Does use of animal therapy during dental care help to reduce anxiety in children and adolescents? A systematic review

Background: Animal-assisted therapy (AAT) is considered a useful technique to reduce anxiety in children and adolescents in medical settings.

Aim: To investigate whether the use of AAT helps to reduce anxiety during dental care in children and adolescents.

Design: Systematic review that included randomized and nonrandomized clinical trials with children up to 18-years of age undergoing dental appointments. The databases Embase, Cochrane, Pubmed/Medline, LILACS, PsycInfo, Scopus, and Web of Science were searched including gray literature. Random-effects meta-analyses using mean difference (MD) and narrative synthesis (vote counting) were implemented. Risk of bias was assessed using RoB2 for randomized clinical trials. The certainty of the evidence was performed using GRADE.

Results: A total of 1103 references were identified, and after a two-phase selection, three studies were included. Anxiety, behavior, and pain were the outcomes. A meta-analysis with 146 participants was performed for anxiety at three time points: before treatment (MD -0.40, CI: -1.06 to 0.26; I² = 0%; p = .24), during treatment (MD -3.64, CI: -11.18 to 3.91; I² = 94%; p = .34), and after treatment (MD -5.97, CI: -17.08 to 5.14; I² = 98% p = .29). There was no difference during dental treatment with or without ATT (dogs), as well as for narrative analysis for any outcome. The risk of bias was high mainly because of the randomization and outcome measurement.

Conclusion: There is no evidence to support or refute that the presence of AAT during dental care can help reduce anxiety in children (5-11 years). Studies with larger samples are suggested. Protocol registration (CRD42021293593).