Better Than Benzodiazepines

Better Than Benzodiazepines. Image credit: © MedAssent DDS

I vividly recall the moment that marked the beginning of my experience utilizing canines for pet therapy to promote wellness. I was 7 months pregnant, walking down the street with my Golden Retrievers when I was approached by the University of California, Los Angeles (UCLA) Director of Animal Assisted Therapy. She shared exciting news about a groundbreaking pilot program aimed at using canine visits to help hospital patients lower their blood pressure, uplift their spirits, and slow their heart rate.

Following rigorous testing and training, my Golden Retrievers and I proudly became one of the first pet teams at UCLA Medical Center. Being able to help patients in this way was profoundly rewarding, and it was exhilarating to be at the forefront of such an innovative form of therapy.

One of my most memorable cases was a visit with a 17-year-old girl who had been shot in the head during a gang altercation. She was extremely embarrassed by her inability to speak normally. What struck me was her willingness to practice her speech with my dogs, though not with humans. This crucial insight is now widely incorporated by speech therapists in schools, libraries, and rehabilitation centers to help patients relearn speech after strokes or head trauma or to help children improve their reading skills. This pioneering program has paved the way for widespread adoption across various health care settings today.

Applications in Dentistry

When I started in the 1990s, animal-assisted therapy (AAT) was still relatively new. Since then, a growing body of research has shown its efficacy in alleviating stress, pain, and anxiety across different patient populations.

Pups have calming tendencies, making dental visits a lot less stressful. Image credit: © MedAssent DDS

This is particularly relevant for dentistry - a 2018 study found that more that 60% of people suffer from fear of the dentist. Even worse, the World Health Organization found that the global prevalence of anxiety and depression increased by a massive 25% following the COVID-19 pandemic.

While therapy dogs are incredibly effective in reducing anxiety, there are times when additional support, such as nitrous oxide or benzodiazepines, is necessary.

Risks of Benzodiazepines

Oftentimes, dentists will prescribe benzodiazepines prior to the procedure to ease patients’ anxiety. However, it may not be the best answer for every patient.

Before prescribing, dentists must carefully review the patient's medication history to avoid dangerous medication interactions. For instance, combining benzodiazepines with opioids, muscle relaxants, or even over-the-counter medications such as Benadryl may increase the risk of excessive sedation, central nervous system depression, respiratory depression, or impaired psychomotor function. Using vetted, dentistry-specific tools like the Digital Drug Handbook can significantly accelerate your medical review while minimizing risk of oversight.

It may be prudent to consider alternative anxiety-relief options before prescribing benzodiazepines. Image credit: © MedAssent DDS

Additionally, as patients age, their bodies process medications differently. Beers Geriatric criteria states patients 65 years and older should avoid benzodiazepines due to the increased risk of confusion, dizziness, and falls. In rare cases, elderly patients might even experience paradoxical reactions like aggression, agitation, or hyperactivity. A 2017 study found that an alarming 57% of older adults were prescribed a potentially age-inappropriate Beers criteria medication by their dentist, highlighting the crucial need for clinicians to carefully evaluate before prescribing. If benzodiazepines are necessary for an older patient, Alprazolam (Xanax), Lorazepam (Ativan), or Temazepam (Restoril) are preferred because they are shorter-acting, which reduces the likelihood of adverse effects.

How Animal-Assisted Therapy Helps My Practice

Integrating my Golden Retrievers into my dental practice has not only endeared them to patients but has also greatly enhanced the overall treatment experience for both patients and staff. Their journey to becoming therapy dogs begins in puppyhood, where they are trained through frequent interaction with adults and children, exposure to loud noises, and acclimation to large groups. Over time, they learn the important difference between playtime at home and maintaining a professional demeanor while on the job. In the clinic, they sit patiently next to the chair, gently nudging a patient’s arm with their nose or placing a paw to encourage petting. This technique, which has proven effective in rehabilitation centers by motivating stroke patients to use their large muscles, brings similar benefits in the dental setting.

While anti-anxiety medications are still useful in certain situations, the universal therapeutic impact these dogs provide is invaluable, making every shared smile and wag undeniably worthwhile.