The Greek version of the Gagging Assessment Scale in children and adolescents: psychometric properties, prevalence of gagging, and the association between gagging and dental fear

The impact of radiographic examination timing and gag reflex on dental fear and cooperation in children: a comparative clinical study

PURPOSE

Identifying factors that disrupt cooperation during radiographic examination, such as dental fear and the gag reflex, is crucial for achieving optimal radiographic outcomes. The aim of the present study is to evaluate the levels of dental fear and cooperation amongst children aged 4-9 years undergoing intraoral radiographic examination at different stages of dental treatment. It also investigates the impact of the gag reflex on children's behaviour during intraoral radiographic examination.

METHODS

A total of 89 children with no prior dental experience were randomly divided into two groups (G1, G2). Children in G1 underwent radiographic examination during their first dental visit, whilst children in G2 underwent the same after the completion of dental prophylaxis at their second visit. Variables assessed included dental fear, gagging and behaviour during radiographic examination. Multivariate logistic and linear regression analysis were performed to assess the variables that have an impact on behaviour during radiographic examination and on dental fear, respectively.

RESULTS

Children in G2 were more likely to exhibit better behaviour during radiographic examination than G1children (OR: 4.709, p value = 0.036). In addition, G1 children demonstrated a greater increase of CFSS-DS score compared to G2 children (β = - 0.698, p value = 0.001) after the second appointment. Gagging during radiographic examination was significantly associated with lower Frankl score during the examination (p = 0.015).

CONCLUSION

Gradual exposure to radiographic examination may significantly enhance children's cooperation during the procedure and confine the progression of dental fear. In contrast, the presence of a gag reflex can compromise patient's cooperation during intraoral radiographic assessment.

Excessive Gag Reflex, Dental Anxiety, and Phobia of Vomiting in Dental Care

BACKGROUND

The most known and commonly studied behavioral obstacle to dental care is dental anxiety. An obstacle that is less studied though no less problematic is excessive gag reflex, which can severely impede dental treatment. Another understudied and possibly related syndrome is emetophobia (a specific phobia of vomiting).

OBJECTIVE

The aim of this study was to examine possible comorbidity amongst self-reported emetophobia, dental anxiety, and excessive gagging in the dental office.

METHODS

A cross-sectional online survey was conducted using the following self-report questionnaires: Dental Anxiety Scale, Gagging Problem Assessment, Gagging Assessment Scale (GAS), and Specific Phobia of Vomiting Inventory (SPOVI).

RESULTS

In all, 164 participants fully completed the questionnaires (87.8% female; mean age, 34 ± 11.07 years). Positive correlations were found amongst all variables (P < .001). High gagging (GAS > 6) was associated with a 7.29 times (P < .000) greater risk of positive emetophobia (SPOVI ≥ 10). Linear regression analyses revealed that the intensity of the reflex and the experience of gagging upon encountering odours in the dental office as well as dental anxiety and vomiting phobia significantly predicted participants' gagging scores as evaluated by GAS (R2 = 0.59; F = 21.16; P < .001).

CONCLUSIONS

The study shows that excessive gagging reflex in the dental office is closely related both to dental anxiety and to emetophobia.

Is the equimolar mixture of oxygen and nitrous oxide (EMONO) associated with audiovisuals effective in reducing pain and side effects during peripheral venous access placement in children? Protocol for a single-centre randomised controlled trial from Italy

INTRODUCTION

Nurses frequently place a peripheral venous catheter during children's hospitalisation. Many studies suggest treatment of venipuncture-related pain. The administration of an equimolar mixture of oxygen and nitrous oxide (EMONO) is employed for pain control; however, no studies have analysed the association between EMONO and audiovisuals.The purpose of the study is to evaluate the effect of EMONO administration when combined with audiovisuals (EMONO+Audiovisual) versus EMONO alone on perceived pain, side effects and level of cooperation during peripheral venous access placement in children aged 2-5 years.

METHODS AND ANALYSIS

The first 120 eligible children admitted to the paediatric ward of the Lodi Hospital and presenting the indication for peripheral venous access will be enrolled. Sixty children will be randomly assigned to the experimental group (EMONO+Audiovisual) and 60 to the control group (EMONO alone).The Face, Legs, Activity, Cry, Consolability scale will be used to assess pain in the children aged 2-years old; pain in the children aged 3-5 years will be assessed using the Wong-Baker scale. The cooperation throughout the procedure will be measured using the Groningen Distress Rating Scale.

ETHICS AND DISSEMINATION

The Milan Area 1 Ethics Committee approved the study protocol (Experiment Registry No. 2020/ST/295). The trial results will be presented at conferences and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT05435118.

