Adult dental anxiety – management strategies


A review by Beaton et al in 2014 indicated that about 36% of the population suffered with dental anxiety with a further 12% having extreme dental fear. A number of psychotherapeutic strategies, pharmacological or a combination of both have been used to manage dental anxiety

This review aimed to assess current management strategies for adult patients with dental anxiety in the dental clinic.


A protocol for the review was registered on PROSPERO and searches conducted on the PubMed, Medline Ovid, Cochrane, Scopus and CINAHL databases. English language publications published between 2011 and 2021 were considered. Prospective, retrospective, and randomised controlled clinical trials (RCTs) on patients with dental anxiety or phobia with qualitative or quantitative outcomes were included. Pharmacological management strategies were not included. Screening and selection of studies was undertaken independently by 4 reviewers with disagreements resolved by discussion. Data extraction was undertaken independently by 3 reviewers. Risk of bias and level of evidence was assessed by 2 reviewers. A narrative summary of the findings was presented.


  • 54 papers were included
  • A broad range of management strategies were identified that reported beneficial effects that were presented in a narrative summary. The strategies that we discussed are shown in the table below: –
  No. of studies
Music therapy 11
Virtual reality 5
Immersive reality 1
Hypnosis 3
Aromatherapy 5
Acupuncture 2
Dog-assisted therapy 1
Brief information 2
Muscle relaxation 1
Biofeedback 1
Stimulation 1
Brief cognitive behavioural intervention 1


The authors concluded: –

Psychotherapeutic behavioural strategies can modify the patient’s experience through a minimally invasive approach with nil or negligible side effects, depending on patient characteristics, anxiety level and clinical situations. These therapies involve muscle relaxation, guided imagery, physiological monitoring, utilizing biofeedback, hypnosis, acupuncture, distraction and desensitization.


The review protocol was registered with PROSPERO and searches were conducted on a wide range of databases. However, the findings were limited to publications in English and those published since 2011 which may have excluded some relevant studies. It is interesting that although not specifically excluded no studies involving pharmacological management strategies were included which as the authors’ note limits the scope of this review. The authors indicate that risk of bias of the included studies and level of evidence was assessed this is not formally presented in the paper although they do note that several interventions have limited supporting evidence. The various psychotherapeutic strategies are summarised nicely in the text. One of these, aromatherapy we have previously looked at (Dental Elf – 22nd Feb 2021).  While the findings suggest benefits from the included interventions well-conducted high-quality studies comparing the various interventions, including pharmacological are needed to determine the most effective and cost-effective strategies for managing dental anxiety.


Primary Paper

Hoffmann B, Erwood K, Ncomanzi S, Fischer V, O’Brien D, Lee A. Management strategies for adult patients with dental anxiety in the dental clinic: a systematic review. Aust Dent J. 2022 Jun 23. doi: 10.1111/adj.12926. Epub ahead of print. PMID: 35735746.

Review protocol on PROSPERO

Other references

Beaton L, Freeman R, Humphris G. Why are people afraid of the dentist? Observations and explanations. Med Princ Pract. 2014;23(4):295-301. doi: 10.1159/000357223. Epub 2013 Dec 20. Review. PubMed PMID: 24356305.

Dental Elf – 12th Apr 2021

Dental Fear in Adults

Dental Elf – 22nd Feb 2021

Aromatherapy and dental anxiety

Dental Elf – 12th Jun 2019

Dental fear and anxiety: Is it related to negative oral health beliefs?

Dental Elf – 8th Mar 2017

Anxiety and pain during dental treatment

Photo Credits

Photo by Pablo Varela on Unsplash



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