Abstract
BACKGROUND: Dental phobia (DP) and injection phobia (IP) are common in pediatric populations, resulting in inability to receive dental care. Internet-based cognitive behavioral therapy (ICBT) has demonstrated efficacy, but its long-term effects are unexplored. OBJECTIVE: This study aimed to evaluate the long-term effects of ICBT on DP and IP in children and adolescents. METHODS: In total, 49 participants (mean age 11.1 years, SD 2.1) with DP, IP, or both underwent a 12-week, parent-guided, exposure-based ICBT, supplemented by visits at local dental clinics and weekly psychologist correspondence. Assessments occurred at baseline, posttreatment, and 1-year follow-up. Primary outcomes included diagnostic status (clinical interview) and ability to receive dental procedures. Secondary outcomes included measures of dental anxiety, injection anxiety, negative cognitions, and self-efficacy. The study was conducted in Sweden. RESULTS: Of the 49 participants, 42 (86%) completed the 1-year follow-up. At 1-year follow-up, 19 (53%) of 36 (86%) participants who initially met the criteria for DP no longer did (P<.001), and 17 (46%) of 37 (88%) participants who initially met the criteria for IP did not fulfill the IP diagnosis (P<.001). Repeated-measures ANOVA showed significant improvements, with large effect sizes for self-reported ability to undergo dental procedures (d=1.1, P<.001), dental fear (d=1.0, P<.001), negative cognitions (d=0.9, P<.001), injection fear (d=0.7, P<.001), and self-efficacy (d=1.1, P<.001). Predictor analysis showed greater improvements in older participants and males. CONCLUSIONS: This study discussed the clinical implications of and approaches to ICBT implementation. ICBT for children and adolescents with DP and IP maintains its effects over a 1-year follow-up period, facilitating improved self-reported willingness to undergo dental treatment. Given its accessibility and sustained efficacy, ICBT should be considered for managing severe dental fear in pediatric dentistry. TRIAL REGISTRATION: ClinicalTrials.gov NCT02588079; https://clinicaltrials.gov/study/NCT02588079.