About the project
This behavioral dentistry project involves pilot testing of the medication D-cycloserine (DCS) to enhance the effect of evidence-based exposure treatment of dental anxiety and avoidance of dental care. The study is an innovative approach to combination therapies, as D-cycloserine alone is not anxiety-reducing, but influences the consolidation of memory of positive and successful adaptation to dental procedures during the exposure treatment, and thereby reducing the fear response.
DCS in higher doses is used as a secondary medication in the treatment of tuberculosis. Studies in animals have identified N-methyl-D-aspartate (NMDA) receptors as being crucial in fear memory acquisition and consolidation as well as in its extinction and reconsolidation. Recent studies have shown that DCS acts a partial DNMT receptor agonist, and that low-doses of the same medication gives an enhancement effect of the NMDA receptor functioning, and thereby increase the extinction and reconsolidation of the fear memory. Human research has indicated that this combination treatment has the potential to shorten the time required for treatment of the anxiety, and thereby effectively reduce behavior management problems and avoidance of dental care. A pilot study of DCS in children (mean age 10 years) with Autistic Disorder has shown that the medication gave significant inprovement compared to placebo and was well tolerated. The specific aim of the present study will be to pilot test the combination of exposure therapy and orally administered low-dose D-cycloserine in adolescents aged 12-18 years, referred to a special clinic for dental treatment because of behavior management problems. The combination approach will be delivered by public dental service dentists that have learned the principles of exposure therapy, and has great potential in prevention of dental anxiety and avoidance of care and thereby reducing the need for general anesthesia (GA). The first part of the project will be a pilot study to test the procedure and instruments and to get more experience with the combination treatment (post-graduate project in pediatric dentistry).