A summary of:
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
Background:
Dental phobia is very common among adults and usually associated with poorer oral health because these patients tend to delay treatment. Treatment may be avoided until advanced disease has caused symptoms that they can no longer bear. Minimum intervention oral healthcare is an approach that has the potential to provide comprehensive personalised patient management pathway for delivering better oral health care for anxious patients.
Minimum intervention oral healthcare (MIOC) combines 4 main domains:
- Detection and diagnosis
- Prevention and control of oral disease
- Minimally invasive operative interventions
- Review/recall
Detection and diagnosis
This is done through an initial clinical assessment in order to allow the clinician to organise the best treatment need for the patient. The aim is to start the patient with the simplest and least invasive procedure to in order to build their trust and confidence. In order to do this, you would need to consider the patient’s medical history, dental history, social history and other components of a history in the dental setting. Questions should also be asked to help explore their anxiety triggers and the anxiety factors e.g. injection, laying back in the chair.
During the dental visit, assess the patient for signs of dental phobia and any urgent treatment needs that they have. An anxiety scale can be used to determine their level of anxiety. As you clinician, you can also observe:
- Their appearance: e.g. not sitting still, pale, crying and agitated
- Communication e.g. no eye contact, quiet or talking too much, aggressive and agitated behaviour
- Common signs of anxiety including sweaty hands, clenched fists, pale skin other symptoms include dry mouth, needing to visit the lavatory, fainting, tiredness and sweating
- Clinical signs: increased respiratory rate, raised BP and HR
Prevention and control of oral disease
It is important that the importance of oral health is emphasised to the patient through oral health advice at each appointment. The key is to encourage positive and protective behaviours. It is important that patients retain the information and get involved in all prevention phases. There is primary prevention that focuses on preventing new cases of oral disease by addressing the risk factors. There is also secondary prevention and treatment focuses on ensuring that the patients dental diseases does not progress.
Minimally invasive operative interventions
Tissue preservation is key at this stage. Interventions should focus on removing and replacing as little tooth tissue as possible in order to maintain patient’s function and aesthetics.
Recall
The purpose of this step is to review the quality of treatment provided for the patient. The patient’s behavioural changes can also be re-assessed and how much they are sticking to their preventative behaviour. The recall period should be agreed upon between the dental team and patient and will take into account a reassessment of the clinical factors and disease susceptibility.
Priscilla Ehikioya, Leeds BDS5