Was there any existing literature on this topic that you dug into before conducting your own research?
Not what we were looking at. I found no experimental or quasi-experimental research with actual measurements. I saw there was a study on patient acceptance of dogs in a pediatric dental office. It just basically found that parents are open to it. I had seen another study about dogs in use for PTSD in general for dental patients, but that was more of a personal service dog in that study.
How did you go about setting up this experiment?
It was a connection of: If we're working on access to care, let's work on it through veteran oral health. We talked to the patients ahead of time to make sure they weren’t afraid of dogs to clear it with them. We ended up with a group of 20 patients – 10 that would be with Ziggy and 10 without.
From a data-collection standpoint, we took a patient’s blood pressure and pulse – standard for a dental appointment – then throughout the appointment took a pulse every five minutes, and then at the end of the appointment took blood pressure and pulse one more time. We have those readings for both the groups – with and without Ziggy.
Ziggy was there for dental hygiene appointments?
Ziggy attended a pretty wide variety of appointments, because the research took place in the student clinic. It's the general dentistry area. Some appointments were cleanings, some general checkups, some were fillings, and some were denture fittings and denture try-ins.
What were your findings?
First result: We had a statistically significant decrease in pulse for the group that had Ziggy present from the beginning of the appointment to their pulse reading at the end of the appointment. That helps us also to say that having a dog there was helpful. Pulses will generally drop over the course of an appointment, but it dropped significantly enough that it was more than a typical drop in pulse you would see just by sitting in the chair.
Then, we compared the two groups, between the patients who had Ziggy present and the patients who didn't. We had a lower average pulse and a lower systolic blood pressure when Ziggy was present. That difference was not statistically significant, mostly because of sample size. If we wanted to get statistically significant results, we would need to replicate it with a larger sample size.
We also qualitatively noted throughout the appointments that, during the injection of local anesthesia, pulse stayed steady when the dog was there and did not when the dog was not there. Local anesthesia application is the most common time for anxiety, so that was a pretty cool finding.
Any surprises that came out of your conclusions?
Actually, I think I expected the dog being there to be helpful, especially for a patient who likes dogs.
That said, initially I didn't expect to actually find a statistically significant result, especially with this initial sample size. It was exciting during the appointments to do the data collection and see a patient’s pulse is still dropping over a two-and-a-half hour appointment with Ziggy.
Beyond the data, are there any other personal anecdotes from the research subjects involved or other folks in the clinic or from your end that were particularly noteworthy?
Overall a lot of verbalizing of, “Wow, this is actually very helpful.” Especially from those patients who initially were neutral about it – going from not really interacting with Ziggy, to hugging at the end. There was this elderly patient who told us, “Oh, this was really great. Thanks for bringing the dog. Next time, for your study, it'd be cool if you tried doing this in a really anxiety-provoking setting."
To that point: How do you see the uses of therapy dogs in dental clinics evolving going forward?
My main goal going into this was to then be able to have my results to present to our administration to say: “This is something worth doing.” Especially because so many therapy dogs are on a volunteer basis, so it costs us no money to do this. When I initially presented the study to our dean, she was super receptive to it and excited.
I graduate in a year, so I was thinking I would never even see the result of this, and I just found out that the School of Dental Medicine will be bringing in therapy dogs to the student clinics starting this June, which is really awesome.
Additionally, some other dental students have approached me and said, "Would you be OK with us doing more, increasing the sample size? Maybe doing it in the endodontics clinic?" I talked to the director of our endodontics department, because root canals are one of the most anxiety provoking appointments – it's one of our biggest no-show rate appointments. She's generally interested in having dogs incorporated into our endo clinics. If we could maybe replicate this study in the endo clinic, that serves a couple of purposes. It gives us a uniform procedure and also we're dealing with a population that is more probably predisposed to feel anxious at the time of the appointment. That would be an ideal next step.
Did anybody show up for an appointment and then express disappointment that the dog wasn't there?
Yeah, patients were definitely disappointed when there was no dog [laughs].
Our student clinics are pretty open, so the other patients that weren’t in the study could see that this patient had a therapy dog. We had several other patients ask, “Could he come to my appointment next?” And a lot of patients waited around at the end to play with him after the appointment was over.
Photo credit: Dayyan Sisson
