Evaluating the Effects of Animal Therapy on Anxiety in Pediatric Dental Patients

评估动物疗法对小儿牙科患者焦虑的影响

• 批准号: 10649010
• 负责人: Laura Anne Jacox
• 金额: $ 15.41万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-15 至 2025-07-14
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10649010
• 关键词: Adult; Adverse event; Affect; Age; Anesthesia procedures; Animals; Anxiety; Appointment; Arousal; Behavior; Behavioral; Biometry; Canis familiaris; Caregivers; Caring; Cessation of life; Child; Childhood; Clinical Trials; Code; Collaborations; Computer software; Data; Data Analyses; Dementia; Dental; Dental Anxiety; Dental Care; Dentistry; Dentists; Devices; Diagnostic; Discipline; Elderly; Emergent care; Emotional; Ensure; Evaluation; Exhibits; Facial Pain; Faculty; Fright; Funding; Future; Galvanic Skin Response; General Anesthesia; Health; Heart Diseases; Heart Rate; Hormones; Hospitalization; Hydrocortisone; Individual; Infection; Inpatients; Intervention; Intravenous; Lead; Learning; Licensing; Literature; Malignant Neoplasms; Measurement; Measures; Medical; Methodology; Minor; Movement; Nervous System Trauma; Oral; Oral health; Outcome; Outpatients; Pain; Parents; Pathological anxiety; Patient Self-Report; Patients; Pediatric Dentistry; Perception; Persons; Physiological; Population; Preventive treatment; Protocols documentation; Public Health; Qualifying; Quality of life; Questionnaires; Randomized; Risk; Salivary; Sampling; Sedation procedure; Stress; Surveys; Techniques; Testing; Therapeutic; Therapeutic Intervention; Toothache; Training; Visit; Work; active control; adverse event risk; age group; alpha-amylase; animal efficacy; animal-assisted therapy; anxiety management; anxiety reduction; cohort; comparison control; expectation; experience; health care settings; health related quality of life; improved; innovation; novel; pain perception; pediatric patients; pharmacologic; protocol development; randomized, clinical trials; response; restraint; saliva sample; sedative; self-reported anxiety

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.

摘要。 牙科焦虑症（DA）影响着50-80%的成年人和6-22%的儿童。受DA影响的个人经常 表现出破坏性行为和避免牙科护理，导致重大不良健康后果，包括 腐烂、疼痛、拔牙、感染、紧急护理甚至住院的比率增加。D.经常 由于创伤性经历，儿童时期会出现DA，并可能导致终身DA。 旨在改善牙科经验的技术必须在儿童时期使用，以避免这些问题。 后遗症对于严重焦虑和衰退的患者，可以使用药物干预。然而，在这方面， 镇静剂和全身麻醉剂经常会遭到护理人员的反对，因为它们的风险很低， 不良事件，包括神经损伤和死亡。动物辅助治疗（AAT）与经过培训的治疗 在许多医疗环境中，狗已经被广泛用作非药物行为指导方法。 虽然在牙科中处于初期阶段，但AAT在儿科人群中的新用途有望 行为管理，减少焦虑，减轻疼痛，创造积极的联系。而且我们的 来自800名患者和父母的数据证实了在牙科中对犬AAT的普遍需求。的目的 本研究旨在评估AAT是否能缓解儿童牙科护理过程中的压力并改善其感知。我们 假设AAT显著增强了焦虑和疼痛的生物计量和自我报告的测量， 儿童牙科患者（相对测量改善>20%）。我们建议评估 AAT对使用唾液应激激素进行预防性治疗期间的应激和疼痛的客观测量， 心率、出汗反应和观察编码数据（目标1）沿着患者对牙科的感知 疼痛、焦虑和未来的访视，并使用经验证的问卷（目标2）。作为正在进行的随机临床试验的一部分， 在一项试验中，数据收集自随机分配至短AAT方案、长AAT方案和长AAT方案的患者（4-7岁）。 以及进行牙科检查和清洁的活性对照组（N=180，每组60）。总的来说，数据来自 这些目标将用于衡量AAT对儿童牙科患者的影响，以指导实施。 这一次级数据分析项目将为AAT产生可行的、可快速实施的方案 在牙科中使用，以减轻DA和改善体验，减少牙科回避及其对健康的重要影响 后遗症我们的跨学科团队是唯一有资格进行拟议的工作，因为我们有 创新的方法、RCT患者数据和样本、BLS 2设施和专业知识，以实现我们的目标。 此应用程序包括跨多个学科的经验丰富的和初级教师之间的协作， 确保我们研究结果的严谨性和可翻译性。