A Paw-sitive Dentist Appointment

The Impact of Providing Therapy Dogs

LEXI DUNNELLS

My transition from teaching high school math to dentistry baffles most people. As different as these two careers may seem, they certainly have one thing in common: everyone loves to tell you how much they hate you.

“You teach math!? I HATED math as a kid, it’s the worst.”

“You’re in dental school? Ugh, I HATE going to the dentist! You must like hurting people.”

A cherished advisor of mine wrote in her letter of recommendation for me for dental school: “Between teaching math and pursuing dentistry, Lexi thrives on taking the things people fear and making them enjoyable.”

If you’re still baffled about why I would move from teaching to dentistry, we should talk about the other key thing these professions have in common: they present a tangible way to improve my community. As a dental student, I am mainly concerned with access to care. I have developed a study around this question. How can I make a visit to the dentist more enjoyable, less anxietyprovoking and, as a result, maybe—if I’m lucky— increase access to care while I’m at it?

There are barriers within each system and practice modality to access and utilization of dental services. One major barrier to oral healthcare utilization is dental anxiety: the apprehension that occurs in anticipation of a dental situation.2 Many factors contribute to dental anxiety, including conditioning, cognitions (misperceptions, catastrophizing, dental beliefs), temperamental and personality characteristics, hypersensitivity to pain and social learning around dental experiences.2 When a patient experiences dental anxiety they are more likely to delay visits, then more likely to develop dental problems, and therefore more likely to only seek symptom-driven treatment, which further contributes to dental anxiety—a vicious cycle with which I’m sure you are all intimately familiar.

In order to find a way to interrupt this cycle, I developed a study to test the hypothesis that having a therapy dog chairside during the dreaded dental appointment might allow the patient to feel less anxious. There has been a recent uptick in the utilization of therapy dogs to help individuals manage anxiety as they navigate stressful situations. For example, there has been a limited number of studies on the impact of dogs on the rehabilitation of veterans with PTSD. While further research is needed, evidence from non-randomized observational studies suggests the utilization of dogs may be helpful in alleviating veterans’ PTSD symptoms and improving quality of life.6 If we could achieve a similar result in a dental setting, we could postulate that the same patient might not avoid or delay dental visits, allowing more access and utilization of preventive services and an increase in comprehensive care (as opposed to emergent care). This study was developed with the hopes of transitioning a patient to view the dentist office as more of a primary care setting—a place more associated with health and less associated with anxiety—a dream many of us likely share.

This is where Ziggy comes in. Luckily for me, I have a therapy dog for a brother. He is an absolutely gorgeous Black German Shepherd and is also insanely smart (almost eerily so). My brilliant mother has spent the last several years training Ziggy extensively and he is now a certified therapy dog. Let’s pause and quickly differentiate between a service dog and a therapy dog. A service dog is intended to serve one person; these are the dogs you’re not supposed to pet. A therapy dog, on the other hand, is trained to serve everyone in their community. You can pet, interact with, and allow these dogs to comfort you to your heart’s desire. My mom and Ziggy bring his comforting talents to a variety of settings, including nursing homes, schools and a ranch for adults with special needs. There was just one thing missing from Ziggy’s resume: dental settings.

Luckily for Ziggy, he has a dental student for a sister. After a litany of logistical arrangements with the CU School of Dental Medicine, I brought my mom and Ziggy into the student clinics and tested my hypothesis. Here’s how it worked. There were two groups of patients: the intervention group, who got to have Ziggy sit with them during their appointment, and the control group, whose appointments were business as usual. Blood pressure and pulse were chosen to measure anxiety because anxiety causes the release of stress hormones in the body and these hormones trigger an increase in heart rate and a narrowing of the blood vessels, which causes blood pressure to rise.14 For both groups, before the appointment, the patient’s blood pressure and pulse were recorded. Throughout the appointment, the patient’s pulse was taken at 5-minute intervals. At the end of the appointment, the patient’s pulse and blood pressure were taken one more time.

The patients who had a therapy dog present during their appointment had a lower post-appointment pulse (M = 64.50, SD = 13.959) compared with the control patients (M = 76.00, SD = 8.992).

Additionally, the patients who had a therapy dog present during their appointment had a lower postappointment systolic blood pressure (M = 131.50, SD = 26.667) compared with the control patients (M = 136.75, SD = 11.399).

In summary, when Ziggy was present, the patients’ pulses decreased enough over the course of the appointment to be highly statistically significant. When Ziggy was sitting with the patients, the patients' pulses even remained steady throughout the administration of local anesthetic. Patients who had Ziggy with them during their appointment also had a lower average pulse and lower average systolic blood pressure compared to the control patients.

Subsequently, a paired t-test was performed in order to determine if a statistically significant difference in pre- and post-measurements was identified. The post-appointment pulse measurements for the intervention group (therapy dog present) were significantly lower (M = 63.20, SD = 12.691) than their pre-appointment pulse measurements (M = 72.50, SD = 13.930), with p < .001.

So, if you’ve thought about bringing a dog into your office because you like dogs or because it sounds fun, now you have some evidence to back it up. You’re welcome.

About the Author

Lexi Dunnells is a student of both dental medicine and public health at CU Anschutz. She has a background in teaching high school and is currently the president of the American Academy of Public Health Dentistry CU student chapter. As a future dentist, she is “determined to make an impact in promoting oral health equity and addressing the disparities in access to oral healthcare.”

References

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6. Stumbo, S. P., & Yarborough, B. J. (2019). Preliminary evidence is promising, but challenges remain in providing service dogs to veterans: Commentary on preliminary efficacy of service dogs as a complementary treatment for posttraumatic stress disorder in military members and veterans (O’Haire & Rodriguez, 2018). Journal of Consulting and Clinical Psychology, 87(1), 118–121. https://doi. org/10.1037/ccp0000352

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12. Nieto, V., Arnett, M., & Furgeson, D. (2019). Attitudes and Access Patterns of Michigan Veterans Ineligible for Oral Healthcare Benefits: A cross-sectional study . The Journal of Dental Hygiene, 93(4), 6–13.

13. Corah, N. L., Gale, E. N., Illig, S. J. (1939). Assessment of a dental anxiety scale. Journal of the American Dental Association, 97(5). https://doi.org/10.14219/jada. archive.1978.0394

14. https://ibcces.org/learning/what-is-the-link-between-anxiety-and-high-bloodpressure/#:~:text=Anxiety%20causes%20the%20release%20of,pressure%20to%20 rise%2C%20sometimes%20dramatically.