Reducing mental distress in patients undergoing dental procedures including hypnosis, relaxation, and counseling

An interesting article titled “Non-pharmacological interventions for reducing mental distress in patients undergoing dental procedures: Systematic review and meta-analysis” by Sophia Burghardt  et al., appears in the Journal of Dentistry in 2018 (vol. 68, pp. 22 – 31). The article seeks to determine the effects of hypnosis, enhanced information, relaxation, music, or cognitive-behavioral approaches on adults undergoing dental procedures. The researchers explored 29 randomized controlled trials and found through random effects meta-analyses significant reduction of mental distress when patients underwent a non-pharmacological intervention. In particular the largest effect was shown for hypnosis.

People experience anxiety and fear of going to a dentist and some even have a diagnosable condition of dental phobia. Research shows a general dentist is capable of treating adults with mild or moderate forms of dental anxiety but those with severe dental anxiety or even dental phobia often requires more specialized care such as psychotherapy. There are several different approaches that can be used in dental care in order to assist anxious patients. Hypnosis is the induction of a state of consciousness in which a person apparently loses the power of voluntary action and is highly responsive to suggestions.Hypnosis is suggested to work by reducing distress and targeting patients with suggestions for positive outcomes. All studies included by the researchers applied hypnosis using pre-recorded audio files which might be a more economic approach. Enhanced information draws on the patient’s cognitive level to transmit sensory and/or procedural information before, during and after a dental procedure. Cognitive-behavioral strategies focus on the reduction of dental anxiety through cognitive restructuring, distraction, sensory focusing, positive reinforcement, or systematic desensitization. Many often think of cognitive-behavioral therapy as a form of counseling. Counselors can help one become more aware of feelings and help work through difficulties. Relaxation techniques are described as teaching or instructing patients in breath control, muscle relaxation, guided imaginary, or autogenic training. Music interventions are known to influence physiological and psycho-emotional responses in patients by arousing memory and association, stimulating imagery, evoking emotions, and promoting relaxation and distraction.

The researchers also note that they found a negative effect on a study of showing patients the details of an operative procedure by using a video and it is believed this could have lead to additional anxiety. Based on the results the researchers feel that non-pharmacological interventions may be beneficial for reducing mental distress in patients undergoing dental procedures. They believe that additional high quality studies are needed to strengthen the evidence of non-pharmacological interventions.

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