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

Dental photography for children: A global survey

BACKGROUND

Clinical photographs are now considered an essential element for accurate and objective dental records. Very little information exists on dental photography in children and the factors that can influence the dentist's decision to take dental photographs.

AIM

This study aimed to assess the current use, attitude and confidence of paediatric dentists using clinical dental photography of children worldwide.

DESIGN

This was a cross-sectional questionnaire-based study distributed online to paediatric dentists around the globe.

RESULTS

The survey was completed by 390 dentists. The majority of participants (82.3%, n = 321) took dental photographs of their patients, and over 74% of the participants were confident in taking dental photographs. Sixty-nine dentists (17.7%) did not take photographs. Seventy-four per cent (n = 240) of those who take dental photographs and 47.8% (n = 33) of those who do not take dental photographs reported an effect on the child's behaviour. The majority of participants expressed interest in receiving further training.

CONCLUSION

Most paediatric dentists take dental photographs of their patients and value their role in the behavioural management of the child patient. Paediatric dentists need further training in children's dental photography, including guidance on proper image recording, storage and transfer.

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.

Do preterm-born children and adolescents have greater need for dental care as compared to full term-born controls?

Background

Preterm birth has been shown to cause various long-term health issues. Children who were born preterm have also been observed to have more dental behaviour management problems (DBMP) during dental examinations and treatment than children born full term. It is known that dental radiographic examinations can be uncomfortable and cause anxiety in paediatric patients. Thus, our aims were to retrospectively compare dental care related examinations and treatments carried out in three different age intervals (3–6 years, 7–12 years, and 13–19 years) among preterm- and full-term born children and adolescents.

Methods

The present study included 311 patient files: 122 very preterm–born and 33 extremely preterm–born children and adolescents (< 32 gestational weeks). A matched control group of 156 full term–born children and adolescents (≥ 37 gestational weeks) was analysed for comparison. Various factors, including DBMP, missed appointments, dental caries, and radiographic examinations, were retrieved from the dental records for three age intervals: 3–6 years, 7–12 years, and 13–19 years.

Results

Extremely preterm–born children missed significantly more dental appointments and presented with more DBMP during dental examinations and treatment than full term–born children in the 3–6-year age group; the same was observed for the very preterm–born in the 7–12-year age group. No significant differences in DBMP during bitewing and periapical examinations or in number of bitewing, periapical and panoramic radiographs occurred between the groups in any age interval.

Conclusion

Preterm–born children and adolescents may need more flexibility in booking and receive reminders for scheduled visits with the general dental team. Due to the non-significant differences in dental care related oral examinations and treatments, the same dental care service may be applied to the preterm- and full-term born children and adolescents.

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.