Could dogs help improve military dental care?

A first-of-its-kind study at Walter Reed National Military Medical Center is researching whether using facility therapy dogs in dentists’ offices could reduce patient anxiety and improve outcomes for military dental treatment programs.

The study focuses on patients requiring complex dental procedures with multiple appointments. Each appointment can be very painful and create a lot of anxiety.

Significant anxiety is relatively common for dental patients and can result in patients declining to show up for treatment, explained John Schmidt, a clinical psychologist at the Naval Postgraduate Dental School located at WRNMMC, and one of the two leads for the study along with Navy Cmdr. Doris Lam. Lam’s dental master’s thesis led to the study.

Before their dental appointment, patients involved in the study are encouraged to meet with a facility dog that provides animal-assisted therapy at WRNMMC. The dogs are highly trained to provide comfort and companionship in a clinical setting.

The hope is that having patients meet with a facility dog can “decrease the amount of pain medication needed, and increase the probability that the person will continue onto their next complex dental appointment,” said Navy Hospital Corpsman Skylor Cervantes. She is one of two leading petty officers for facility dogs at WRNMMC in Bethesda, Maryland; and is participating as a handler for dogs in the dental study.

The goal is to reduce dental problems and enhance oral health and improve dental readiness.

“This is especially problematic in our military population as poor oral health care and missing dental treatments can directly impact mission readiness and deployment status for our war fighters,” Schmidt said.

Facility therapy dogs have been part of WRNMMC patient care since 2005. All of the canines receive initial service dog training for working with veterans. Before being assigned to a medical facility, the dogs also receive additional training and are screened for temperaments that work well in a medical environment.

Reducing Anxiety

The study at the Comprehensive Dentistry Clinic assesses anxiety levels by using self-reported measures of dental anxiety and satisfaction with care, as well as any missed appointments, Schmidt explained.

“All participants also have their heart rate monitored during each study visit to determine if the interactions with the facility dogs results in reduced physiological reactivity during dental procedures,” Schmidt said. This added measure is novel for a study using facility therapy dogs to address dental anxiety.

How the Study Works

In the study, researchers evaluate patients over the course of three visits. One group of patients see the dogs 10 minutes before two of three appointments. Another group of patients does not see a dog until the third appointment.

The patients also fill out questionnaires beforehand. These questionnaires contain three modules assessing dental anxiety, phobia, fear, and feared dental stimuli. This measure also assesses emotional, behavioral, physiological, and cognitive components of the anxiety and fear response, Schmidt explained.

Meanwhile, the dog handler stays outside of the room with the dog. “Once we go in the room, I let the dog do the work,” Cervantes said. “The patient interacts with the dog. They pet them, they can do different tricks with the dog just to get their mind off of what's going on, or what's about to go on.”

Some patients like to interact with the handler to find out about the dog, and other patients like to just focus on the dog itself.

”We try to make the patient as comfortable as possible. And the dogs do a really good job with interacting with the patient and keeping focused on the patient,” Cervantes said.

Anxious Patients

Cervantes explained how having a facility dog at appointments gives patients a more positive attitude and motivates them to continue their multiple treatments.

“It gives the patient something to look forward to, especially when they're introduced to the dog, Then we try to get them in on a day where that same dog can be there again, or they can see another dog if they want,” Cervantes said.

“Because of this interaction, they know the appointment is not going to be as bad.”

Preliminary study results are quite encouraging, Schmidt said.

“The patients love interacting with the dogs and many of the patients have reported reduced dental anxiety, satisfaction with the dog intervention, and have followed through with their dental care.”

The study began in 2016, but was paused during the COVID-19 pandemic. Schmidt and Lam expect the study to be completed next year, and present their findings.