Parents' acceptance and their children's choice of pet for animal-assisted therapy (A.A.T.) in 3- to 12-year-old children in the dental operatory -A questionnaire-based pilot study

Does use of animal therapy during dental care help to reduce anxiety in children and adolescents? A systematic review

BACKGROUND

Animal-assisted therapy (AAT) is considered a useful technique to reduce anxiety in children and adolescents in medical settings.

AIM

To investigate whether the use of AAT helps to reduce anxiety during dental care in children and adolescents.

DESIGN

Systematic review that included randomized and nonrandomized clinical trials with children up to 18-years of age undergoing dental appointments. The databases Embase, Cochrane, Pubmed/Medline, LILACS, PsycInfo, Scopus, and Web of Science were searched including gray literature. Random-effects meta-analyses using mean difference (MD) and narrative synthesis (vote counting) were implemented. Risk of bias was assessed using RoB2 for randomized clinical trials. The certainty of the evidence was performed using GRADE.

RESULTS

A total of 1103 references were identified, and after a two-phase selection, three studies were included. Anxiety, behavior, and pain were the outcomes. A meta-analysis with 146 participants was performed for anxiety at three time points: before treatment (MD -0.40, CI: -1.06 to 0.26; I²  = 0%; p = .24), during treatment (MD -3.64, CI: -11.18 to 3.91; I²  = 94%; p = .34), and after treatment (MD -5.97, CI: -17.08 to 5.14; I²  = 98% p = .29). There was no difference during dental treatment with or without ATT (dogs), as well as for narrative analysis for any outcome. The risk of bias was high mainly because of the randomization and outcome measurement.

CONCLUSION

There is no evidence to support or refute that the presence of AAT during dental care can help reduce anxiety in children (5-11 years). Studies with larger samples are suggested. Protocol registration (CRD42021293593).

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.

A Reflection on the Current Status of Animal-Assisted Therapy in India

The field of animal-assisted therapy is advancing quickly throughout the world gaining popularity as a complementary therapy. Several countries, especially in the East, are still in their nascent phase in utilizing animal-assisted therapy and a more realistic presentation of their status should drive them towards effective initiatives to promote the field. The primary objective of this paper is to throw light on the current scenario of animal-assisted therapy in India. The relevant databases such as Scopus, Google Scholar, Proquest, PubMed, and JSTOR were searched to identify the research literature. The organizational websites, news, and blog articles, as well as institutional repositories, were explored to maximize the evidence. A total of 24 articles were found which included published research articles as well as unpublished conference papers. Results found a dearth of practice and research throughout the country indicating an urgent need to direct steps in promoting the growth of the field. The contemporary issues in the implementation of animal-assisted therapy such as cultural and religious beliefs, lack of awareness, lack of practising organizations and therapists warrant immediate attention. Reducing the research and practice gap alongside focusing on creating awareness, changing public perception, introducing coursework in educational institutions, the publication of evidence-based research will help in the acceptance and growth of this novel therapeutic field.

Dog-assisted therapy in the dental clinic. Part B. Hazards and assessment of potential risks to the health and safety of the dental therapy dog

Background

A dental therapy dog may help anxious patients in the dental clinic overcome their fear and facilitate the completion of necessary dental care. Dental clinic activities are associated with hazards that may pose potential risks to the health and safety of the dental therapy dog.

Objectives

To describe potential hazards associated with risks to health and safety to therapy dogs in dental clinics and to present suggestions for risk minimisation by adopting best practices in dental clinic settings.

Materials and method

Literature searches in Medline, http://Clinicaltrials.gov, and Google Scholar for qualitative and quantitative assessments of occupational hazards and risks in dental clinics, in combination with a review of the reference list of the included studies. Identified hazards and risks were analysed relative to their relevance for the health and welfare of a therapy dog present in a dental clinic setting.

Results

Workplace hazards in the dental clinic that apply to both humans and therapy dogs are allergies, sharps injury, eye injury, stress, rhinitis, hearing impairment, and other hazards. Additional concerns associated with risks for the dental therapy dog are situations involving erratic patient behaviour and threats if the patient is an undisclosed disease carrier. Risks to the health and safety of the dental therapy dog in the clinics are present but are low if the dental clinical staff and dog handlers comply with best practices.

Conclusions

Best practice includes awareness amongst the clinic staff and the dog handler of all potential hazards in the dental clinic and on how to reduce these hazards as well as adverse events that may scare the dental therapy dog. The dental therapy dog team must be specially trained to work in a dental clinic. Each treatment session has to be exclusively tailored to that specific appointment and the individual patient.