The prevalence and influencing factors of gag reflex in children aged 7-14 years in the dental setting

BACKGROUND

Gag reflex may occur in patients of all ages and often considered having a multifactorial aetiology.

OBJECTIVE

The aim of the study was to evaluate the prevalence and influencing factors of gag reflex in Turkish children aged 7-14 years in the dental setting.

METHODS

This cross-sectional study was carried out among 320 children aged between 7 and 14 years. First, an anamnesis form which include sosyodemographic status, monthly level of income, children past medical and dental experiences was filled by mothers. Children's fear levels were evaluated using the Dental Subscale of Children's Fear Survey Schedule(CFSS-DS) while mother's anxiety levels using the Modified Dental Anxiety Scale(MDAS). The revised dentist section of gagging problem assessment questionnaire (GPA-R-de) was used for both children and mothers. Statistical analysis was done with SPSS program.

RESULTS

The prevalence of gag reflex among children was 34.1%, among mothers was 20.3%. The association between child and mother gagging was found statistically significant (χ²  = 53.121, p < 0.001). When the mother of the child gagged, the risk of child gagging increases 6.83 times (p < 0.001). Higher CFSS-DS scores of children increase risk of gagging (OR = 1.052, p = 0.023). Children who were previously treated mostly in public hospitals significantly more likely to gag compared with private dental clinics (OR = 10.990, p < 0.001).

CONCLUSION

It was concluded that negative past dental experiences, previous dental treatments with local anaesthesia, history of hospital admission, number and place of previous dental visits, dental fear level of children, and low education level and gagging of mother have an influence on the gagging of children.

Study Regarding the Optimal Dimension of Intraoral Bitewing Radiographs in Patients with Primary Dentition

The aim of this study was to determine the optimum dimensions of a radiographic plate to allow correct visualization of dental tissues and correct fit in the oral cavity of children with deciduous dentition. A quasi-experimental clinical study was carried out in children of both sexes aged between 3 and 5 years. The study variables were the complete visualization of the dental structures, the surveillance of ischemia on soft tissues, stimulation of the gag reflex, and acceptance of the radiographic plate by the pediatric patient through a validated visual analogue scale that measures anxiety. The data obtained were subjected to a descriptive and comparative statistical analysis carried out for both study phases. A total of 80 children participated in the study. The optimal dimensions obtained for the radiographic plate were 19.5 mm in height and 27.3 mm in width. Visualization of the dental tissues during both phases was not statistically significant (p = 0.412). However, there were statistically significant differences regarding the presence of ischemia, gag reflex, and child rejection (p < 0.001). A smaller radiographic plate allows correct visualization of the coronal dental tissues without causing rejection, ischemia, or gag reflex in patients in the deciduous dentition.

Gagging and cooperation in 4-12-year-old children over a series of dental appointments

PURPOSE

The purposes were to evaluate if gagging can affect children's cooperation with treatment, investigate possible changes in gagging and study factors that can predict children's behaviour over dental treatment.

METHODS

255 children aged 4-12 years, needing at least three consecutive dental appointments, completed the Children's Fear Survey Schedule-Dental Subscale before examination. The Gagging Problem Assessment was performed before the initial examination and after the third/final appointment. Frankl's Behaviour Rating Scale (FBRS) was used to rate children's behaviour. Multivariate Mixed Linear and Logistic Regression Models were used.

RESULTS

Children with definitely positive behaviour were significantly older, less fearful and less likely to gag before treatment. Girls and older children had lower odds of gagging over time, while fearful children had higher odds. There were no statistically significant associations between gagging over time, FBRS and the type of dental treatment at the third appointment. The percentage of children who gagged after the third appointment (27.05%) was significantly lower as compared to the percentage found at the initial appointment (32.54%; p = 0.004).

CONCLUSION

Among the variables studied, age, dental fear, initial GPA and type of treatment were good predictors of children's behaviour during dental treatment.

The use of interactive distraction technique to manage gagging during impression taking in children: a single-blind, randomised controlled trial

PURPOSE

To evaluate the effect of interactive distraction technique on the severity of gagging and success of impression taking in children between age 5 and 10 years.

METHODS

This single blind, randomised controlled trial recruited 48 children aged 5-10 years requiring maxillary impressions. Selected children were randomly allocated to one of the two groups: (1) Test group, use of interactive distraction, and (2) Control group, no use of interactive distraction, during impression taking. Dental anxiety was scored using Facial Image Scale (FIS) before and after impression taking. Gagging-related Impression Success Scale (GISS) and Gagging Severity Index (GSI) were recorded by a blinded assessor. Nonparametric tests were used to compare the variables between the groups.

