Methods: Inclusion criteria were defined according to the PICO methodology (Patients, Interventions, Controls, Outcome): Study populations with documented severe dental anxiety, measured with validated psychometric scales (DAS, DFS), or fulfilling psychiatric criteria for dental phobia. Behavioral intervention based on cognitive behavior therapy (CBT)/behavior therapy (BT). Control condition defined as information, pharmacological sedation, general anesthesia, placebo/no treatment. Outcome variables measuring level of dental anxiety; acceptance of conventional dental treatment (without pharmacological sedation); dental treatability ratings; quality of life and health-related quality of life; and complications. Further criteria: RCT or systematic reviews; publication date from 1970.
Results: The systematic literature review identified ten RCT publications. CBT/BT give a significant reduction of dental anxiety, measured with DAS, DFS, but based on low and very low quality of evidence, respectively. There is some support that CBT/BT improve the patients’ acceptance of conventional dental treatment more than general anesthesia (low quality of evidence).
Conclusions: More well-designed efficacy studies on behavioral interventions for dental anxiety/phobia are needed, however, there is some evidence that behavioral interventions will reduce severe dental anxiety/phobia.