Secondary outcomes
anxiety
In contrast to the patient‐ and parent/guardian reported outcomes and experiences in this trial indicating a positive effect of having a therapy dog present, the selected psychometric measurements were more variable. The biological variance likely impacted this small sample's physiological responses. Similar observations have also been made in recent publications reporting on the experiences with the use of therapy dogs in the oral health care of pediatric patients (Vincent et al., A challenge in a clinical study on this theme is identifying the most appropriate objective and subjective measures of anxiety and fear reduction among pediatric patients. There are no gold standards amongst the many reported physiologic (also known as “objective”) outcomes, including heart rate, blood pressure, skin temperature, electrodermal activity, pulse oximetry, and different saliva biomarkers such as cortisol, alpha‐amylase, and oxytocin (Guinot Jimeno et al., Psychometric anxiety assessment has been predominantly assessed using STAI‐CH (State‐Trait anxiety inventory for children) in different healthcare settings (Feng et al., The heart rate variability and skin conductance were measured according to the manufacturer's instructions. However, the recorded data could not be analyzed reliably. One reason was that the electrodes ideally should have been placed in good time before the clinical examination to allow ample time for the adaptation between the skin, the conductance gel, and the electrodes. In this study, the children were not seated in the dental chair longer than necessary to undertake the clinical examination. Moreover, frequent micro and macro movements while sitting in the dental chair caused signaling noise and artifacts. In retrospect, the selected electrophysiological measurements seem not ideal for measuring child anxiety in a dental operatory setting.