The first time 11-year-old Levi McAllister had a tooth pulled, he screamed, kicked, and struggled so much that his mom had to hold him down. So, when Levi returned to Charlotte Pediatric Dentistry in January to get two more teeth pulled, dental hygienist Barb Kucera had a surprise for him: a friendly yellow Labrador retriever named Atkins.
"Would you like Atkins to lie on your lap?" she asked.
Levi nodded, and Kucera helped Atkins hop into the dental chair and rest her head on a pillow on Levi's chest. As Levi stroked the soft fur on Atkins's ears, the dentist numbed Levi's mouth and eased out two of his teeth.
"The dog made me feel happy and calm," Levi said.
Across the U.S., a growing number of dentists are bringing in four-legged staff members to reduce stress for both children and adults -- typically at no additional cost to patients. Dental patients at a practice in Green Bay, WI, can cuddle with a cockapoo named Charlie, for instance, while those at a practice in Nashville, TN, visit with PeeWee, a French bulldog. In Cornelius, NC, Whalen Dentistry advertises that a goldendoodle named Beamer will "make any appointment a little less ... RUFF!"
Yet the proliferation of dental dogs highlights a surprising lack of regulation. In most states, nothing prevents a dentist from bringing in an untrained pet and calling it a comfort or therapy dog, possibly putting patients at risk for an infection or a dog attack. Patients with allergies or a fear of dogs might also have concerns.
In North Carolina, complaints from patients concerned about sanitation and safety prompted state regulators to approve a rule allowing only certain types of highly trained dogs in dental exam rooms. It took effect in June 2021 and is thought to be the first regulation of its kind nationwide.
As many as 1 in 3 Americans experience dental anxiety and fear. For them, a visit to the dentist can be terrifying, and research indicates dogs can help.
A small study published in the journal Animals found that patients with a fear of the dentist who had a dog lie on their laps during treatment experienced a decrease in their stress and blood pressure levels. Other research shows that animals in healthcare facilities can reduce the perception of pain and boost patients' moods.
The Americans with Disabilities Act allows people with disabilities to bring a service dog into healthcare facilities, including dental clinics. Such animals do not pose a significant risk of transmitting infection in a dentist's office, according to the U.S. Centers for Disease Control and Prevention.
The North Carolina State Board of Dental Examiners published an initial rule that would have allowed only service dogs for patients with disabilities in dental exam rooms, effectively banning "rehabilitative facility dogs" like Atkins. In response, dog lovers and dental patients flooded the board with emails, said Bobby White, the board's CEO and legal counsel.
The board then proposed also allowing facility dogs in dental offices. Facility dogs get the same intense training as service dogs but learn tasks to help many people, rather than just one, said Kyria Henry Whisenhunt. Whisenhunt is the executive director and founder of the Paws4people Foundation, the North Carolina-based nonprofit that trained Atkins and three other dental dogs in the state.
Facility dogs are trained to work in specific professional environments, Whisenhunt said. For instance, Atkins had to be desensitized to sounds such as the screech of the dentist's drill. The dog also had to practice laying her head on a patient's lap and staying still while a dentist works.
Other facility dogs work with professionals in special education, physical and occupational therapy, and mental healthcare.
The new North Carolina regulation defines a "certified facility dog" as one trained in a program accredited by an organization that promotes training standards for assistance dogs, such as Assistance Dogs International or Animal Assisted Intervention International. It also requires the dog's handler to be trained and certified.
"Our whole goal was to make sure the dogs are safe," White said. "There's a lot of difference between a facility dog that has special training and a person who goes on the internet, buys a vest, and puts it on a Chihuahua."
The Animal Legal and Historical Center at Michigan State University searched laws and regulations in all 50 states for Kaiser Health News and found that only Virginia, New Jersey, and Georgia specifically prohibit animals (except for service animals) in dental facilities. Center attorney Rebecca Wisch found no other guidelines related to dogs in a dental office. "I think the NC regulation is unique," she said in an email.
Dr. James Sparks, an Oklahoma dentist who is president of the American Association of Dental Boards, said he wasn't aware of any similar laws. He added that he personally would never bring an animal into his practice. "I can't take the chance of a dog jumping up while I do work," Sparks said.
Atkins, who is 6 years old, received 600 hours of training from Paws4people. She and Kucera then trained together for an additional 50 hours. There was no charge for Kucera to get Atkins, but she had to commit to raise $10,000 for the foundation. Although Atkins lives with Kucera, she is owned by Paws4people.
On the days Atkins works at Charlotte Pediatric Dentistry, a sign in the reception area alerts patients that a dog is on duty. If someone has allergies or a fear of dogs, the staff puts Atkins in her kennel in a back room.
For the youngest patients, Atkins jumps into the dental chair and models behavior. She gets her own clip-on napkin and holds her mouth open while Kucera checks her teeth with a mirror.
When patients want Atkins in their laps, Kucera uses a disposable drape to create a barrier between the patient's clothing and the dog so the patient doesn't go home covered with dog hair. She said that she's never had a problem with Atkins disturbing a dentist's work and that many families request the pooch for every appointment.
McAllister said that's his plan, too. "It's just really helpful," he said. "Everyone should have one."
KHN is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.