Animal-assisted therapy for fear and anxiety management during pediatric dental treatment: case reports

Animal-assisted therapy (AAT) is associated with the relief of pain, stress, and anxiety in various healthcare fields. To evaluate the usefulness of AAT to provide emotional support and assist in behavioral management of patients for routine pediatric dentistry, 2 children underwent dental treatment with and without the application of AAT after their guardians provided informed consent. The patients' stress, anxiety, and behavior in the sessions with and without AAT were compared. The patients were a 4-year-old boy and a 7-year-old girl who required rehabilitative treatment of primary teeth. During initial evaluations, basic behavioral management techniques were applied, but no significant progress in the patients' behavior was observed. Therefore, AAT with trained dogs was suggested. The first treatment sessions were conducted without the presence of animals, and AAT was implemented in the second appointments. The patients' salivary cortisol levels were measured at the beginning and end of the treatments, and the Facial Image Scale was used to assess children's anxiety. A pediatric dentist observed the children's behavior by applying the Brazilian version of the Venham Behavior Rating Scale, in which scores range from 0 for acceptable behavior (total cooperation) to 5 for unacceptable behavior, with scores 1 to 5 representing increasing degrees of protest. During AAT sessions, there was an apparent reduction in the patients' anxiety levels; salivary cortisol decreased from the beginning to end of treatment in both patients (from 1.15 to 0.95 mg/mL in the boy; from 6.05 to 0.77 mg/mL in the girl). A relative improvement in behavior was also observed. The experiences of these 2 pediatric patients suggest that AAT could help to control pain and stress as well as improve the behavior of children during dental procedures.