ABSTRACT. Dental anxiety (DA) affects a striking 50-80% of adults and 6-22% of children. Individuals affected by DA often exhibit disruptive behavior and avoidance of dental care, leading to major adverse health outcomes, including increased rates of decay, pain, extractions, infections, emergent care and even hospitalization. DA frequently develops in childhood due to traumatic experiences and can lead to lifelong DA. Behavioral management techniques aimed at improving dental experiences must be employed during childhood to avoid these sequelae. For patients with severe anxiety and decay, pharmacological interventions may be used. However, sedatives and general anesthesia are frequently met with caregiver objections, as they carry low risks for adverse events, including neurological injury and death. Animal-Assisted Therapy (AAT) with a trained therapy dog has been used widely as a non-pharmacologic behavior guidance approach in numerous medical settings. Though in its nascent stages in dentistry, the novel use of AAT in a pediatric population holds promise for behavior management, reducing anxiety, mitigating pain, and creating positive associations. Furthermore, our data from 800 patients and parents confirm a pervasive desire for canine AAT in dentistry. The objective of this study is to evaluate whether AAT alleviates stress and improves perceptions during pediatric dental care. We hypothesize that AAT significantly alleviates biometric and self-reported measures of anxiety and pain in pediatric dental patients (with relative measure improvements of >20%). We propose to evaluate effects of AAT on objective measures of stress and pain during preventative treatment using salivary stress hormones, heart rate, sweat response, and observational coding data (Aim 1) along with patients' perceptions of dental pain, anxiety, and future visits with validated questionnaires (Aim 2). As part of an ongoing randomized clinical trial, data are collected from patients (age 4-7 years) randomized to a short AAT protocol, a long AAT protocol and an active control with a dental exam and cleaning (N=180, 60 per group). Altogether, data generated from these aims will be used to measure the impact of AAT on pediatric dental patients to guide implementation. This secondary data analysis project will generate results on feasible, rapidly implementable protocols for AAT use in dentistry to mitigate DA and improve experiences, to reduce dental avoidance and its significant health sequelae. Our interdisciplinary team is uniquely qualified to conduct the proposed work as we have the innovative methodologies, RCT patient data and samples, BLS2 facilities, and expertise to achieve our aims. This application includes collaboration between experienced and junior faculty across multiple disciplines to ensure the rigor and translatability of our findings.

NARRATIVE. Determining whether Animal-Assisted Therapy (AAT) could serve as a low risk, efficacious approach for managing dental anxiety and providing positive dental experiences in children would allow for rapid implementation of canine therapy in dentistry. We will evaluate whether short and long AAT interventions alleviate stress and improve perceptions during preventative pediatric dental care, to guide AAT protocol development and use to improve lifelong oral health with broad public health impact.