Does animal-assisted therapy help reduce dental anxiety?


It is known that dental anxiety is common among children and adolescents which can lead to poor attendance for dental appointments and poor oral health. Animal-assisted therapy (AAT) is a therapeutic intervention performed by health professionals in a documented way where an animal is present during the procedure to calm anxious patients. Animals used in AAT have undergone training and temperament testing to ensure the safety of the animal, the dental team, and the patient. Although AAT is already established in other areas, such as medicine and physiotherapy, there is little research for its use in dentistry.

The aim of this systematic review is to assess whether the use of animal-assisted therapy helps reduce anxiety during dental care in children and adolescents.


This review followed PRISMA guidelines, and the protocol was registered in PROSPERO database. Searches were conducted in Embase, Cochrane, PubMed/Medline, LILACS, PsycInfo, Scopus, and Web of Science. The gray literature was searched in Google Scholar, OpenGrey, and ProQuest Dissertations and Thesis. Two reviewers independently collected the data and a third reviewer helped in any cases of disagreements. Only randomised controlled trials were included and the risk of bias was assessed with the revised Cochrane risk of bias tool for randomized trials. A narrative summary was presented.


  • Three RCTs were included, involving a total of 187 children aged 5 to 11 years old.
  • Dental anxiety was defined as the primary outcome. Behaviour and pain were secondary outcomes.
  • The animal used in all studies was a dog, although the search was performed for all animal types.
  • One study used peripheral skin temperature to assess anxiety while the other two used the modified dental anxiety scale.
  • The type of dental procedure performed during the dental appointment ranged from fluoride varnish application to tooth extraction.
  • All studies were considered to be at a high risk of bias as it is impossible to blind participants to having an animal therapy dog in the room.
  • Two studies found no difference in anxiety with and without the therapy dog present. One study did report an improvement in anxiety for patients with a therapy dog present.


The present systematic review demonstrates that there was no difference in anxiety, behavior, or pain during dental treatment with or without dogs in most of the evaluated time points.


It is likely that the small sample size and lack of studies influenced the findings for this systematic review. The dental procedures performed were not standardised meaning that the differences in anxiety, pain, and behaviour cannot be attributed to the AAT alone. A child attending for fluoride varnish is likely to have a different level of dental anxiety to a child attending for a dental extraction and arguably these two situations cannot be compared.  It could also be argued that dentists will have different approaches to manage dental anxiety which could also impact anxiety scores. Further research, preferably a well-designed randomised controlled trial, involving standardised dental procedures and a power calculation to ensure adequate sample size, is required to determine the benefits of AAT in dentistry. It is known that due to its environmental impact, nitrous oxide gas will likely be phased out of pediatric dentistry as the UK moves towards reaching its sustainability goals. Animal-Assisted Therapy could be a more sustainable approach to manage and improve the dental anxiety of patients in the future, however more research is required before this can be considered.


Primary paper

Ribeiro CDPV, Alves JB, Kominami PA, Takeshita EM, Bezerra ACB, Massignan C. Does use of animal therapy during dental care help to reduce anxiety in children and adolescents? A systematic review. Int J Paediatr Dent. 2022 Oct 8. doi: 10.1111/ipd.13033. Epub ahead of print. PMID: 36208050.

Review protocol on PROSPERO

Photo credits

Photo by Jamie Street on Unsplash


Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+