Dog-assisted therapy in the dental clinic: Part A-Hazards and assessment of potential risks to the health and safety of humans

Evidence-based analysis of multi-pronged approaches for education and behavior management of autistic patients in a dental setting

BACKGROUND

Autism spectrum disorder is a neurodevelopmental condition which has posed a challenge to carers, pediatricians and dentists through the years. Over the last four decades, the disorder has been better understood and management techniques have evolved. In the field of dentistry, the autistic child presents difficulty in management, even for the simplest dental procedures. A comprehensive understanding of other psychoeducational and behavioral approaches to manage autism is very important. This article aims to introduce various important key techniques such as Applied Behavior Analysis, TEACCH, Sensory Adapted Dental Environment, Picture Exchange Communication System, and Animal Assisted Therapy and analyze their application in dentistry.

METHODS

A search of literature was carried out in Clinicaltrials.gov, Medline and Scopus with the search terms "Applied Behavior Analysis," "TEACCH," "Sensory Adapted Dental Environment," "Picture Exchange Communication System," and "Animal Assisted Therapy" along with "autism OR autistic," "dental OR dentistry OR oral health." After the screening for inclusion and exclusion criteria, 10 eligible articles were included, in English, published within the last 10 years.

RESULTS

Limited research was available regarding these lesser-known behavioral approaches in dentistry. The few that were available showed encouraging results. The different techniques proved useful in increasing acceptance of dental treatment and reducing behavioral disturbances. The patients experienced reduced dental anxiety, lesser discomfort, improved communication, and knowledge.

CONCLUSION

Pediatric and special care dentists are likely to benefit by incorporating the recommended comprehensive behavior management techniques in their practice. There is evidence that these techniques will reduce behavioral disturbances in autistic children thereby making primary dental care possible without the need for sedation or general anesthesia.

Intraoral clinical examinations of pediatric patients with anticipatory anxiety and situational fear facilitated by therapy dog assistance: A pilot RCT

OBJECTIVE

To evaluate whether the presence of a certified therapy dog specially trained for working in a dental setting may facilitate dental care of anxious pediatric patients.

METHODS

The Norwegian Regional Committee for Medical and Health Research Ethics approved a randomized cross-over trial with a study sample of n = 16 children aged between 6 and 12 years. The trial was registered on clinicaltrials.gov. Pediatric patients referred to specialist care at the Public Dental Service Competence Center of Northern Norway (TkNN) because of anxiety were invited to partake in the trial. Study participants met twice for an intraoral examination by a specialist pediatric dentist. Per random allocation, a therapy dog team was present in the clinic operatory during the clinical examination on the first or the second visit. The primary outcome was the assessment of patient compliance during the intraoral examination (yes/no). Secondary outcomes were measurements of child satisfaction and anxiety using the CFSS-DS scale (Dental subscale of Children's Fear Survey Schedule) completed by a parent/guardian. Supplementary outcomes were salivary cortisol level, heart rate variability, and skin conductance.

RESULTS

Ten boys and six girls (mean age 8.5) were recruited. All completed both clinical visits and demonstrated full compliance while undergoing a dental examination. All study participants and guardians reported great satisfaction. The salivary cortisol level reduction during the clinical examination on the first visit decreased by 30% in the presence of the therapy dog and 20% without, while the decrease during the clinical examination on the second visit was 29% in the presence of the therapy dog and 3% without. Within the limitations of the experimental setup, the electrophysiological measurements were unreliable in the current study population.

CONCLUSION

Dog-assisted therapy in a dental care setting appears to have a positive effect on children with dental anxiety or children that avoid dental care.

Patient and Caregiver Perceptions of Animal Assisted Activity in Orthodontics

Simple Summary

Dental anxiety impacts a significant fraction of children and adults, leading to lifelong avoidance of the dentist and increased emergency dental care. Animal-assisted activity (AAA) is widely used in medicine to reduce anxiety and pain, with promise in dentistry. However, dentistry has been slow to adopt AAA, with a state dental board banning therapy animals in dental clinics due to patient concerns over dog safety, allergies, and cleanliness. Our goal was to determine how orthodontic patients and their caregivers viewed canine therapists in dental clinics to see whether AAA would be welcomed by most families. (No dog therapy occurred as part of this study, so the efficacy of AAA for dental anxiety management was not evaluated). Orthodontic patients and parents/caregivers were asked to fill out a survey about their dental anxiety and their desire for and concerns regarding therapy animals in dental clinics. More than a third of patients had moderate or greater anxiety related to dental care. A vast majority of participants believed that therapy dogs would make dental experiences more enjoyable and reduce fear, with a small minority raising concerns about cleanliness, allergies, and safety. Among patients and caregivers, there is broad acceptance and desire for AAA in dental and orthodontic settings. Future research should be aimed at determining how AAA can improve the experiences of dental patients.

