Dental Fear in Adults and the Hall Technique
Thu, February 2, 2023

Dental Fear in Adults and the Hall Technique

The common reason why many adults in different parts of the world fear having dental treatment is that they have undergone it as a child, which may have proven to be quite traumatic, involving injections and drilling. / Photo by Iakov Filimonov via 123RF


Most people have something they are afraid of but not all fears are the same. Some might be afraid of snakes or spiders or even speaking in front of a crowd. These are what we call phobias that while they seem irrational have a perfect psychological reason. You can count the fear of visiting the dentist among such a condition. Referred to as dentophobia, it is a kind of fear that is not just slight nervousness but manifests as a huge feeling of dread before every dentist appointment.

The common reason why many adults in different parts of the world fear having dental treatment is that they have undergone it as a child, which may have proven to be quite traumatic, involving injections and drilling. This is according to Nicola Innes and Mark Robertson, University of Dundee’s professor of pediatric dentistry and clinical lecturer in pediatric dentistry, respectively. The two explained the importance of the Hall technique to address this.


The Hall Technique

The Hall Technique is a child-centered approach to managing baby tooth decay without the need for drilling or injections. It involves sealing in the decay and bacteria by putting a small, stainless-steel crown on top of the affected tooth. When the bacteria causing decay is not receiving sugar and oxygen it needs to survive, it cannot make the acid that gradually dissolves the enamel in teeth. The enamel is the outer surface layer of the teeth that protects against tooth decay and is the hardest mineral substance in the body.

The University of Dundee’s user manual also detailed that the Hall Technique needs careful case selection, excellent patient management, and a high level of clinical skill. The technique is named after Scotland’s general dental practitioner Dr. Norna Hall, who created and used the technique for more than 15 years until she retired. Before the Hall Technique, preformed metal crowns (PMCs) were utilized for restoring the primary molars or the last of the primary teeth to fall out. With the hall technique, fitting the crown is non-invasive and quick.

In the trial conducted by Innes and Robertson, wherein they compared sealing the tooth decay using the traditional tooth fillings and the Hall Technique, results showed that the latter has a higher success rate. About 93% to 98% of kids avoid teeth infection or toothache for the next two to five years. Furthermore, kids either find the Hall Technique easy to cope with or they prefer the method than the traditional procedure that involves drilling and injection. This is also regardless if the procedure was conducted in a classroom or dental clinic or whether it was performed by a dental student, general dentist, or special dentist.

How Effective Is the Hall Technique?

A 2014 US retrospective study that appeared in the Journal of the American Dental Association also explained that the Hall technique was effective in the same way dentists would use specialist crowns that involved removing the decay, drilling, and injections. Separate studies in Sudan, the UK, and Germany found the procedure to be cheaper compared to the traditional method of drilling and filling.

It is well known that the Hall Technique is effective in treating a tooth, but the authors wanted to know what its effects are for the long term. This is why they studied 1,058 kids between three and seven years old. The authors divided the kids into three groups to determine which among the three common ways of managing tooth decay is most effective. These children involved in the study were known to have a history of tooth decay and the authors followed them up after three years.


Three Ways of Managing Tooth Decay

The first method used is the traditional approach, which involved numbing the tooth with injections and removing the dental decay using drills. The standard filling material was then applied as well as a high-fluoride varnish. The dental therapist or the dentist also provided a diet and toothbrushing advice as part of the preventative treatment accompanied in the first method.

The second method was the Hall Technique that filled over the decay but did not use injections. Preventative treatment was also accompanied by this method. For the third method, however, only preventative treatment was utilized.

The result showed that after three years, no difference was found between the participants who underwent the first and second methods. However, there were slightly higher episodes of infection and dental pain among kids who were a part of the prevention-alone group. The researchers added that the most cost-effective treatment was the sealing-in accompanied by prevention strategy.

An important factor in the acceptability of the three treatments mentioned was the trust that parents and children had in the dentist. It was also important to have the same dentist throughout the procedure. Parents and kids have reduced dental fear and more positive experiences if the dentist was patient, caring, gentle, and explained the procedures to them.

Tooth decay and sugar consumption

An international organization that serves as the main representative body of more than a million dentists worldwide, the World Dental Federation FDI shared that between 60% to 90% of schoolchildren worldwide and nearly 100% of adults have tooth decay, which often leads to discomfort and pain. In the Global Burden of Disease study involving 291 conditions, the most prevalent of all is an oral disease that affects 3.9 billion people all over the world. Dental carries or untreated decay impacts about 44% of the world’s population.

Worldwide consumption has also tripled in the past 50 years. The increase is most noticeable in emerging countries. Because of exposure to sugar and other risks, dental caries became one of the most chronic diseases worldwide. Our World in Data, a scientific online publication that focuses on large global problems, also shared the dietary compositions in the United States measured in kilocalories per day—1 kilocalorie (kcal) = 1000 calorie (cal). It detailed that the US consumed 515.00 kcal in 1961, which increased to 574.00 kcal in 1970, 556.00 kcal in 1980, 590.00 kcal in 1990, 639.00 kcal in 2000, and 600.00 kcal in 2013 (latest available data).

There is also a shortage of dentists in several countries. Countries with the lowest number of dentists, dental assistants, dental technician, and related occupation personnel per 1,000 people were Senegal (0.79 per 1,000 population), Benin (0.08), Cameroon (0.38), Botswana (4.04), Mozambique (0.75), Mexico (10), Chile (16), Peru (18), Jamaica (9), Haiti (2.10), Guyana (3.58), Dominica (6.77), Indonesia (5.48), Thailand (16.77), and Myanmar (8.06).

On the other hand, countries with the highest number of dentistry personnel per 1,000 population in 2018 were Brazil (123.68), Cuba (166), Libya (90.61), Italy (83.16), Norway (86.52), Iceland (83.28), Romania (80.72), Lithuania (95.83), Qatar (83.86), and Estonia (95.77).

Oral diseases affect people throughout their lifetime that cause pain, disfigurement, and discomfort. The application of the Hall Technique gives hope to reduce the number of individuals who fear going to the dentist and can likewise lessen the negative effect of dental procedures on kids.