Skip to main content

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



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.


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.


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


Animal-assisted therapy is an effective behavior management strategy.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  • Aka W, Jedrychowski JR. Intraoperative and postoperative physiological monitoring practices by pediatric dentists. J Clin Pediatr Dent. 1995;19(2):91.

    PubMed  Google Scholar 

  • Ammann P, Kolb A, Lussi A, Seemann R. Influence of rubber dam on objective and subjective parameters of stress during dental treatment of children and adolescents–a randomized controlled clinical pilot study. Int J Pediatr Dent. 2013;23(2):110–5.

    Article  Google Scholar 

  • Barker SB, Knisely JS, McCain NL, Best AM. Measuring stress and immune response in healthcare professionals following interaction with a therapy dog: a pilot study. Psychol Rep. 2005;96(3):713–29.

    Article  Google Scholar 

  • Brickel CM. Pet-facilitated psychotherapy: a theoretical explanation via attention shifts. Psychol Rep. 1982;50(1):71–4.

    Article  Google Scholar 

  • Busato P, Garbín RR, Santos CN, Paranhos LR, Rigo L. Influence of maternal anxiety on child anxiety during dental care: cross-sectional study. São Paulo Med J. 2017;135(2):116–22.

    Article  Google Scholar 

  • Calcaterra V, Veggiotti P, Palestrini C, De Giorgis V, et al. Post-operative benefits of animal-assisted therapy in pediatric surgery: a randomised study. PLoS ONE. 2015;10(6):e0125813.

    Article  Google Scholar 

  • Casamassimo PS, Fields HW, McTigue DJ, Nowak AJ. Paediatric dentistry—Infancy through Adolescence. 5th ed. Philadelphia: Elsevier; 2013. p. 252.

    Google Scholar 

  • Caprilli S, Messeri A. Animal-assisted activity at A Meyer Children’s Hospital: a pilot study. Evidence-based Complemen Alt Med. 2006;3(3):379–83.

    Article  Google Scholar 

  • Chikkala J, Chandrabhatla SK, Vanga NR. Variation in levels of anxiety to dental treatment among nonorphan and orphan children living under different systems. J Nat Sci Biol Med. 2015;6(Suppl 1):S13.

    Article  Google Scholar 

  • Coren S. How therapy dogs almost never came to exist. Psychol Today 2013.

  • Eggiman J. Cognitive-behavioral therapy: a case report. Animal-Assisted Therapy, 2006. Available at

  • Ernst L. Animal-assisted therapy: an exploration of its history, healing benefits, and how skilled nursing facilities can set up programs. 2015; 10.

  • Erten H, Akarslan ZZ, Bodrumlu E. Dental fear and anxiety levels of patients attending a dental clinic. Quintessence Int. 2006;37:304–10.

    PubMed  Google Scholar 

  • Goettems ML, Ardenghi TM, Demarco FF, Romano AR, Torriani DD. Children’s use of dental services: influence of maternal dental anxiety, attendance pattern, and perception of children’s quality of life. Commun Dent Oral Epidemiol. 2012;40(5):451–8.

    Article  Google Scholar 

  • Gussgard AM, Weese JS, Hensten A, Jokstad A. Dog-assisted therapy in the dental clinic: part A—Hazards and assessment of potential risks to the health and safety of humans. Clin Exp Dent Res. 2019a;5(6):692–700.

    Article  Google Scholar 

  • Gussgard AM, Weese JS, Hensten A, Jokstad A. 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. Clin Exp Dent Res. 2019b;5(6):701–11.

    Article  Google Scholar 

  • Havener L, Gentes L, Thaler B, Megel M, et al. The effects of a companion animal on distress in children undergoing dental procedures. Issues Comprehens Pediatr Nurs. 2001;24(2):137–52.

    Article  Google Scholar 

  • Jafarzadeh M, Arman S, Pour FF. Effect of aromatherapy with orange essential oil on salivary cortisol and pulse rate in children during dental treatment: a randomized controlled clinical trial. Adv Biomed Res. 2013;2:10.

    Article  Google Scholar 

  • Jegatheesan B, Beetz A, Choi G, Dudzig C, Fine A, Garcia RM, Johnson R, Ormerod E, Winkle M, Yamazaki K. IAHAIO WHITE PAPER the IAHAIO definitions for animal assisted intervention and animal assisted activity and guidelines for wellness of animals involved task force. Final Report. 2013.

  • Jimeno FG, Bielsa SY, Fernández CC, Rodríguez AL, Bellido MM. Objective and subjective measures for assessing anxiety in paediatric dental patients. Eur J Paediatr Dent. 2011;12:239–44.

    Google Scholar 

  • Kazdin AE. Establishing the effectiveness of animal-assisted therapies: methodological standards, issues, and strategies. How animals affect us: examining the influence of human-animal interaction on child development and human health. 2011:35-51.

  • King C, Watters J, Mungre S. Effect of a time-out session with working animal-assisted therapy dogs. J Veterinary Behav Clin Appl Res. 2011;6(4):232–8.

    Article  Google Scholar 

  • Kruger KA, Trachtenberg SW, Serpell JA. Can animals help humans heal? Animal assisted interventions in adolescent mental health. Center for the Interaction of Animals and Society (CIAS) and University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, USA; 2004.

  • Levinson B. Pet-oriented child psychotherapy. Springfield: Charles C. Thomas; 1969.

    Google Scholar 

  • Marcus DA, Bernstein CD, Constantin JM, Kunkel FA, et al. Animal-assisted therapy at an outpatient pain management clinic. Pain Med. 2012;13(1):45–57.

    Article  Google Scholar 

  • Marwah N, Prabhakar AR, Raju OS. Music distraction—its efficacy in management of anxious pediatric dental patients. J Indian Soc Pedo Prev Dent. 2005;23(4):168–70.

    Article  Google Scholar 

  • Murphy MG, Fields HW, Machen JB. Parental acceptance of pediatric dentistry behavior management techniques. Pediatr Dent. 1984;6(4):193.

    PubMed  Google Scholar 

  • Murthy R, Bearman G, Brown S, Bryant K, et al. Animals in healthcare facilities: recommendations to minimize potential risks. Infect Control Hosp Epidemiol. 2015;36(5):495–516.

    Article  Google Scholar 

  • Odendaal JS. Animal-assisted therapy—magic or medicine? J Psychosomatic Res. 2000;49(4):275–80.

    Article  Google Scholar 

  • Palestrini C, Calcaterra V, Cannas S, Talamonti Z, et al. Stress level evaluation in a dog during animal-assisted therapy in pediatric surgery. J Vet Behav. 2017;17:44–9.

    Article  Google Scholar 

  • Peretz B. Relaxation and hypnosis in pediatric dental patients. J Clin Pediatr Dent. 1996;20(3):205–7.

    PubMed  Google Scholar 

  • Ram D, Shapira J, Holan G, Magora F, et al. Audiovisual video eyeglass distraction during dental treatment in children. Quintessence Int. 2010;41(8):673–9.

    PubMed  Google Scholar 

  • Shiloh S, Sorek G, Terkel J. Reduction of state-anxiety by petting animals in a controlled laboratory experiment. Anxiety Stress Coping. 2003;16(4):387–95.

    Article  Google Scholar 

  • Shindova M, Belcheva A. The effect of parental presence on the dental anxiety during clinical examination in children aged 6-12 years. J Int Med Assoc Bulgaria. 2013;19(4):435–8.

    Google Scholar 

  • Smith PG, Morrow RH, Ross DA. Field trials of health interventions a toolbox. Oxford: OUP; 2015. p. 25.

    Google Scholar 

  • Tsai CC, Friedmann E, Thomas SA. The effect of animal-assisted therapy on stress responses in hospitalized children. Anthrozoös. 2010;23(3):245–58.

    Article  Google Scholar 

  • Urbanski BL, Lazenby M. Distress among hospitalized pediatric cancer patients modified by pet-therapy intervention to improve quality of life. J Pediatr Oncol Nurs. 2012;29(5):272–82.

    Article  Google Scholar 

  • Valentí Soler M, Agüera-Ortiz L, Olazarán Rodríguez J, Mendoza Rebolledo C, et al. Social robots in advanced dementia. Front Aging Neurosci. 2015;7:133.

    Article  Google Scholar 

  • Viswanath D, Kumar M, Prabhuji ML. Dental anxiety, fear and phobia in children. Int J Dent Res Dev. 2014;4(1):1–4.

    Google Scholar 

  • Wilkins W. Desensitization: social and cognitive factors underlying the effectiveness of Wolpe’s procedure. Psychol Bull. 1971;76:311–7.

    Article  Google Scholar 

  • Wilson S. Pharmacological management of the pediatric dental patient. Pediatr Dent. 2004;26(2):131–6.

    PubMed  Google Scholar 

  • Yasemin M, Kasımoğlu Y, Kocaaydın S, Karslı E, İnce EB, İnce G. Management of dental anxiety in children using robots. InSignal Processing and Communication Application Conference (SIU), 2016; pp 237–240.

Download references


We thank the therapy dogs, Pearl and Pepe, and the Animal Angels Foundation for providing us with therapy dogs for our research.

Author information

Authors and Affiliations


Corresponding author

Correspondence to T. K. Thakkar.

Ethics declarations

Conflict of interest

Disclosure of potential conflicts of interest: The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

:This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional ethics committee of Dr. D. Y Patil medical college (FRC/2018/Pedo./01).

Informed consent

An informed consent was obtained from all the participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Thakkar, T.K., Naik, S.N. & Dixit, U.B. 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. Eur Arch Paediatr Dent 22, 459–467 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Animal-assisted therapy
  • Behavior
  • Pet therapy
  • Dental anxiety
  • Dental phobia