Gagging and its associations with dental care–related fear,fear of pain and beliefs about treatment

BackgroundGagging is a behavioral response that interferes with oral health care and may be related to dental care–related fear. Little is known, however, about the epidemiology of gagging during dental treatment.MethodsTo explore this phenomenon, the authors recruited participants from the waiting area of an oral diagnosis clinic. Participants completed a gagging behavior questionnaire, the Dental Fear Survey, the Fear of Pain Questionnaire—9, the Revised Dental Beliefs Survey and a demographics questionnaire.ResultsAlmost one-half of the 478 participants reported gagging on at least one occasion during dental visits, and 7.5 percent of participants reported almost always or always gagging. With higher frequency of problems with gagging, patients were more likely to have greater levels of dental care–related fear, fear of pain and more negative beliefs about dental professionals and dental treatment. Furthermore, participants who gagged more readily had greater dental care–related fear than did participants who had less of a propensity to gag.ConclusionsGagging in the dental office is a prevalent problem, and dental care–related fear and fear of pain are associated with more frequent gagging.Practical ImplicationsGiven the prevalence of patients reporting problems with gagging, it may be helpful for providers to assess patients' propensity for gagging, which can be a barrier to treatment. By targeting dental care–related fear, fear of pain and negative beliefs about dental care in patients who often gag when receiving dental care, clinicians may be able to help reduce gagging in frequency or intensity, potentially making treatment more comfortable for patients and easier for dental care providers.     

High fear of intra‐oral injections: prevalence and relationship to dental fear and dental avoidance among 10‐ to 16‐yr‐old children

The present study aimed to: (i) estimate the prevalence of self‐reported high fear of intra‐oral injections, high blood‐injury fear, and injection fear; (ii) explore the overlap between high fear of intra‐oral injections and high fear of dental treatment; and (iii) evaluate the possible consequence of high fear of intra‐oral injections in terms of avoidance of dental care. The sample included 1,441 subjects, 10‐ to 16‐yr of age, attending elementary schools in a county of Norway. Data were collected using questionnaires that were completed in classrooms. The survey instruments used were the Intra‐Oral Injection Fear‐scale, the Children's Fear Survey Schedule‐Dental Subscale, the Injection Phobia scale for children, and the Mutilation Questionnaire for children. In total, 13.9% of the children reported high intra‐oral injection fear. A strong association was found between fear of intra‐oral injections and dental fear. When an intra‐oral injection was needed, 10.6% would avoid dental treatment. In multiple regression analysis, high intra‐oral injection fear was found to be associated with avoidance of dental treatment (OR = 6.52; 95% CI: 3.99–10.67). It was concluded that high fear of intra‐oral injections was prevalent and might lead to avoidance of necessary dental treatment. Hence, intra‐oral injection fear should be addressed before treatment of dental fear.     

Gagging Problem Assessment: a re‐evaluation

The Gagging Problem Assessment (GPA) is an instrument to evaluate dental gagging. Although the GPA seemed to be reliable and valid in a pilot study, a replication study with more subjects was needed. Based on the pilot study, the number of items was reduced, resulting in the revised version of the GPA (GPA‐R). The aims of this study were to replicate the reliability of the GPA‐R and to investigate the correlation between dental gagging and general anxiety. Dental gagging patients (n = 59) were compared with a control group (n = 17) at t0 and 3 weeks later. The ‘gagging group’ also filled in the SCL‐90 anxiety scale. Gagging‐specific homogenous domains and internal consistency were determined. Stability and distinguishing capacity of the GPA‐R were assessed. SCL‐90‐Anxiety scores were compared with standard values in a non‐clinical population. The GPA‐R patient part was able to reliably discriminate between the absence or the presence of dental gagging. However, the reliability of the GPA‐R‐dentist part was insufficient. The GPA‐R seems to be sensitive to subtle differences in acts of the dentists. To overcome these problems, more detailed and explicit instructions on how to use the GPA‐R should be formulated and more specific gagging stimuli should be included. The ‘gagging group’ reported ‘fear of choking’ significantly more often than the control group (P = 0·008). This finding might be important for the treatment of dental gagging. Considering the outcome of our study, development of a new diagnostic gagging tool needs another approach that focuses on gagging severity.     

