A critical review of approaches to the treatment of dental anxiety in adults

•We reviewed randomized trials aimed at reducing dental anxiety in adults.•Treatments reviewed include CBT, relaxation, medication, hypnotherapy, and acupuncture.•CBT techniques delivered in a variety of formats are most efficacious.•Medication, hypnotherapy, acupuncture, and nitrous oxide sedation warrant further study.

Dental anxiety and specific phobia of dental procedures are prevalent conditions that can result in substantial distress and oral health impairment. This paper critically reviews 22 randomized treatment trials aimed at reducing dental anxiety and avoidance in adults, published in peer-reviewed journals between 1974 and 2012. The following treatment techniques are reviewed: various forms of cognitive-behavioral therapy (CBT), relaxation training, benzodiazepine premedication, music distraction, hypnotherapy, acupuncture, nitrous oxide sedation, and the use of lavender oil scent. CBT delivered in a variety of formats, including one-session treatment, has the most evidence for its efficacy. Cognitive techniques, relaxation, and techniques to increase patients’ sense of control over dental care are also efficacious but perform best when combined with repeated, graduated exposure. Other interventions require further study in randomized trials before conclusions about their efficacy are warranted. Limitations of the extant outcome research and implications for future treatment and research are discussed.