Disseminable Evidence-Based Treatment for the Dental Office: Virtual Exposure Tools for Dental Fear - neVR Fear the Dentist

PROJECT SUMMARY/ABSTRACT Each year over 20 million adults with moderate fear and over 14 million adults with severe fear visit the dentist. Because fear portends poor future oral health, patients with dental fear come to experience their worst fears: pain, surgical procedures, and the need for more frequent dental visits. Avoidance is the natural and reinforced response, ironically guaranteeing a repetition of the feared events. Breaking this cycle is the primary target of this proposal. Standard treatment — compassionate but ultimately counterproductive — includes anti-anxiety medication or more substantial anesthesia, which (a) does nothing to reduce subsequent anxiety or avoidance, (b) leads to continued dental problems, and (c) perpetuates the cycle of fear—>avoidance—>dental problems. Alternatively, cognitive-behavioral treatments (CBT) for dental fear have been developed, subjected to dozens of high-quality trials, and found to be efficacious. However, CBT has, almost exclusively, been offered only in a few specialty clinics worldwide associated with universities; there is no disseminable model for integrating CBT into the workflow of dental practices. To fill this gap, this Fast-Track STTR proposal describes plans for development and testing of a marketable product that can bring effective dental fear treatment to dental offices within the currently existing U.S. practice ecosystem. neVR Fear the DentistTM is a commercializable suite of self-administered eHealth tools to treat dental fear that can be implemented in private practice dental offices throughout the U.S. and is eminently scalable. neVR Fear the DentistTM comprises three major evidence-based interventions. First is a self-administered eHealth app for CBT/psychoeducation with exposure therapy — delivered via a mobile tablet — that can be used privately in waiting rooms. Second is a communication-eliciting intervention, in which the patient records a “Pre-Game Plan” — to be reviewed with the dental staff before dental services — comprising (1) pre-treatment fear levels, (2) the factor generating the most anxiety, (3) a stop-signal the patient will use to alert dentist, (4) things the dental team can do to maximize this patient's comfort, and (5) a self-generated anxiety management plan. All patients in the treatment group will receive the first two EBIs as a single intervention on the tablet. Third (for patients who are in the severe range) is a 1-hr virtual reality exposure treatment (VRET). VRET will allow us to provide CBT that can be self-administered within the normal operations of dentistry and will allow every dental practice to be a dental fear specialty clinic. Such an approach is necessary to shift clinical practice, as the nearly 200,000 U.S. dentists will only adopt an approach designed, from the bottom up, to fit both the busy-ness and business of 21st-century dental practices. The research component will use an adequately powered RCT to test both (a) the effectiveness of neVR Fear the DentistTM and, using the NIH's Experimental Medicine Approach to Behavioral Change model, (b) whether inhibitory learning is the mechanism through which it affects change.