Abstract

Dental anxiety affects up to 21% of children and 80% of adults and is associated with lifelong dental avoidance. Animal assisted activity (AAA) is widely used to reduce anxiety and pain in medical settings and has promise in dentistry. The primary objective of this study was to evaluate caregiver and patient perceptions of canine AAA in orthodontics. A cross-sectional survey consisting of pre-tested and validated questions was conducted (n = 800) including orthodontic patients (n = 352 minors, n = 204 adults) and parents/caregivers (n = 244) attending university orthodontic clinics. In this study, AAA and dog therapy were not used or tested for dental anxiety management. More than a third of orthodontic patients (37%) had moderate or greater anxiety related to care. Participants believed that therapy animals would make dental experiences more enjoyable (75%) and reduce anxiety (82%). There was little to no concern expressed regarding cleanliness (83%), allergies (81%), and safety (89%) with a therapy animal in dental settings. Almost half of the participants would preferentially select an orthodontic office offering AAA. In light of the COVID-19 pandemic, we assessed whether perceptions of AAA changed before and after the shutdown of dental offices, with no significant differences. Across patients and caregivers, the responses support the use of AAA in orthodontic settings with minimal concerns.

Canine-Assisted Interventions and the Relevance of Welfare Assessments for Human Health, and Transmission of Zoonosis: A Literature Review

CAIs (canine-assisted interventions) include "canine-assisted therapy" in which a therapist sets client-oriented goals, 'canine-assisted activities' with recreational goals for clients, and 'canine-assisted education/learning' in which teachers or coaches create learning goals for students or clients. CAIs vary in nearly every way; their only common trait is the involvement of dogs to respond to human need. However, the benefits of involving dogs are highly dependent on the animal's health and behavior. A dog exhibiting negative behavior or an unwell dog might pose a risk, especially for CAI target groups, specifically individuals with immunosuppression, chronic illness, children, elderly, etc. Therefore, positive animal welfare as preventative medicine to avoid incidents or transmission of zoonosis is an attractive hypothesis, with implications for human and animal, health and well-being. This review aims to summarize the current published knowledge regarding different aspects of welfare in CAIs and to discuss their relevance in the light of health and safety in CAI participants. As method for this study, a literature search was conducted (2001-2022) using the Prisma method, describing issues of dog welfare as defined in the Welfare Quality® approach. This welfare assessment tool includes 4 categories related to behavior, health, management, and environment; it was, therefore, applicable to CAIs. Results indicate that dogs working in CAIs are required to cope with diverse variables that can jeopardize their welfare. In conclusion, we propose regular welfare assessments for dogs in CAIs, which would also protect the quality of the CAI sessions and the clients' safety and well-being.

Improving oral health care accessibility for homeless and vulnerably housed pet-owning populations

Individuals experiencing homelessness face unique barriers to oral health care. In collaboration with local universities in Ottawa, Canada, research was conducted to explore the experiences of Community Veterinary Outreach (CVO) clients in accessing oral health care. CVO utilizes a One Health approach, providing preventive veterinary care alongside human health care services to promote health service uptake among pet owners experiencing homelessness. Based on the results of 4 research projects, this short communication proposes recommendations for promoting accessible oral health care and increasing service uptake at One Health clinics by CVO clients experiencing homelessness. Relevant themes leading to the recommendations were 1) barriers to care, including financial and individual circumstances, and discrimination by service providers; and 2) facilitators of care, including the presence of pets, compassionate care, and care received in community settings. Recommendations to improve accessibility of oral health services for CVO clients are 1) continuation of pet-friendly services; 2) delivery of oral health care in alternative settings; and 3) reduction of discrimination through continuing education for oral health professionals. It is hypothesized that the implementation of these recommendations will improve oral health care service accessibility and uptake among clients at CVO clinics and in the community.

Assessment of dental anxiety in children between 5 and 10 years of age in the presence of a therapy dog: a randomized controlled clinical study

PURPOSE

Children are often afraid to visit a dentist. Dental anxiety is a worldwide issue and a barrier to successful treatment outcome. Pet therapy, especially through dogs, has been demonstrated to be beneficial in reducing anxiety. In today's generation, where dopamine is prevalent, attention is hijacked, and children are tethered to screens-this research on animal-assisted therapy outlines the impact on children undergoing simple dental procedures, and to evaluate its use in long-term behavior management, and child and parental acceptance of this technique.

METHODS

One hundred and two children between five and 10 years of age and requiring simple dental procedures were selected randomly and divided into two groups. In Group A, dental treatment was carried out in the presence of a therapy dog, and in Group B (the control group), dental treatment was carried out in a regular dental setup. Anxiety levels were evaluated by pulse rate and anxiety rating scale. Prior to exiting the room, the parents were asked to rate the child's interaction with therapy dogs.

RESULTS

According to an independent t test, reduction in anxiety was highly significant (p < 0.001).

CONCLUSION

Animal-assisted therapy is an effective behavior management strategy.