Leveraging technology to increase the disseminability of evidence-based treatment of dental fear: An uncontrolled pilot study

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Objectives: U.S. and global estimates indicate that over 30% of adults fear receiving dental care, including over 20% who have visited a dentist in the last year, leading to avoidance and degraded oral and systemic health. Although evidence-based cognitive-behavioral treatments for dental fear (CBT-DF) exist, they have little impact on the millions who seek dental care annually because they are not disseminable (6 h of in-chair time, delivered only in person at a few sites). We developed a disseminable CBT-DF stepped-care treatment comprising (Step 1) a mobile-health application and, for those who remain fearful, (Step 2) a 1-h, one-on-one psychological treatment session that allows practice during exposure to the patient's most-feared stimuli. We hypothesized that the treatment would (a) be rated highly on usability and credibility and (b) result in clinically consequential (i.e., lowering fear into the 0–3 “no/low fear” zone) and statistically significant changes in global dental fear. Method: Racially/ethnically diverse patients (N = 48) with moderate to severe dental fear were recruited; all completed Step 1, and n = 16 completed Step 2. Results: As hypothesized, users found the stepped-care treatment highly usable, credible, and helpful. Critically, this stepped-care approach produced reductions in patients' dental fear that were both clinically consequential (with half no longer fearful) and statistically significant (d = 1.11). Conclusions: This usable, credible, stepped-care approach to dental fear treatment holds promise for liberating evidence-based CBT-DF from specialty clinics, allowing broad dissemination.

Original languageEnglish (US)
Pages (from-to)36-42
Number of pages7
JournalJournal of public health dentistry
Issue number1
StatePublished - Mar 1 2024


  • cognitive behavioral therapy
  • dental anxiety
  • dental fear
  • mHealth
  • mobile application
  • mobile health
  • stepped care
  • telemedicine

ASJC Scopus subject areas

  • General Dentistry
  • Public Health, Environmental and Occupational Health


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