Childhood dental anxiety is a common problem with over half of children reporting moderate levels of dental anxiety. Children with dental anxiety are more likely to avoid dental treatment and have worse oral health status and quality of life than their peers. Dental treatment of dentally anxious children can be time-consuming and stressful for dental professionals and missed and cancelled appointments have a financial impact on dental practices.

Cognitive Behavioural Therapy (CBT) is highly effective in treating a range of anxiety disorders in both children and adults, however, access to this therapy is limited. 'Guided self-help' CBT (where a healthcare practitioner supports the individual to work through an intervention) provides a viable alternative to CBT therapy and can be used as part of a 'stepped care' approach for the treatment of anxiety. NICE (2011) recommends this tiered approach to the management of common mental health problems (e.g. anxiety).

Dr Jenny Porritt, a Health Psychologist working at the Centre for Behavioural Science and Applied Psychology (CeBSAP) at Sheffield Hallam University, was part of the multidisciplinary team that developed the first evidence-based self-help CBT guide aimed at reducing dental anxiety in children aged 11-16 years old. This project was funded by an NIHR Research for Patient Benefit grant (2013-2015) and aimed to

1. Involve children, parents and dental professionals in the design and development of evidence-based CBT self-help resources for the reduction of dental anxiety in children.
2. Develop a child-centred and theory-based self-report questionnaire which could be used to assess changes in children's dental anxiety.
3. Undertake a preliminary evaluation of the feasibility, acceptability and effectiveness of the CBT self-help intervention.

A series of self-help resources (paper based and online https://llttf.com/home/dental-anxiety/) were developed for children, their parents and dental professionals. The evaluation revealed there was a significant reduction in dental anxiety and increase in health-related quality of life following use of the CBT resources.

The child dental anxiety guides have been approved by the British Society of Paediatric Dentistry (BSPD) and were second place in the BSPD Outstanding Innovation Award 2017. Other prizes include

• British Dental Association Community Dental Service group conference - 1st prize for service improvement 2016
• BMA Patient Information Award – highly commended and shortlisted for children award 2017
• Yorkshire & Humber Academic Health Science Network – Best Patient Driven innovation award 2018

To date, the use of the guides has been disseminated to 800 dentists/dental care professionals at events across England and Scotland. Around 300 packs containing copies of the guides have been purchased from the online store or Academic Unit by individuals, Local Dental Committees, Community Dental Services and NHS England to a value of £1800. The use of the guides has been incorporated into the clinical care pathway for the management of anxious patients for dentists working in NHS England Central Midlands. The dental corporate body ‘Centre for Dentistry’ is currently trialling the use of the resources in two of its 25 dental practices.

Key outputs from the research include

• Morgan, H.D. Rodd, J.M. Porritt, S.R. Baker, C. Creswell, T. Newton, C. Williams, Z. Marshman. (2017) Children's experiences of dental anxiety. Int J Paediatr Dent.,27;2:87-97. doi: 10.1111/ipd.12238.
• Porritt, J., Rodd, H., Morgan, A., Williams, C., Gupta, E., Kirby, J., Creswell, C., Newton, T., Stevens, K., Baker, S., Prasad, S.,Marshman, Z. (2018). Development and evaluation of the Children’s Experiences of Dental Anxiety Measure (CEDAM). Int J Paediatr Dent., 28; 2:140-151 doi 10.1111/ipd.12315
• Porritt, J., Rodd, H., Morgan, A., C, W., Gupta, E., Kirby, J., Marshman, Z. (2016). Development and Testing of a Cognitive Behavioral Therapy Resource for Children’s Dental Anxiety. JDR Clinical & Translational Research, 2(1), 23-37.
• Rodd, H., Kirby, J., Duffy, E., Porritt, J., Morgan, A., Prasad, S., Marshman, Z. (2018). Children's experiences following a CBT intervention to reduce dental anxiety: one year on. BDJ, 225, 247. doi: 10.1038/sj.bdj.2018.540
• Marshman, Z., Morgan, A., Porritt, J., Gupta, E., Baker, S., Creswell, C., Newton, T., Stevens, K., Williams, C., Prasad, S., Kirby, J., Rodd, H. (2016). Protocol for a feasibility study of a self-help cognitive behavioural therapy resource for the reduction of dental anxiety in young people. Pilot Feasibility Stud.,1;2:13. doi: 10.1186/s40814-016-0054-2