The Social Validation of Pharmacological Approaches to the Management of Dental Anxiety in Adults: Impact of Treatment Urgency, Method of Intervention and Treatment Outcome

Article excerpt

One hundred and twenty-eight adult patients attending a clinic at a United Kingdom dental hospital rated vignettes describing the management of an adult who was severely dentally anxious. There were 8 vignettes, which varied systematically along three dimensions: treatment urgency (presence or absence of pain), method of intervention (psychological approach versus use of sedation) and treatment outcome (good outcome - individual overcame dental anxiety to attend regularly, or poor outcome - individual did not attend following the treatment). Participants were assigned one vignette at random and rated the acceptability and humaneness of the treatment approach using the Treatment Evaluation Inventory (Kazdin, French, & Sherick, 1981). Overall the psychological intervention was rated as more acceptable than the use of sedation (F = 7.60, p < 0.01), and interventions which resulted in good outcomes were rated as more acceptable (F = 148.8, p < 0.001). There was no significant effect of treatment urgency. Ratings of acceptability are strongly influenced by the outcome of the treatment regardless of the urgency of treatment need.

Keywords: dental anxiety, behavior management, social validity.

Researchers working within the framework of applied behavior analysis have often been concerned to determine the social validity of their interventions. Wolf (1978) suggested that data on social validity can be collected by answering three questions:

Does society deem the program goals to be desirable and appropriate for the client?

Are the client and the significant people in his/her life satisfied with the change that occurred during treatment?

Are the procedures used to achieve change acceptable to the client, his/her significant others and the broader community?

There has been relatively little attention paid to the social validation of treatment, despite a great deal of emphasis being placed on consumer involvement in the design of treatments and services (Worcester, 2003). The third of Wolf's questions, concerning the acceptability of treatment, is interesting given that acceptability as a concept appears in many aspects of public health. It is enshrined in the Primary Health Care Approach (WHO, 1978), it is included as a dimension of access (Penchansky & Thomas, 1981) and definitions of health need (Matthew, 1972).

A limited number of recent studies have addressed the acceptability of behavior management techniques for dentally anxious children, but there have been no published studies on behavior management for adults who fear dental treatment. Behavior problems among children receiving dental treatment are relatively common. Holst, Hallonsten, Schroder, Ek, and Edlund (1993) reported that among a sample of 273 3-year-olds attending the dentist for the first time 13% acted reluctantly and 11% negatively. A number of restrictive and nonrestrictive techniques for managing anxious children are available, including pharmacological approaches and a range of behavior management approaches (American Academy of Pediatric Dentistry, 2004). Murphy, Fields, and Machen (1984) assessed the attitudes of parents towards 10 different behavior management techniques employed in pediatric dentistry, the acceptability of which they ranked after they had viewed them on video. General anesthesia, sedation and the use of Hand-Over-Mouth (where a dentist places his or her hand over a child's mouth, restraining the child, and explains that he/she wishes the child to act appropriately) were generally viewed as the most unacceptable techniques. In a further study by Fields, Machen, and Murphy (1984) the same methodology was used but additionally parents were provided with information on the nature of the dental treatment to be performed. They found that the acceptability of the behavior management technique was related to the nature of the treatment performed. Pharmacological treatments (general anaesthesia and sedation) were judged unacceptable except when used for extractions and restorations. …