Risk factors for impaired oral health among 18‐ to 34‐year‐old Australians

Objectives: The objective of this study was to determine risk factors for a summary measure of oral health impairment among 18‐ to 34‐year‐olds in Australia. Methods: Data were from Australia's National Survey of Adult Oral Health, a representative survey that utilized a three‐stage, stratified, clustered sampling design. Oral health impairment was defined as reported experience of toothache, poor dental appearance, or food avoidance in the last 12 months. Multivariate Poisson regression models were used to evaluate effects of sociodemographic characteristics, self‐perceived oral health, dental service utilization, and clinical oral disease indicators on oral health impairments. Effects were quantified as prevalence ratios (PR). Results: The estimated percent of 18‐ to 34‐year‐olds with oral health impairment was 42.4 [95 percent confidence interval (CI) 37.7‐47.2]. In the multivariate model, oral health impairment was associated with untreated dental decay (PR 1.38, 95 percent CI 1.13‐1.68) and presence of periodontal pockets 4 mm+ (PR 1.29, 95 percent CI 1.03‐1.61). In addition to those clinical indicators, greater prevalence of oral health impairment was associated with trouble paying a $100 dental bill (PR 1.37, 95 percent CI 1.12‐1.68), usually visiting a dentist because of a dental problem (PR 1.46, 95 percent CI 1.15‐1.86), reported cost barriers to dental care (PR 1.46, 95 percent CI 1.16‐1.85), and dental fear (PR 1.43, 95 percent CI 1.18‐1.73). Conclusions: Oral health impairment was highly prevalent in this population. The findings suggest that treatment of dental disease, reduction of financial barriers to dental care, and control of dental fear are needed to reduce oral health impairment among Australian young adults.     

Association between dental pain and depression in Korean adults using the Korean National Health and Nutrition Examination Survey

The purpose of this study was to evaluate the relationships between the prevalence of depression and dental pain using a well characterised, nationally representative, population‐based study. This study analysed data from the 2012 Korea National Health and Nutrition Examination Survey (n = 4886). Oral health status was assessed using the oral health questionnaire, and oral examination was performed by trained dentists. Depression was defined as the participant having been diagnosed as depression during the previous year. Logistic regression was applied to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI), controlling for a range of covariates. Results demonstrated that participants included in ‘root canal treatment is necessary’ showed higher prevalence of self‐reported dental pain; in particular, participants with depression presented more dental pain than those without depression. After adjusting for sociodemographic factors, self‐reported dental pain increased in participants with depression. The AOR (95% CI) for having self‐reported dental pain was 1·58 (1·08–2·33) in dentists' diagnosis of no dental pain/depression group, 1·62 (1·32–1·98) in dentists' diagnosis of dental pain/no depression group and 2·84 (1·10–7·37) in dentists' diagnosis of dental pain/depression group. It was concluded that depression was associated with dental pain after adjustment for potential confounders in Korean adults. Thus, dentists should consider the possible presence of psychopathology when treating patients with dental pain.     

Self‐reported Bruxism ‐ associations with perceived stress,motivation for control,dental anxiety and gagging*

Summary To examine possible associations between self‐reported bruxism, stress, desirability of control, dental anxiety and gagging. Five questionnaires were distributed among a general adult population (402 respondents): the Perceived Stress Scale (PSS), Desirability of Control Scale (DC), Dental Anxiety Scale (DAS), Gagging Assessment Scale (GAS), and Bruxism Assessment Questionnaire. A high positive correlation between DAS and GAS (R = 0·604, P < 0·001) was found. PSS was negatively correlated with DC (R = ?0·292, P < 0·001), and was positively correlated with GAS (R = 0·217, P < 0·001) and DAS (R = 0·214, P < 0·001). Respondents who reported bruxing while awake or asleep showed higher levels of GAS, DAS and PSS than those who did not. There were no differences between the bruxers and the non‐bruxers (sleep and aware) with regard to the DC scores. The best predictors of awake bruxism were sleep bruxism (OR = 4·98, CI 95% 2·54–9·74) and GAS (OR = 1·10, CI 95% 1·04–1·17). The best predictors of sleep bruxism were awake bruxism (OR = 5·0, CI 95% 2·56–9·78) and GAS (OR = 1·19; CI 95% 1·11–1·27). Self‐reported sleep bruxism significantly increases the odds for awake bruxism and vice versa. Tendency for gagging during dental care slightly increases the odds of both types of self‐reported bruxism, but desirability of control is not associated with these phenomena.     

