The Special Care Dental team from Furness and South Lakes have been highly commended in the National Oral Health Awards in the Best Care of Nervous Patients category for the development of an anxiety management pathway based on psychological treatment approaches.

The CLIC Engaging for Improvement (E4I) Scheme focused on designing a new pathway for patients in Cumbria that require specialist dental treatment. The pathway uses cognitive behavioural therapy techniques (CBT) to help patients who suffer from extreme dental anxiety.

Sue Mchugh, Clinical Lead Dentist, and Emma Apsden, Dental Nurse, at NCIC from Kendal Dental Clinic, initiated the project.

Sue said:“We receive many referrals for patients with extreme dental anxiety who in many cases have severely neglected mouths. Some of these patients have endured extreme pain and embarrassment in what they see as a reasonable alternative to visiting a dentist.

“Traditionally, many of these patients would be offered sedation for a course of treatment and only revisit us when in pain. We felt that we could offer a more appropriate alternative by accessing more psychological treatment. We signed up to a 6 day CBT course and decided to set up an anxiety management pathway for patients. We were totally focused on what we wanted to achieve and wanted to demonstrate a viable alternative to sedation.”

A pilot study was created using CBT techniques for a selection of patients. Anxiety scores and attendance rates for these patients were measured before and after treatment and then compared to those treated with sedation.

Emma said: "We saw anxiety scores dramatically decrease for all patients in the pilot group but patients attending for repeat sedation all had anxiety scores similar to, or even higher than when they initially attended. We also had a 100% attendance rate from the start through to completion of treatment for these patients compared to a 27% failure rate for sedation patients.”

One patient who took part in the study said: “Sue and Emma were absolutely brilliant. By the time I had finished my treatment I was actually looking forward to coming to appointments. I would find myself leaving with a big smile on my face because I was so happy with the way I had been treated. I feel happy with my mouth for the first time ever which has impacted on me positively. I want to look after my dental health now because I can see the positive effects that come from it.”

Sue adds: “We have taught people that it is ok to be anxious but that they are in control; by responding to their individual needs we have left them feeling empowered to deal with something that has overshadowed their lives for many years. From a service delivery point of view, the sense of achievement is indescribable. Teeth are teeth, but to help somebody who is so afraid and to make them feel valued is the greatest feeling any clinician can have.”

Natalie Carman, Clinical Director, Dental Services added: “This is an inspirational project and an excellent example of integrated care in action. I am proud to be working with those who care so passionately for the patients we see.”

To find out more about Engaging for Improvement, please go to: