitute formalised CBT for the treatment of phobia. This article aims to briefly outline the role of CBT within dental phobia care pathways, outline existing services which provide CBT approaches within the UK and identify the possible training options available to dental care professionals interested in the approach.The authors wish to note that the UK services and training options outlined in this article, were those known to them at the time of writing - there may be others we are not aware of. [ABSTRACT FROM AUTHOR]

Dental anxiety is well documented within dental literature, and is a condition with which dentists and dental care professionals alike will be familiar. Its consequences may extend beyond dental implications alone, but can also have the potential to affect a patient's quality of life. It is important that as a dental profession we are aware of the methods which can be used to manage various forms of dental anxiety, and to refer to specialist services as appropriate. This paper focusses on detailing both the evidence-based behavioural and pharmacological strategies that may be employed for both dentally anxious adults and children. [ABSTRACT FROM AUTHOR]