Gagging

Gagging is a protective reflex to stop unwanted entry into the mouth and oropharynx. Some people have a reduced or absent reflex, while others have a pronounced one. Pronounced gag reflexes can compromise all aspects of dentistry, from the diagnostic procedures of examination and radiography to any form of active treatment. In some patients with marked gagging reflexes, it can lead to avoidance of treatment. Many techniques have been described that attempt to overcome this problem, and a variety of management strategies is necessary to aid the delivery of dental care. This is a review of the etiology of gagging problems, clinical assessment, and their classification and categorization prior to clinical treatment. It discusses as well methods for managing patients with gag reflexes during dental treatment.     

Dental status and self‐assessed chewing ability in 70‐ and 80‐year‐old subjects in Sweden

The objective was to compare two cohorts of elderly people, 70 and 80 years old, with respect to dental status and self‐assessed chewing ability. The hypotheses were as follows: (i) dental status is associated with self‐assessed chewing ability; (ii) chewing ability is poorer among the 80‐ than the 70‐year‐old subjects. Identical questionnaires were in 2012 sent to all subjects born in 1942 and 1932, living in two Swedish counties. The response rate was 70·1% resulting in samples of 5697 70‐ and 2922 80‐year‐old subjects. Answers to questions on self‐assessed chewing ability, dental status and some other factors have been analysed. Dental status varied but was in general good; 72% of the 70‐ and 60% of the 80‐year‐old subjects reported that they had all or only few missing teeth. Rate of edentulism was 3% and 7%, respectively. Removable partial dentures were reported by 6% and 10%, respectively, implant treatment by 13% in both cohorts. Self‐assessed chewing ability was mostly good and correlated with the number of teeth (Spearman rho = 0·46). A majority of the edentulous subjects assessed their chewing ability as very or fairly good. Logistic regression showed that self‐assessed chewing ability was significantly associated with a number of dental variables but also with general health. In conclusion, dental status was relatively good at both ages but somewhat poorer in the older cohort. Dental status, some other dental variables and being healthy were in both age groups significantly associated with self‐assessed chewing ability.     

Determinants of change in oral health‐related quality of life over 7 years among older Japanese

Because there are more elderly people than ever before and because they are living for longer periods of time, it is essential to understand the determinants of healthy ageing. This study examined changes in oral health‐related quality of life (OHRQoL) among Japanese elderly over a 7‐year period. A sample of independently living individuals (aged 60+ years) underwent a questionnaire and dental examination at baseline and 7 years afterwards. The Geriatric Oral Health Assessment Index (GOHAI) was used to assess the impact of oral conditions. Occlusal force and salivary flow were also assessed. Of the 411 participants assessed at baseline, 130 (31·6%) accepted to participate after 7 years. There were no significant differences between those lost to follow‐up and those assessed at 7 years, except that a higher proportion of the latter rated their baseline general health as good. Among the latter, the overall mean GOHAI score did not change significantly (11·8 at baseline and 11·1 at follow‐up; P = 0·16). However, after controlling for age, gender and baseline GOHAI score, participants who had lost teeth or experienced a decline in occlusal force after 7 years had higher follow‐up GOHAI scores (indicating poorer OHRQoL). Unfavourable changes in clinical oral status over time are reflected in poorer self‐rated oral health.     

