Celebrating 10 years of our dental psychology service

This month we are celebrating 10 years of the dental psychology service at the Trust. The team, who were the first in-house dental psychology service at a London NHS Trust, provide invaluable support and care to patients with dental anxiety and persistent pain.

We spoke with team members Dr Jennifer Hare, consultant health psychologist, and Dr Beth Guildford, consultant clinical psychologist, to find out more about the team's work.

What is the Dental Psychology Service?

We are a specialist service based in Guy’s Dental Hospital that exists to identify, assess and treat psychological difficulties that are related to and/or impact on dental care, treatment and outcomes.

The team started looking at dental phobias and the impact of these on patients’ care back in 2008. Thanks to huge efforts from the academic team led by Professor Tim Newton at King’s College London and clinical leads at the Trust, the team were able to get the service off the ground. 5 years later we were established as a fully funded NHS service with a full-time psychologist. Now, 10 years into the established service, we have grown to a team of five psychological professionals and two clinical nurse specialists working together with our dental colleagues to support patients with dental phobias and persistent pain.

Why might someone be referred into the service?

Persistent pain or phobias can really impact someone’s quality of life. Pain can mean individuals find it difficult to do everyday activities such as work, exercising or hobbies. People’s mood and their relationships with others can also be affected. Dental phobias also mean that patients are unable to receive the treatment they need in a timely manner without sedation, or enduring severe distress.

Common conditions we see within the service include:

• Dental anxiety - fear, anxiety or stress associated with a dental setting
• Persistent gagging
• Persistent mouth and face pain
• Burning mouth syndrome
• Temporomandibular dysfunction – a group of conditions affecting the movement of the jaw

?How do you support patients?

We work alongside a multi-disciplinary team to provide a holistic approach to patients’ care. Everyone’s treatment pathway is unique, but some approaches can include:

• Cognitive behavioural therapy, with a focus on gradually increasing the level of exposure to someone’s fear (graded exposure therapy). If an individual has a fear of dentists and their offices, we can help patients get used to sitting in a dental chair, or getting them used to someone looking in their mouth. Our unique placement in a dental hospital means we have access to this specialist equipment to support patients.
• Acceptance and commitment therapy. This is about helping individuals change their relationship with pain so they are able to respond differently, and resume activities they have been avoiding due to pain.

These techniques help provide individuals with the tools they need to access care when they need it. Also, by reducing the need for sedation for procedures, the risk of procedures is reduced, whilst the capacity in the hospital is also kept free as we have less people returning as regular patients.

What’s next for the team?

Over the past 10 years we’ve seen a shift in perception of what dental anxiety is. NHS England’s national guidance now recognises the spectrum of effective treatment types available. Several members of our team contributed to the new NHS England guidelines, which promote the role of cognitive behavioural therapy and behaviour management, in the hope that more services might be established to support patients across the country. ?We hope this shift continues, and would like to see a continued focus on mental and psychological health support integrated as a part of everyday care in the dental setting.

We hope to continue providing a high-quality service for the patients accessing our service and also support the growth of services like ours across the country, where more people can benefit from oral healthcare and are able to self-manage conditions that affect their mouths.

We are also exploring the use of virtual reality for exposure therapy, and how this could help patients not just on the hospital site, but in primary care settings too.

Dr Hare recently won Psychological Professional of the Year in our Allied Health and Psychological Professional (AHPP) 2023 awards.

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