Shortly before the COVID-19 pandemic hit, I wrote about dental therapy dogs and the potential benefits and risks associated with having dogs in dentists’ offices to alleviate patient stress. A pilot study (Gussgard et al, Clin Exp Dent Res 2023) has since been done looking at the impact of therapy dogs on dental patient stress, with a focus on measuring salivary cortisol in kids. Like a lot of small studies, we have to be careful not to over-interpret the results, but the study showed that the concept is worth more study:

• 16 children (median age 8.5 years) were studied.
• Kids underwent a standard dental exam twice, with or without the presence of a specially trained therapy dog.
• Kids were randomly assigned to have the exam with the dog first, or the dog-free exam first, to see whether interacting with the dog on the first visit impacted their stress at the second visit.
• The researchers took samples, including saliva samples for cortisol testing, at both visits. Saliva samples were collected in the waiting room before the procedure, then again in the waiting room after the procedure.
• A questionnaire was also administered before and after each exam.

What is a “specially trained therapy dog?“

This dog was trained to interact closely and in a structured manner with kids in a busy and high stimulus (e.g. noise, smell, activity) dental office. The dog was trained to either lay on the child’s lap or next to the child on an elevated table, so the child could see and touch the dog throughout the procedure (see pictures below).

Each child was introduced to the dog in the waiting room, then chose to either have the dog on their lap or next to them during the exam.

Parent-reported CFSS-DS (children’s fear survey schedule – dental subscale) scores and child-reported happy/sad face scores were assessed:

• Parent reported CFSS-DS scores at the second visit were lower for children that had their first exam with the dog versus those that did not (36 vs 28). The small sample size precluded statistical analysis, but the numerical difference showed promise for a potential beneficial effect of the dog.
• Child reported sad/happy face scores showed a similar outcome. Kids that had their first exam with the dog had happiness scores that were higher when they came in for the second visit

These results suggest that the kids had both a positive response during the dental exam and, importantly, that the effect carried over when they came for the next visit, as they were less anxious.

Saliva cortisol levels were also assessed as an indicator of stress:

• Contact with the dog on the first visit resulted in a greater drop in cortisol levels during the second visit, compared to kids that didn’t have the dog on the first visit (2.5 nmol/L decrease vs 0.4 nmol/L decrease).

These results were also not significantly different, so we have to be careful not to over-interpret the results; however, given the small sample size, these results suggests there are benefits that should be studied further.

Will a therapy dog be coming to a dental clinic near you?

Probably not, at least not anytime soon. A lot of work goes into training these dogs, and they need supervision during the exam, so it’s not going to be of interest to all clinics. There are also infection control concerns, but those are manageable, and we’ve previously addressed this for both the patients and the dogs.

Despite the small sample size, this study shows there is a potential benefit of therapy dogs in dental exams, which we should try to understand more. While there might not be widespread use of such therapy dogs for every appointment, it could be of particular use in certain situations, so having a dog that’s trained for a clinic for sporadic use could be feasible.