Accepted for/Published in: JMIR Pediatrics and Parenting
Date Submitted: Jul 9, 2025
Date Accepted: Sep 10, 2025
Internet-Based Cognitive Behavioral Therapy for Children and Adolescents with Dental or Injection Phobia: 1-year follow-up
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:
To evaluate the long-term effects of ICBT for DP and IP in children and adolescents.
Methods:
49 participants (mean age 11.1, SD 2.1 years) 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, post-treatment, 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.
Results:
Of the participants, 86% (42/49) completed the 1-year follow-up. At 1-year follow-up, 53% (19/36) who initially met criteria for DP no longer did (p<.001), and 46% (17/37) who initially met criteria for IP did not fulfill IP diagnosis (p<.001). Repeated-measures ANOVA showed significant improvements with large effect sizes for 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:
ICBT for children and adolescents with DP and IP maintains its effects over a one-year follow-up period, facilitating improved willingness to undergo dental treatment. Given its accessibility and sustained efficacy, ICBT should be considered for managing severe dental fear in pediatric dentistry. Clinical implications and approaches to implementation are discussed. Clinical Trial: ClinicalTrials.gov NCT02588079; https://clinicaltrials.gov/study/NCT02588079
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