Caries prevalence and severity in urban Fijian school children

Objectives. To determine the prevalence and severity of dental caries in a sample of urban Fijian school children. Design. Cross‐sectional. Sample and methods. Children aged between 6 and 8 years who attended one of four primary schools in different localities of Suva completed self‐report questionnaires and were examined for dental caries. Results. A total of 704 children (response rate = 72·4%) returned questionnaires and were examined dentally. The prevalence of dental caries in the primary dentition was 87·6% and in the permanent dentition, 46·7%. The mean dfs and mean DFS were 8·43 (SD 7·82) and 2·38 (SD 1·37), respectively. High caries prevalence and severity were associated with infrequent brushing, snacking on sugar‐containing foods, having seen a dentist before, and having last visited a dentist because of pain. Conclusions. The caries prevalence of the sample was comparable with findings from a national oral health survey conducted in 1985/86, but the caries severity was greater. As in other developing countries, this may be due to an increased availability of refined sugar products without a concurrent rise in oral health awareness. The study findings contribute to the overall picture of Fijian school children's dental health.     

The role of personality traits in self‐rated oral health and preferences for different types of flawed smiles

Symmetric, aligned and luminous smiles are usually classified as ‘beautiful’ and aesthetic. However, smile perception is not strictly governed by standardised rules. Personal traits may influence the perception of non‐ideal smiles. We aimed to determine the influence of personality traits in self‐rated oral health and satisfaction and in the aesthetic preference for different strategically flawed smiles shown in photographs. Smiles with dark teeth, with uneven teeth, with lip asymmetry and dental asymmetry were ordered from 1 to 4 as a function of the degree of beauty by 548 participants, of which 50·7% were females with a mean age of 41·5 ± 17·6 years (range: 16–89 years). Self‐assessment and oral satisfaction were recorded on a Likert scale. Personality was measured by means of the Big Five Inventory (extraversion, agreeableness, conscientiousness, neuroticism and openness), and the Life Orientation Test was used to measure optimism and pessimism. Of the four photographs with imperfect smiles, dental asymmetry was the most highly assessed in 63% of the sample, and the worst was lip asymmetry, in 43·7% of the sample. Some personality traits (above all conscientiousness and openness) were significantly correlated with the position assigned to the photographs with dental and lip asymmetry or with misaligned teeth. The extraversion, agreeableness and openness traits were correlated with the self‐perceptions of oral health and aesthetics of the participants. Dental asymmetry seems to be better tolerated than lip asymmetry. Personality traits are weakly but significantly correlated with the aesthetic preference and oral health values, conscientiousness and openness being the most relevant domains in this sense.     

The influence of gender on the relationship between dental anxiety and oral health‐related emotional well‐being

International Journal of Paediatric Dentistry 2013; 23: 180–187 Background and aim. Children’s dental fear and/or anxiety (DFA) has been associated with declines in oral health and quality of life. The influence of gender on the relationship between DFA and oral health‐related well‐being in children is analysed. Design. The decayed, missing and filled permanent teeth (DMFT) index was obtained from 161 school‐aged children (7–14 years old). Data from children’s self‐assessed oral health, oral health‐related emotional well‐being and dental anxiety were collected using questionnaires. Results. Low scores of emotional well‐being were associated with negative self‐assessment of oral health and high levels of dental anxiety. Females reported decreased oral health‐related emotional well‐being compared with males. The analysis of possible moderating effects confirmed that gender influenced the relationship between oral health and DFA. The DMFT index was not associated with self‐assessed oral health status, emotional well‐being or DFA. Conclusion. For girls, high levels of DFA were associated with low levels of oral health‐related emotional well‐being. In contrast, dental fear and/or anxiety did not influence oral health‐related emotional well‐being in boys.     

Factors affecting dental fear in French children aged 5–12 years

International Journal of Paediatric Dentistry 2010; 20: 366–373 Background. While dental anxiety is often correlated with prior negative dental experience, prevention of dental anxiety should in theory include early exposure to the dental setting. Objective. We set out to evaluate factors affecting dental fear in French children. Methods. Dental fear was evaluated using a visual analogue scale (DF‐VAS) in a group of 1303 French children (681 boys and 622 girls) aged 5–11 years (mean: 8.12 years, SD: 1.42 years). Indicators of caries and oral hygiene were evaluated on dental examination. Indicators of well‐being related to oral health, dental experience, and oral health education were collected via a structured interview. Results. Dental fear was scored low in 75.7% (DF‐VAS 0–3), moderate in 16.7% (DF‐VAS 4–6), and high in 7.6% (DF‐VAS 7–10). DF‐VAS decreased statistically with experience of a prior dental visit. Children who had at least one decayed tooth presented a higher level of dental fear than those with no decay, while children with fillings were significantly less anxious than those without previous dental care. Conclusions. This study shows that for children aged 5–12 years, prior experience of the dental setting can act as a positive component of dental fear.     

