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Cognitive behavioural therapy

‘Implants in London’  is one of the few places in the UK, and further Europe, that prides itself with offer of the best non-pharmacological (behavioural and cognitive) treatments used in the dental clinic or surgery in order to assist anxious individuals obtain needed dental care.

CBT Essex

One in seven of the population admit to be highly anxious about undergoing dental treatment and require careful and considerate management by dental practitioners.

Fear of the Dentist

Dental fear (also called odontophobia, dentophobia, dentist phobia, dental anxiety), refers to the fear of dentistry and of receiving dental care. In rare individuals this fear could eventually lead to the form of the post-traumatic stress disorder, caused by previous traumatic dental experiences.

People who are very fearful of dental care often experience a “cycle of avoidance,” in which they avoid dental care due to fear until they experience a dental emergency requiring invasive treatment, which can then further reinforce their fear of dentistry.

Tailor-made Psychological Treatment

In identified individuals, we will undertake a unique, tailor-made psychological treatment along with the dental treatment programme, taking account of the patients’ individual needs, and considering all aspects of their particular concerns.

The importance of firstly identifying dental fear and then understanding its aetiology, nature and associated components is of paramount importance.

Anxiety Management Techniques

Following the initial assessment or establishment of the dental fear, anxiety management techniques we can offer will range from sessions with your dentists with emphasis on good communication and establishing rapport to the use of systematic desensitization and hypnosis. Some techniques, such as for example cognitive behavioural therapy (CBT) or cognitive analytical therapy (CAT), require specialist input but many others are adopted for all our dental patients, regardless of their known level of dental anxiety.


In our clinic patients are, first and foremost, individuals, and there is no such thing as ‘one-size-fits-all’ treatment.

Good Understanding Between Patient and Dentist

We strongly believe that a high level of understanding between our dentists and our clients, good communication and a phased treatment approach are the core reasons for our success that also constitutes our greatest strength.

Finally, all our anxiety and fear treatments are evidence based and under strict review and development by our consulting psychotherapist and our visiting psychiatrist, whose help is enlisted if levels of higher need are anticipated.

Treatments And Coping Methods

Communication With Your Dentist


Talking with your dentist is the key to beating dental distress. Modern dentistry can be almost painless. Therefore, it’s worth taking the time to discuss your fears — and the potential treatment options — with your dentist.

Feeling in Control

You can feel more in control if you take part in decisions about your treatment. And that can help you to feel less anxious. Your dentist should discuss with you all the procedures you may need. You may be able to have several procedures done at one time or have a series of shorter appointments. Ask your dentist to describe the types of pain control available. Then decide which you feel will work best for you.

During the appointment, ask your dentist to explain what’s happening at every stage of the procedure. This may help to lower your anxiety. When you know what the dentist is about to do next, you can prepare yourself. You won’t be taken by surprise.

On the other hand, some people may feel less anxious if they don’t know what’s happening. If this is true for you, explain this to your dentist. He or she should be willing to adapt to your wishes whenever possible.

Hand Signals

Another helpful technique is to agree on a hand signal you can use if you want everything to stop right away. This will give you a sense of control. It can help to lessen your anxiety. You don’t have to wait until you’re having pain to give the signal. You may ask the dentist to stop because you’d like to rinse your mouth or simply catch your breath, or just take a break for a few seconds.


You may feel embarrassed to discuss your fears. Remember that you are not alone. Fears are not uncommon. Once your dentist knows what the issues are, he or she will be better able to find workable solutions.


One way to reduce stress during a dental appointment is to distract yourself with something more pleasant. Some dentists provide headphones so you can listen to music. Or you can bring your own. An increasing number of dentists use virtual-reality goggles. They allow you to see and hear lifelike images and sounds. This can be a welcome distraction while your dentist is treating you.

Pain Control

Research has shown that fear of pain is the main reason people avoid seeing the dentist. Even those who schedule regular dental appointments cite fear of pain as being a significant issue.

In recent years, dentists have developed a wide variety of medicines and techniques to handle pain. They can reduce or eliminate pain during most procedures. These include:


