Concerns about dental treatment in patients awaiting sedation
Research type
Research Study
Full title
What are the concerns about dental treatment experienced by patients awaiting sedation, and how do they perceive their ability to cope with treatment with or without sedation?
IRAS ID
334106
Contact name
Chloe Feldon
Contact email
Sponsor organisation
Newcastle University
Duration of Study in the UK
1 years, 7 months, 15 days
Research summary
Research Summary:
Dental anxiety is common, with around 36% of UK adults experiencing moderate and 12% experiencing severe dental anxiety. Dental anxiety can lead to avoidance of dental treatment, which can lead to poor health outcomes and reduced quality of life.
Conscious sedation is a technique that can help people with severe dental anxiety to access treatment. This involves injection of a drug which relaxes the patient followed and local anaesthetic being injected into the mouth to numb the area, allowing the procedure to be completed. The patient is awake throughout and able to talk but might not remember the treatment afterwards.
Few NHS dentists in primary care settings in the North East offer conscious sedation, and therefore refer patients to the sedation department at the Newcastle Dental Hospital (NDH) where there is a waiting list. Although conscious sedation often helps patients to accept treatment, it is not an anxiety treatment and it is recommended that where conscious sedation is offered, psychological therapy should also be offered. However, this is not currently available at NDH.
When asked why they are anxious about dental treatment, people have responded to questionnaires stating that they find it ‘dangerous’, ‘disgusting’ or ‘unpredictable’. In interviews, patients’ reasons for their anxiety have included ‘unsupportive dentists’, ‘embarrassment’, ‘shame’, ‘powerlessness’, and ‘vulnerability’.
Although some of these factors may explain why some patients feel they are only able to cope with dental treatment with conscious sedation, there is a gap in the literature exploring this qualitatively (via interviews) from the perspective of people on the waiting list for this technique. The aims of this study are to explore the concerns about dental treatment amongst people waiting for dental sedation at the NDH, and to explore their thoughts about their ability to cope with or without sedation.
Summary of Results:
Many people feel worried about going to the dentist or having dental treatment (known as dental anxiety). When people are very worried, it can make them avoid going to the dentist. This can lead to worse problems with their teeth and mouth, and they might need more serious or painful treatment later, which can cause more dental anxiety. This can make people feel trapped in a cycle where the worry keeps growing each time they avoid going.
This study looked at how adults with dental anxiety feel about dental treatment, how they try to deal with it, and what they find helpful. The study involved interviews with twelve adults who were on an NHS dental hospital waiting list. They were waiting for treatment under conscious sedation. This is a type of medicine that helps people feel calm and relaxed during dental treatment, where they stay awake but feel sleepy and less anxious.
The information from the interviews was looked at using reflexive thematic analysis. This is a way to find patterns or themes in what people say. As part of this, the researcher also had to think about how their own views and ideas might affect what they noticed in the information.
People in the study said their anxiety was linked to past experiences and also current feelings in the dental chair. Dental treatment felt difficult and unpleasant, but some people had ways of dealing with this (coping strategies). These worked better when dental staff and the wider dental care system supported and understood them. Some people said they were embarrassed or ashamed about their dental health or about being anxious. Feeling powerless or not in control in the dental chair made people more anxious.
Conscious sedation helped some people feel calmer during treatment, but it did not take away their dental anxiety. Some people saw sedation as the only way to be able to have treatment, and others only needed it for more serious dental work. Some had not had it before and were waiting for their first time.
It is recommended that when people are given conscious sedation, they should also be offered psychological therapy to help with their anxiety. Psychological therapy means talking to a trained person who can help people understand and manage their feelings. Most people in this study said they would like this kind of support, but psychological therapy was not available in the dental service they were using. This showed a gap in the care offered to people with dental anxiety.
This study also showed that neurodivergent people (for example, people with autism or ADHD) can find dental visits harder. They might be more sensitive to things like sounds, lights, or touch, and might find it harder to talk with the dentist about how they feel. It would be helpful to do more qualitative research to understand this better. This study looked at people who were having sedation, but in the future, it would also be helpful to talk to people struggling with dental anxiety who do not want sedation, to understand their feelings better.
The findings show that dental anxiety is complicated. They also add to a review done by the researcher, which looked at eleven other studies about people’s experiences of dental anxiety. The qualitative methods used in this study were important to have a deeper understanding of dental anxiety in people with dental anxiety having conscious sedation.
REC name
South West - Frenchay Research Ethics Committee
REC reference
23/SW/0153
Date of REC Opinion
9 Jan 2024
REC opinion
Favourable Opinion