RESULTS

Maxillary impressions were successfully recorded in all children in the Test group; either with no gag (87.5%) or with gag (12.5%). In 33.3% control children impressions could not be recorded. Statistically significant, strong association was found between the interactive distraction and GISS (p = 0.003, Cramer's V = 0.32). Mean GSI and post-impression FIS scores were significantly lesser in the Test group (p = 0.029 and p = 0.048, respectively). Significant increase in the mean FIS scores was observed after recording impression in the Control group. Post-impression FIS showed significant positive correlation with GSI (Test: p = 0.003, Control: p = 0.009) and significant inverse correlation with GISS (Test: p = 0.003, Control: p = 0.01).

CONCLUSION

Interactive distraction technique used in this study is a simple, non-invasive and cost-effective method to effectively manage gagging and successfully record a maxillary impression in children between age 5 and 10 years.

Factors associated with gagging during radiographic and intraoral photographic examinations in 4-12-year-old children

AIMS

No studies are available in paediatric samples evaluating gagging during toothbrushing, radiographic and/or intraoral photographic examinations. The aims were to collectively examine potential factors associated with gagging during radiographs and intraoral photographs in 4-12-year-old children.

METHODS

Parents/guardians of 395 children (aged 4-12 years old) completed questionnaires asking about their children's toothbrushing habits. Children completed Greek versions of the Gagging Assessment Scale (GAS) and the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), while the dentist used the shorter version of the Gagging Problem Assessment (GPA-de-c/SF) to objectively assess gagging. X-ray and Photo Rating Scales were created to evaluate gagging during X-rays and photographs, respectively. Multivariate logistic regression was used to examine the relationship between the potential factors and gagging.

RESULTS

59 of 275 patients (21%) and 56 of 276 patients (20%) who needed X-rays and intraoral photographs, respectively, gagged. Children who gagged during X-rays had significantly higher GAS scores (p = 0.007). Boys, younger children, and those who gagged on GPA-de-c/SF were more likely to gag during X-rays, and children who gagged on GPA-de-c/SF were more likely to gag during photographs. Brushing habits were not related to dental fear or gagging.

CONCLUSION

Of the variables which we studied, GPA-de-c/SF most strongly affected the odds of gagging during taking radiographs and/or intraoral photographs.

The correlation of gagging threshold with intra-oral tactile and psychometric profiles in healthy subjects: A pilot study

Excessive gag reflex could be problematic for adequate dental care. Although various factors may increase the susceptibility to gagging, its contributing factors have not been fully determined. This study aimed to determine whether gag reflex was associated with tactile sensitivity and psychological characteristics. Fifteen volunteers of healthy males and females each were recruited for this study. After completing a questionnaire describing the self-perceived gag reflex activity, a disposable saliva ejector was inserted along the palate into the mouth until gagging was evoked. The ratio of the insertion depth to the palatal length was used as an index for the gagging threshold. The two-point discrimination (TPD) and Semmes-Weinstein monofilament (SWM) tests were performed to assess the tactile sensitivity of the palatal regions (hard palate, anterior and posterior soft palate). The Symptom Checklist-90-Revised was used to investigate the relationship between the gagging threshold and the psychological status. Our findings showed that the gagging threshold had a significant positive correlation with the TPD and SWM thresholds on the hard palate. The psychological profiles of psychoticism and hostility score were also significantly correlated with the gagging threshold. However, there were no significant differences in the tactile and gagging thresholds, as well as the psychological profiles, between males and females. Our results suggested that the tactile sensitivity of the anterior palate is a determining factor for the gagging threshold and implied that the initial response of the oral entry site to stimulation may lead to the development of gag reflex.

Gagging prevalence and its association with dental fear in 4-12-year-old children in a dental setting

AIM

The aims were to determine the prevalence of gagging in children in the dental setting, detect any association between gagging and dental fear in that setting, and determine if the association varied by type of setting.

DESIGN

A total of 734 children (4-12 years old), seeking dental care either at a University paediatric dental clinic (UC) or at a private paediatric practice (PP), filled out the Greek version of the Gagging Assessment Scale (GAS, subjective assessment) and the Greek version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). The shorter form of the Gagging Problem Assessment-dentist part for children (GPA-de-c/SF, dentist's objective measurement) was used to assess their gag reflex.

RESULTS

A total of 209 children (28.47%) gagged according to the GPA-de-c/SF. There was no significant difference in gagging between UC and PP children. Children rated as gaggers on the GPA-de-c/SF reported significantly higher GAS and CFSS-DS scores (U = 33 629.000; P < 0.001, U = 31 955.500, P < 0.001, respectively). Also, there was a significant association between GAS and CFSS-DS (rho = 0.307, P < 0.001).

CONCLUSIONS

In the dental setting, there were significant relationships between dental fear, the dentist's objective measurement of gagging severity, and the child's subjective gagging assessment.