Applied behavioural analysis principles in dentistry: techniques to overcome dental fear, improving attendance and compliance

Dental fear is a global, socially important health concern, impacting quality of life, psychological well-being, and oral and general health. Avoidance behaviour influences patients’ attendance, with pain often the antecedent catalyst for accessing care.
Applied behaviour analysis (ABA) studies the application of the principles, methods, and procedures of the science of behaviour as applied systematically to improve socially significant behaviour.
Dental teams using behavioural assessment can assess dental fear, its aetiology and nature, to identify apprehensive patients. Dental fear should be acknowledged, discussed and evaluated. Effective communication increases patient satisfaction, co-operation and compliance, and reduces dental fear. Assess, advise, agree, assist, arrange. ABA strategies help patients to resolve dental fear through coping and increased self-efficacy, but require willing and motivated patients. Goals should be set, with patients’ self-identified barriers removed.
Behaviour modification therapies aim to change undesirable behaviours through learning, behavioural and cognitive strategies. Cognitive behavioural therapy (CBT) techniques focus on thought and behavioural patterns to help patients identify unproductive or self-defeating thoughts, and is currently the most accepted and successful psychological treatment for anxiety and fear. Patients should be aided during treatment via coping to restructure perceptions of dental treatment with perceived control and predictability. Anxiety can affect memory, resulting in catastrophising and remembering increased pain after treatment.
Dental fear can be managed with behavioural and/or pharmacological intervention. It is worthwhile to convince patients via role induction to participate actively in treatment as this decreases pain perception, improves mood and focuses attention away from pain. Dentists benefit more from non-pharmacological approaches, resulting in highly satisfied patients and strong practices.

Journal of the Irish Dental Association 2018; 64 (1): 30-34.

Georgina Staunton
BA(Hons) Psychology
Registered Dental Hygienist

Dr John Hyland
Lecturer in Psychology
School of Arts, Dublin Business School, 13-14 Aungier Street, Dublin 2. Visiting Research Fellow, School of Nursing & Midwifery, Trinity College Dublin

Corresponding author: Georgina Staunton E: