Article Data

  • Views 2478
  • Dowloads 506

Original Research

Open Access

Dog-assisted therapy for control of anxiety in pediatric dentistry

  • Sérgio Luiz Pinheiro1,*,
  • Camila Silva2
  • Lidiane Luiz2
  • Nubia Silva2
  • Rafaela Fonseca2
  • Thaís Velásquez2
  • Diana Roberta Grandizoli3

1Center for Life Sciences, Postgraduate Program in Health Sciences, Pontifícia Universidade Católica de Campinas (PUC-Campinas), 13034-685 Campinas, SP, Brazil

2Department of Pediatric Dentistry, PUC-Campinas, 13034-685 Campinas, SP, Brazil

3Center for Life Sciences, Postgraduate Program in Health Sciences, PUC-Campinas, 13034-685 Campinas, SP, Brazil

DOI: 10.22514/jocpd.2023.080 Vol.47,Issue 6,November 2023 pp.38-43

Submitted: 14 February 2023 Accepted: 12 April 2023

Published: 03 November 2023

*Corresponding Author(s): Sérgio Luiz Pinheiro E-mail:


Anxiety is common in pediatric dental care, and affects the behavioral management of children. Animal-assisted therapy (AAT) has been shown to improve children’s behavior. However, few studies have applied this technique in dentistry. The aim of the present study was to evaluate the applicability of dog-assisted therapy to control anxiety during pediatric dental treatment. Twenty children were selected from the Pediatric Dentistry Clinic of the Pontifical Catholic University of Campinas (PUC-Campinas), Brazil. Participants were divided into two groups: Control (n = 11; visits = 16), in which children were conditioned by methods routinely used in the clinic; and AAT (n = 9; visits = 23), in which children had contact with a dog therapist first at the reception desk and then again inside the office. The dog therapist stayed beside the dental chair with the child throughout the procedures. Corah’s Dental Anxiety Scale (CS) and heart rate (HR) were used for evaluation of child anxiety. The results were tested for normality of distribution with the Shapiro-Wilk method, and subsequently analyzed in BioEstat 5.0. HR results were compared by Analysis of Variance (ANOVA) with Tukey’s test, and CS scores, with the Wilcoxon test. There was a significant reduction in HR in the AAT group (p = 0.0069). In the Control group, HR did not change before, during, or after treatment (p = 0.6052). Controls showed a significant increase in anxiety measured by CS before and after treatment (p = 0.0455). In the AAT group, there was no change in CS scores before and after treatment (p = 0.3739). AAT could be an alternative to reduce anxiety during pediatric dental care.


Anxiety; Pediatric dentistry; Animal assisted therapy; Dogs

Cite and Share

Sérgio Luiz Pinheiro,Camila Silva,Lidiane Luiz,Nubia Silva,Rafaela Fonseca,Thaís Velásquez,Diana Roberta Grandizoli. Dog-assisted therapy for control of anxiety in pediatric dentistry. Journal of Clinical Pediatric Dentistry. 2023. 47(6);38-43.


[1] MILLER J, CONNOR K. Going to the dogs… for help. Nursing. 2000; 30: 65–67.

[2] Wohlfarth R, Mutschler B, Beetz A, Kreuser F, Korsten-Reck U. Dogs motivate obese children for physical activity: key elements of a motivational theory of animal-assisted interventions. Frontiers in Psychology. 2013; 4: 796.

[3] Kamioka H, Okada S, Tsutani K, Park H, Okuizumi H, Handa S, et al. Effectiveness of animal-assisted therapy: a systematic review of randomized controlled trials. Complementary Therapies in Medicine. 2014; 22: 371–390.

[4] Martin F, Farnum J. Animal-assisted therapy for children with pervasive developmental disorders. Western Journal of Nursing Research. 2002; 24: 657–670.

[5] Braun C, Stangler T, Narveson J, Pettingell S. Animal-assisted therapy as a pain relief intervention for children. Complementary Therapies in Clinical Practice. 2009; 15: 105–109.

[6] Beetz A, Julius H, Turner D, Kotrschal K. Effects of social support by a dog on stress modulation in male children with insecure attachment. Frontiers in Psychology. 2012; 3: 352.

[7] Beetz A, Uvnas-Moberg K, Julius H, Kotrschal K. Psychosocial and psychophysiological effects of human-animal interactions: the possible role of oxytocin. Frontiers in Psychology. 2012; 3: 234.

[8] O’Haire ME. Animal-assisted intervention for autism spectrum disorder: a systematic literature review. Journal of Autism and Developmental Disorders. 2013; 43: 1606–1622.

[9] Berry A, Borgi M, Francia N, Alleva E, Cirulli F. Use of assistance and therapy dogs for children with autism spectrum disorders: a critical review of the current evidence. The Journal of Alternative and Complementary Medicine. 2013; 19: 73–80.

[10] Lundberg A, Srinivasan M. Effect of the presence of an aquarium in the waiting area on the stress, anxiety and mood of adult dental patients: a controlled clinical trial. PLOS ONE. 2021; 16: e0258118.

[11] Pruskowski KA, Gurney JM, Cancio LC. Impact of the implementation of a therapy dog program on burn center patients and staff. Burns. 2020; 46: 293–297.

[12] Prado CMCS, Pinheiro SL. Physical therapy with toys and dog-assisted therapy in infants: observational study. Physiotherapy and Research. 2022; 29: 189–195.

[13] KLINGBERG G, BROBERG AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. International Journal of Paediatric Dentistry. 2007; 17: 391–406.

[14] McGrath C, Bedi R. The association between dental anxiety and oral health-related quality of life in Britain. Community Dentistry and Oral Epidemiology. 2004; 32: 67–72.

[15] Behavior guidance for the pediatric dental patient. Pediatric Dentistry. 2018; 40: 254–267.

[16] Cote CJ, Wilson S; AMERICAN ACADEMY OF PEDIATRICS; AMERICAN ACADEMY OF PEDIATRIC DENTISTRY. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics. 2019; 143: e20191000.

[17] Corah NL. Development of a dental anxiety scale. Journal of Dental Research. 1969; 48: 596.

[18] Balasubramaniyan N, Rayapati DK, Puttiah RH, Tavane P, Singh SE, Rangan V, et al. Evaluation of anxiety induced cardiovascular response in known hypertensive patients undergoing exodontia—a prospective study. Journal of Clinical and Diagnostic Research. 2016; 10: ZC123–127.

[19] De Carvalho RW, Falcao PG, Campos GJ, Bastos Ade S, Pereira JC, Pereira MA, et al. Anxiety regarding dental treatment: prevalence and predictors among Brazilians. Ciência & Saúde Coletiva. 2012; 17: 1915–1922. (In Portuguese)

[20] Pop-Jordanova N, Sarakinova O, Pop-Stefanova-Trposka M, Zabokova-Bilbilova E, Kostadinovska E. Anxiety, stress and coping patterns in children in dental settings. Open Access Macedonian Journal of Medical Sciences. 2018; 6: 692–697.

[21] Tshiswaka SK, Pinheiro SL. Effect of music on reducing anxiety in children during dental treatment. Gaúcha Journal of Dentistry. 2020; 68: e20200033.

[22] Rangel CRG, Pinheiro SL. Laser acupuncture and intravascular laser irradiation of blood for management of pediatric dental anxiety. Journal of Oral Science. 2021;63: 355-357.

[23] Dahlander A, Soares F, Grindefjord M, Dahllof G. Factors associated with dental fear and anxiety in children aged 7 to 9 years. Dentistry Journal. 2019; 7: 68.

[24] Wu L, Gao X. Children’s dental fear and anxiety: exploring family related factors. BMC Oral Health. 2018; 18: 100.

[25] Cruz-Fierro N, Vanegas-Farfano M, Gonzalez-Ramirez MT. Dog-assisted therapy and dental anxiety: a pilot study. Animals. 2019; 9: 512.

[26] Cass K, Bocklage C, Sulkowski T, Graves C, Ghaltakhchyan N, Rapolla A, et al. Patient and caregiver perceptions of animal assisted activity in orthodontics. Animals. 2022; 12: 1862.

[27] Calcaterra V, Veggiotti P, Palestrini C, De Giorgis V, Raschetti R, Tumminelli M, et al. Post-operative benefits of animal-assisted therapy in pediatric surgery: a randomised study. PLOS ONE. 2015; 10: e0125813.

[28] Hajar R. Animal-assisted therapy. Heart Views. 2015; 16: 70.

[29] Sobo EJ, Eng B, Kassity-Krich N. Canine visitation (pet) therapy. Journal of Holistic Nursing. 2006; 24: 51–57.

[30] Silva NB, Osorio FL. Impact of an animal-assisted therapy programme on physiological and psychosocial variables of paediatric oncology patients. PLOS ONE. 2018; 13: e0194731.

[31] Thakkar TK, Naik SN, Dixit UB. 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. European Archives of Paediatric Dentistry. 2021; 22: 459–467.

[32] Lundqvist M, Carlsson P, Sjödahl R, Theodorsson E, Levin L. Patient benefit of dog-assisted interventions in health care: a systematic review. BMC Complementary and Alternative Medicine. 2017; 17: 358.

[33] McCullough A, Ruehrdanz A, Jenkins MA, Gilmer MJ, Olson J, Pawar A, et al. Measuring the effects of an animal-assisted intervention for pediatric oncology patients and their parents: a multisite randomized controlled trial [formula: see text]. Journal of Pediatric Oncology Nursing. 2018; 35: 159–177.

[34] Moreira RL, Gubert FD, Sabino LM, Benevides JL, Tome MA, Martins MC, et al. Assisted therapy with dogs in pediatric oncology: relatives’ and nurses’ perceptions. Brazilian Journal of Nursing. 2016; 69: 1188–1194.

[35] 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. International Journal of Paediatric Dentistry. 2023; 33: 181–195.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Scopus: CiteScore 2.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Submission Turnaround Time