Reduction of fear and anxiety in adult fearful patients.

Dental fear is most often of multifactorial origin and is most successfully treated by behavioural therapies. The need for specialized treatments is related to the severity of the fear reaction and its consequences. For the majority of anxious patients simple treatment techniques readily available and applicable in general practice should be used. These procedures aim to restructure the patient's anticipation and evaluation of the dental situation. However, the establishment of specialized research and treatment centres has resulted in improved understanding and knowledge of the severely phobic patients with long-standing avoidance symptoms. These individuals suffer from more disseminated effects of dental fear and benefit most from broadly based therapies that use both cognitive-behavioural and psychophysiological components. There may also be indications for the use of pharmacological therapies. The immediate posttherapy successful outcome rates are at levels of 70 to 80 per cent for broadly based therapies or combinations of treatment modalities. In spite of an obvious shortage of follow-up investigations, Swedish studies on severely phobic and avoiding groups have revealed that similar outcome figures may be valid over longer periods of time. The Swedish studies also indicate beneficial side-effects on the patients' general well-being and psychosocial situation.