  • Topical anesthetics — Applied with a Q-tip, topical anesthetics are used routinely to numb an area of the mouth or gum before the injection of a local anesthetic
  • Laser drills — Laser drills may cause far less pain than conventional mechanical models. They can be used to prepare some cavities for fillings.
  • Electronic anesthesia — This may be used as an alternative to injections of local anesthetic. The dentist puts electrodes on the cheeks. They transmit a numbing electrical current into the jaw. Some patients report that electronic anesthesia is more effective than drugs
  • Cranial electrotherapy stimulation — This is another form of electronic anesthesia. Electricity passes into the brain and makes you feel relaxed and “heavy.” You control the intensity of the current. You can increase or decrease it as needed to control pain
  • Nitrous oxide (laughing gas) — This is one of the most common forms of in-office pain control. The gas may make you feel relaxed or even euphoric. The effects wear off quickly once the gas is turned off. Nitrous oxide generally is used as a supplement to other drugs, not as a replacement
  • Electronic anesthesia delivery systems — Many people dread the injection of anesthetic that precedes many dental procedures. It’s not the injection itself that causes most of the pain, but the pressure of the fluid entering the body. Electronic delivery systems adjust the flow of anesthetic so that it finds a route through the tissues that causes the least discomfort
  • Intravenous sedation — This technique usually is reserved for patients who are having extensive dental procedures. However, it also can be used if you are simply too anxious to have dental treatment done otherwise. A tranquilizer is injected into a vein in your hand or arm. You will be awake, but deeply relaxed
  • General anesthesia — This means you will be “put to sleep” during the whole procedure. Some dentists have the equipment and staff to perform general anesthesia in the office. It’s often done in a hospital, however. Serious side effects can occur. These may include drops in blood pressure or heartbeat irregularities (arrhythmias). For this reason, general anesthesia should be only used when other forms of sedation or pain control aren’t enough.

Relaxation Techniques

When you’re tense or upset, your body releases “stress chemicals,” such as adrenaline. These chemicals cause a variety of physical responses. Your muscles tighten, and you breathe faster. The pain receptors in your brain become more sensitive. These reactions themselves can make you feel more fearful and anxious.

Studies have shown that relaxation techniques can help reduce levels of stress hormones as well as pain and anxiety. People who practice these techniques often discover that their “fear responses” diminish over time.

There are many types of relaxation techniques. Some of the most effective include:

  • Guided imagery — This is a simple mental technique. A health care professional helps you imagine having a pleasant experience or being in a soothing place. The idea is to create as much mental detail as you possibly can. You may become so involved in the mental images that you hardly notice what the dentist is doing.
  • Deep breathing — This technique involves breathing slowly and deeply. It’s also called diaphragmatic breathing. Deep breathing floods the body with oxygen and other chemicals that relax the central nervous system and help reduce discomfort.
  • Progressive relaxation — With this technique, you consciously try to relax each muscle in the body. You start with the toes and move all the way up to the head (or vice versa). Progressive relaxation reduces muscular tension, which can help to reduce pain.


Relaxation techniques are easy to learn, but for best results you have to practice. Many therapists and dentists incorporate these techniques in their practices. They will teach you the best ways to begin.


Sedatives such as diazepam (Valium) relax the central nervous system. This is different from analgesics, which block pain. Sedatives help people feel calmer and more relaxed.

Dentists often avoid oral sedatives because they typically take about 30 minutes to work. The side effects, such as drowsiness, may last for hours. However, a dentist or physician may prescribe sedatives as part of an overall treatment plan.


Forget the Hollywood image of someone losing consciousness while staring at a swinging watch. Hypnosis is simply a technique that creates a profound state of relaxation. The effects of hypnosis are similar to the effects of meditation. You may be able to practice on your own.

Many therapists practice hypnosis, and some dentists are familiar with the technique. Self-hypnosis is effective. However, some people get better results when they work with a skilled practitioner. Some people with dental phobia ask their therapists to go with them to the dentist’s office until they master the techniques on their own.

Acupuncture and Acupressure

Acupuncture originated in China more than 4,000 years ago. This form of medicine involves inserting needles into certain locations, called acupoints, on the body. Research has shown that acupuncture may trigger the body to release pain-relieving chemicals called endorphins.

Western physicians once scoffed at acupuncture and other Eastern medical techniques. Now they agree that these practices may have some value. A related technique is acupressure. Instead of needles, pressure is applied to the acupoints.

Acupuncture is becoming more common in general medicine. For now, it’s something of a rarity among dentists.

Support Groups

Most communities have support groups for people who suffer from anxiety or phobias. Support and self-help groups do more than provide emotional support. They’re also a useful source of practical tips and coping skills.

You can learn about support groups in your area by calling mental health professionals or hotlines. Or use the Internet.


People who neglect their dental health because they are phobic may want to see a mental health professional.

Psychologists and psychiatrists often use a technique called systematic desensitization to overcome a phobia.

Patients are exposed gradually, in a controlled and careful manner, to the things they fear. This is an effective treatment for many types of phobias, including dental phobia.

Other types of therapy include cognitive therapy and psychotherapy.

Cognitive therapy helps people develop practical strategies for overcoming dental phobia. In psychotherapy, people are encouraged to understand where their fears come from and make peace with difficult events in the past.

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