One session treatment for dental phobia in an underserved population

项目摘要/摘要 牙科恐惧症与逃避适当的牙齿护理、牙齿健康状况不佳以及社交功能减退有关 和口腔生活质量。虽然牙科恐惧症可能会持续很多年，但这种疾病通常首先表现为 在童年或青春期。西班牙裔青年患牙科恐惧症的风险可能特别高 因为西班牙裔/拉丁裔家庭不太可能对牙齿健康采取预防性立场。这意味着 西班牙裔年轻人第一次接触牙医更有可能是为了接受与以下疾病有关的治疗 疼痛、不适或羞耻--这些学习经历与牙科恐惧症的发展有关。 虽然我们对牙科恐惧症的病因学已经有了很好的了解，但我们对牙科恐惧症 如何治疗青少年的牙科恐惧症。最近，一次暴露疗法(OST)针对特定的 事实证明，恐惧症成功地解决了儿童和青少年中的各种恐惧症。然而，年轻人 患有牙科/医学恐惧症的患者没有被纳入评估OST的试验，因为需要包括 牙科保健专业人员在治疗。因此，此应用程序的主要目标是为 并进行第三阶段试验，将OST治疗儿童和青少年牙科恐惧症与积极对照进行比较 在以西班牙裔为主的人群中进行治疗，并检查抑制性学习作为机制 对焦虑和恐惧的变化负责。UG3阶段的目标是做好必要的准备工作 对于试验，包括开发所有研究文档和最终确定临床站点。其他内容 普遍定期审议第三阶段的计划包括评估研究程序的可接受性和可行性。 还有一项试验，检查服用OST的年轻人是否有证据表明抑制性学习发生了变化。这个 UH3阶段的主要目的是在#年的第三阶段社会/行为临床试验中检查OST的疗效 哪个OST是由牙科卫生员提供的。这项试验将把牙科诊所随机分成两个 治疗臂(OST与对照)，因此患者的反应和假想的治疗机制可以 被评估。还将审查与今后的传播和执行工作有关的因素。它是 假设OST可以提供一种有效的治疗选择，可以由卫生学家在 牙科诊所。也就是说，这种疗法可以减少年轻人的焦虑和恐惧回避。此外， 尽管暴露疗法在年轻人中得到了很高水平的经验支持和大量的实验室工作 已经被用来发展理论来解释它的影响，主要假设的作用机制- 抑制性学习--尚未在临床试验的背景下作为中介进行研究；因此，这 这项工作可以促进我们对驱动最有希望的治疗方法之一的机制的理解 焦虑症患者。

PROJECT SUMMARY/ABSTRACT Dental phobia is associated with avoidance of proper dental care, poor dental health, and decrements in social and oral quality of life. Although dental phobia may persist for many years, the disorder usually first manifests during childhood or adolescence. Hispanic youth may be at particularly high risk of developing dental phobia because Hispanic/Latino families are less likely to take a preventative stance toward dental health. This means that Hispanic youths’ first encounters with a dentist are more likely to be for treatment that is associated with pain, discomfort, or shame – the types of learning experiences related to the development of dental phobia. Although our knowledge about the etiology of dental phobia is well developed, we know considerably less about how to treat dental phobia in youth. Recently, a one-session exposure therapy treatment (OST) for specific phobias has proven successful in addressing a variety of phobias in children and adolescents. However, youth with dental/medical phobias have not been included in the trials assessing OST because of the need to include dental health professionals in the treatment. Therefore, the primary goal of this application is to prepare for and conduct a Stage III trial comparing OST for dental phobia in children and adolescents to an active control treatment in a predominantly Hispanic population and to examine inhibitory learning as the mechanism responsible for changes in anxiety and fear. The aims of the UG3 phase are to do the preparatory work needed for the trial, including the development of all study documentation and finalizing the clinical sites. Additional plans during the UG3 phase include the assessment of the acceptability and feasibility of the study procedures and a trial examining whether youth treated with OST show evidence of changes in inhibitory learning. The primary aim of the UH3 stage is to examine the efficacy of OST in a Stage III social/behavioral clinical trial in which OST is delivered by dental hygienists. This trial would randomize dental clinics to one of the two treatment arms (OST vs. Control) so that patient response and the hypothesized mechanism of treatment can be assessed. Factors related to future dissemination and implementation efforts will also be examined. It is hypothesized that OST can provide an efficacious treatment option that can be delivered by hygienists in the dental office. That is, that the treatment can decrease both anxiety and phobic avoidance in youth. Moreover, although exposure therapy has a high level of empirical support in youth and a good deal of laboratory work has been conducted to develop the theory to explains its effects, the main hypothesized mechanism of action – inhibitory learning – has not been studied as a mediator within the context of a clinical trial; therefore, this work could advance our understanding of the mechanism driving one of the most promising treatments for individuals with anxiety disorders.