The Use of Needle Desensitisation to Treat and Resolve Dental Phobia Caroline Campbell, Callum D Simpson, Greig D Taylor Glasgow Dental Hospital and School, Glasgow, UK Needle Desensitisation (ND) Pre-Treatment MCDASf Phobia is a clinical mental disorder where subjects display persistent and extreme fear of objects or situations with avoidance behaviour and interference of daily life. 1 Assessment with an appropriate clinical history and assessment tool is recommended. 2 In Glasgow Dental Hospital and School (GDH & S), paediatric dental anxiety is measured with a 9-question version of the Modified Child Dental Anxiety Scale (faces version) (MCDASf). A score of >27/45 indicates that the patient has high levels of dental fear or phobia. Treatment success can be measured in terms of completion of restorative treatment or resolution of the fear/phobia. ND is one anxiety management strategy that can be used to facilitate the delivery of local anaesthetic whilst also helping the child to cope with a needle phobia. It is most successful in information-seeking patients (monitors), and is frequently used alongside relaxation techniques. 3 ND reduces anxiety through repeated non-threatening exposure to fear provoking stimuli (Figs 1+2). The readiness of the child to move on to subsequent stages of the desensitisation process is measured on a visual analogue scale (VAS) (Fig 3). An 8-year-old boy (Fig 1& 2) was referred for restoration of permanent molars. He was needle phobic with a 2 year history of attendances at general dental practitioner (GDP) and public dental services (PDS). Assessment history revealed a palatal injection (GDP) triggered his dental phobia, inhalation sedation was not successful (PDS). His MCDASf score was 31/45 (Fig 4) indicating both dental and medical needle phobia. He was an information seeker and happy for relaxation exercises and needle desensitisation (ND). Clinical examination revealed caries in 16, 26, 36, 75 and 46, the OPT radiograph confirmed these teeth were restorable. Relaxation was taught at his assessment visit. He completed the seven stage needle desensitisation over two visits, with L.A. administered and restoration of 16. All carious teeth were subsequently restored and at his review appointment he remains caries free both clinically and radiographically. His MCDASf is now 15/45 (Fig 5). A comprehensive assessment is essential in understanding the best treatment option. Establishing early the patient’s coping strategy- information seeking (monitors) v blunting allows for a tailored approach to treating the anxiety of the individual that is more likely to succeed in resolving the phobia. It can be argued that strategies which teach the monitoring patient to cope with their anxiety such as relaxation, and understanding their own fear such as ND, are most beneficial to the patient. These give the patient tools which they can take forward into future treatment by their own GDP. Resolution of the phobia and reduction in MCDASf scores can be seen to be the best measure of success for fearful/phobic patients, rather than simply the completion of treatment. References: 1. Ost LG, Skaret E (eds). Cognitive Behaviour Therapy for Dental Phobia and Anxiety. New York: Wiley-Blackwell Publishing, Howards KE, Freeman R. Reliability and Validity of a faces version of the Modified Child Dental Anxiety Scale. Int J Paed Dent 2007; 17: Taylor GD, Campbell C. A clinical guide to needle desensitization for the paediatric patient. Dental Update 2015; 42 (4): Post-Treatment MCDASf 31/45 15/45 Fig 4: Pre-treatment MCDASf showing a score of 31/45, which indicates dental phobia Fig 5: Post-treatment MCDASf indicates dental phobia has resolved Fig 1: ND stage 4- holding assembled syringe Fig 3: Visual Analogue Scale used to assess patient’s response to each ND stage Comments and Discussion Phobia and Anxiety Case Report Fig 2: ND stage 5- “cap on” practice