Abstract
The gag reflex, also known as gagging, is a physiological protective mechanism designed to prevent the entry of foreign objects into the respiratory tract. The gag reflex reaction in dentistry can range from mild to severe. Gagging’s multifactorial origin has been highlighted in the literature; generally, gagging is divided into somatic (direct stimulation) and psychogenic or learned (indirect stimulation) subgroups, although it is not always possible to differentiate between the two. A pronounced gag reflex may negatively affect the quality of oral health and compromise the successful outcome of dental procedures such as radiographic examination. For some children, gagging in the dental setting might be followed by uncooperative behaviour in that setting, as the child learns to associate dentistry with negative experiences. To the best of our knowledge, there are no studies available assessing the relationship between gagging, dental fear and children’s behaviour across a course of de ...
The gag reflex, also known as gagging, is a physiological protective mechanism designed to prevent the entry of foreign objects into the respiratory tract. The gag reflex reaction in dentistry can range from mild to severe. Gagging’s multifactorial origin has been highlighted in the literature; generally, gagging is divided into somatic (direct stimulation) and psychogenic or learned (indirect stimulation) subgroups, although it is not always possible to differentiate between the two. A pronounced gag reflex may negatively affect the quality of oral health and compromise the successful outcome of dental procedures such as radiographic examination. For some children, gagging in the dental setting might be followed by uncooperative behaviour in that setting, as the child learns to associate dentistry with negative experiences. To the best of our knowledge, there are no studies available assessing the relationship between gagging, dental fear and children’s behaviour across a course of dental treatment in paediatric samples. However, studies in adult population have shown that gagging is strongly associated with dental fear and anxiety in the dental setting. The primary aim of this thesis was to study factors related to gagging in children aged 4-12 years old in the dental setting either at a University paediatric dental clinic (UC) or a private paediatric practice (PP). More specifically, to assess the prevalence of gagging and to determine if there was an association between dental fear and gagging (self-assessed by the child and objectively-assessed by a paediatric dentist) in such a setting (Chapter 3). Subsequently, relationships between demographic variables (age and gender), the child’s brushing habits and gagging during radiographic examination and/or undergoing intraoral photography have been examined in a sample of children presenting for an initial or recall visit in the UC (Chapter 4). Finally, the relationship between gagging and children’s cooperation have been also examined, exploring possible changes in gagging across several dental appointments, studying meanwhile the factors that can predict children’s cooperative behaviour during those appointments (Chapter 5). A total of 734 children, aged 4-12 years, seeking new patient or recall patient dental care either at a UC (N=395) or a PP (N=339) 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). Patient’s parents completed a form that indicated the age and the gender of their children, information about their children’s toothbrushing habits and whether or not the child had previously been to a dentist. 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 by a well-calibrated paediatric dentist. X-ray and Photo Rating Scales were created to evaluate gagging during x-rays and photographs, respectively. Frankl’s Behaviour Rating Scale (FBRS) was used to rate children’s behaviour at three consecutive dental sessions (1. only clinical examination, 2. prophylaxis-fluoride application, and 3. dental treatment with local anesthesia or sealants). After the third-final appointment, the GPA-de-c/SF was performed once again (GPAfinal).Gagging was identified in almost 30% of children in the dental setting, and was more common in boys, younger patients, and more fearful patients (Chapter 3). Brushing habits were not related to whether or not the child gagged on the GPA-de-c/SF. Additionally, children who gagged on the objective measurement were more likely to gag during X-rays and intraoral photographs. Of the variables which we studied, the GPA-de-c/SF is the best predictor for gagging in the dental environment (Chapter 4). Finally, fearful children had high odds of gagging over time. Children who gagged before treatment (GPAinitial) presented with more negative behaviour during all appointments. The percentage of children who gagged after the third appointment (27.05%) was significantly lower (p=0.004) compared to the initial appointment (32.54%). Among the variables we studied, age, dental fear, GPAinitial and type of treatment were good predictors of children's behaviour over dental treatment (Chapter 5).Gagging has a significant impact on oral health care delivery. Dentally fearful children are more likely to gag during dental treatment. Thus, early identification of gagging can prompt paediatric dentists to use alternative techniques to overcome or minimize gagging-related problems during treatment. Since the GPA-de-c/SF can be administered before dental treatment begins, paediatric dentists can use this measure to help predict which children may need special care to reduce the chances that they will gag during treatment.
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