New study: Animal-assisted therapy may relieve dental anxiety in children

图源：Evaluating effects of animal-assisted therapy on pediatric dental care patients

Good Dental News |Recently, the Journal of the American Dental Association (ADA)ALREADYA prospective clinical trial published in the journal showed that animal-assisted therapy (AAT) can reduce postoperative pain perception in children and improve physiological stress response during treatment.

The research team pointed out in their paper that 6% to 22% of children experience anxiety during dental visits, which may lead to treatment interruptions and maladaptive behaviors, resulting in long-term avoidance of oral health care. Exploring whether animal-assisted therapy can serve as an effective non-pharmacological approach to managing these behaviors is of research value.

The study included 39 children aged 7 to 14 years who underwent invasive dental procedures (such as fillings or extractions). Children in the AAT group interacted with trained treatment dogs for 2 minutes before treatment, while children in the control group either participated in coloring activities or waited quietly.

The study data showed that children in the AAT group reported lower postoperative pain scores than those in the control group (P=0.001). Specifically, 53% of children in the control group reported increased postoperative pain, while only 21% of children in the AAT group experienced this.

Children in the AAT group showed a decreasing trend in heart rate at key treatment points (such as moving from the consultation room to the treatment room, or after the procedure began), with smaller fluctuations than the control group. According to the research team's analysis, this heart rate change reflects the "anticipatory" nature of anxiety—the heart rate decreases once the anxiety-inducing event occurs.

图源：Evaluating effects of animal-assisted therapy on pediatric dental care patients

Through video behavior coding analysis, the research team found that children in the AAT group maintained a longer duration of lower limb relaxation during treatment (P=0.204). This objective indicator was positively correlated with self-reported anxiety and fear scores—children with higher anxiety and fear exhibited more verbal stress indicators such as crying and groaning, as well as defensive actions such as covering their mouths with their hands in the study videos.

In the control group, children who used handheld mirrors to distract themselves experienced more physical movement and distraction due to fatigue from holding the mirrors for extended periods.

However, the research team did not detect differences in salivary cortisol and α-amylase levels between groups. Their analysis suggests this may be related to the novelty of saliva collection itself for the children. Cortisol peaks typically occur 20 to 30 minutes after stress, but the study design only collected samples 8 minutes after the critical point, potentially missing the peak window. Furthermore, the appointment times were distributed between 9 AM and 5 PM, and the diurnal fluctuations in hormone levels may have masked the intervention effect.

Animal-assisted therapy (AAT) is showing promise as a low-risk, non-pharmacological approach to behavioral management in pediatric dentistry. Compared to the potential risks of cardiovascular instability and impaired airway reflexes associated with moderate to deep sedation, or the high costs of general anesthesia, AAT offers an alternative.

The research team pointed out that,90% of parents said they would be willing to have therapy dogs involved in their children's dental treatment, and 68% hoped to include them in their routine program.

According to previous reports from Good Teeth, a diverse toolkit for managing dental anxiety in children has been developed both domestically and internationally. This includes non-pharmacological methods such as visual distraction using dental surgical microscopes, VR virtual reality therapy, and medical weighted blankets, as well as pharmacological regimens such as intravenous sedation. The addition of AAT provides clinicians with options that offer greater emotional connection and physiological regulation, in addition to basic behavioral guidance techniques such as "tell-show-do".

It should be noted that this study was pilot-scale, and the sample size (39 individuals) was insufficient to detect small to moderate effect sizes. A randomized block design was not implemented (due to limited treatment time for the dogs, they were grouped only according to appointment date). Heterogeneity was observed in surgical procedures (sealing, filling, extraction) and anesthesia used (nitrous oxide, local anesthesia).

The research team suggests that future research could explore the long-term intervention effects of therapy dogs accompanying patients at the chair throughout the treatment process, and capture the complete curve from stress to recovery through a more refined hormone collection time window.