A review of gagging problems in dentistry: I. Aetiology and classification

Some people have a pronounced gag reflex that can be a severe limitation to their ability to accept dental care and the clinician's ability to provide it. It can compromise all aspects of dentistry, from diagnostic procedures to active treatment and can be distressing for all concerned. Many techniques have been described that attempt to overcome the problem. Dentists will undoubtedly see patients with gagging problems and knowledge of a variety of management strategies is necessary to aid the delivery of dental care. This first paper looks at the background to gagging problems and their classification and categorization prior to clinical treatment. The second article will look at the clinical assessment of the patient presenting for dental treatment with a history of gagging problems. It will also review methods used to manage patients with gagging reflexes during dental treatment.     

Oral health‐related quality of life among rural‐dwelling Indigenous Australians

Background: There is limited information on the impact of poor oral health on Indigenous Australian quality of life. This study aimed to determine the prevalence, extent and severity of, and to calculate risk indicators for, poor oral health‐related quality of life among a convenience sample of rural‐dwelling Indigenous Australians. Methods: Participants (n = 468) completed a questionnaire that included socio‐demographic, lifestyle, dental service utilization, dental self‐care and oral health‐related quality of life (OHIP‐14) factors. Results: The prevalence of having experienced one or more of OHIP‐14 items ‘fairly often’ or ‘very often’ was 34.8%. The extent of OHIP‐14 scores was 1.88, while the severity was 15.0. Risk indicators for having experienced one or more of OHIP‐14 items ‘fairly often’ or ‘very often’ included problem‐based dental attendance, avoiding dental care because of cost, difficulty paying a $100 dental bill and non‐ownership of a toothbrush. An additional risk indicator for OHIP‐14 extent was healthcare card ownership, while additional indicators for OHIP‐14 severity were healthcare card ownership and having had 5+ teeth extracted. Conclusions: Risk indicators for poor oral health‐related quality of life among this marginalized population included socio‐economic factors, dentate status factors, dental service utilization patterns, financial factors and dental self‐care factors.     

A review of gagging problems in dentistry: aetiology and classification.

Some people have a pronounced gag reflex that can be a severe limitation to their ability to accept dental care and the clinician's ability to provide it. It can compromise all aspects of dentistry, from diagnostic procedures to active treatment and can be distressing for all concerned. Many techniques have been described that attempt to overcome the problem. Dentists will undoubtedly see patients with gagging problems and knowledge of a variety of management strategies is necessary to aid the delivery of dental care. This first paper looks at the background to gagging problems and their classification and categorization prior to clinical treatment. The second article will look at the clinical assessment of the patient presenting for dental treatment with a history of gagging problems. It will also review methods used to manage patients with gagging reflexes during dental treatment.     

Self‐report of temporomandibular joint clicking and psychological factors: is there an association?

The objectives of this study were to test the hypothesis that self‐reported TMJ clicking sounds in adolescents are positively associated with non‐specific somatic symptoms, self‐perception of body image and care‐seeking behaviour. A cross‐sectional study was carried out in 353 young adolescents (48·4% females) recruited from community (N = 272) and orthodontic clinic (N = 81) settings. Assessments included self‐reported TMJ clicking, non‐specific physical symptoms, body image concerns and for the clinic sample only, the source of motivation for treatment. TMJ sounds were self‐reported by 19% of the sample and were associated with higher scores for non‐specific physical symptoms and body image concerns (P < 0·001). Adolescents who were self‐motivated to seek orthodontic treatment had greater scores for non‐specific physical symptoms, more body image concerns and tended to report TMJ sounds more often (26·3% and 7·7% respectively; P = 0·41) than those who were solely parent/family‐motivated to seek treatment. Self‐reported TMJ sounds in adolescents were associated with a propensity to somatisation and concerns with body image. Care‐seeking adolescents have greater non‐specific physical symptoms and body image concerns and tend to report more frequent TMJ sounds.