Effectiveness of intellectual color game, audio-visual and stress ball distraction methods on gagging and anxiety management in children

Objectives: To compare the effectiveness of Intellectual color game, Audio-Visual and Stress Ball distraction methods on gagging and anxiety management in children. Study design: One hundred eight children, between 5 and 12 years of age, with gag reflex score ranging from G1 to G3 requiring upper and lower alginate impressions for diagnostic purpose were included in the study. The baseline gagging score (G0) and baseline anxiety (A0) was recorded for included children. Then upper and lower impressions were attempted with unflavored alginate by employing one of the selected distraction methods (Intellectual Color Game, Audio-Visual, Stress-Ball) by randomization protocol. The anxiety and gag reflex scores were recorded after impression procedure and analyzed statistically. The p value set was p ≤ 0.05. Results: Children in stress ball group showed higher significant change in the pre and post gagging scores when compared to audio visual and intellectual color game groups. While assessing anxiety scores, all the three groups showed significant change between the pre and post anxiety scores. Conclusion: Intellectual Color Game, Audio-Visual and Stress-Ball distraction methods can be recommended as implicit tools for gagging and anxiety management in children.

Anxiety; Distraction; Gagging; Intellectual color game; Stress ball

1. Roy S, Bhayya D, Gupta S, Upadhyay K, Tiwari S, Rao A. Awareness and prevention of patient gag reflex among pedodontists in India: a web-based survey. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2016; 34: 238–243.

2. Bassi GS, Humphris GM, Longman LP. The etiology and management of gagging: a review of the literature. The Journal of Prosthetic Dentistry. 2004; 91: 459–467.

3. Dickinson CM, Fiske J. A review of gagging problems in dentistry: I. Aetiology and classification. Dent Update. 2005; 32: 26–28, 31–32.

4. Davies AE, Kidd D, Stone SP, Mac Mahon J. Pharyngeal sensation and gag reflex in healthy subjects. Lancet. 1995; 345: 487–488.

5. Musani S, Musani I, Dugal R, Kothavade M. Gagging: aetiology and management. Indian Journal of Dental Advancements. 2010; 2: 332–336.

6. Saita N, Fukuda K, Koukita Y, Ichinohe T, Yamashita S. Relationship between gagging severity and its management in dentistry. Journal of Oral Rehabilitation. 2013; 40: 106–111.

7. Singh RK, Gupta VK, Kumar A, Singh A, Shetty R, Pandey V. Effectiveness and comparison of various audio distraction aids in management of anxious dental paediatric patients. International Journal of Contemporary Medical Research. 2016; 3: 1532–1534.

8. Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clinical, Cosmetic and Investigational Dentistry. 2016; 8: 35–50.

9. Al-Khotani A, Bello LA, Christidis N. Effects of audiovisual distraction on children’s behaviour during dental treatment: a randomized controlled clinical trial. Acta Odontologica Scandinavica. 2016; 74: 494–501.

10. Rosted P, Bundgaar M, Gordon S, Pedersen AML. Acupuncture in the management of anxiety related to dental treatment: a case series. Acupuncture in Medicine. 2010; 28: 3–5.

11. Avisa P, Kamatham R, Vanjari K, Nuvvula S. Effectiveness of acupressure on dental anxiety in children. Pediatric dentistry. 2018; 40: 177–183.

12. Akarslan ZZ, Erten H. Reliability and validity of the Turkish version of the shorter form of the gagging problem assessment questionnaire. Journal of Oral Rehabilitation. 2010; 37: 21–25.

13. Fiske J, Dickinson C. The role of acupuncture in controlling the gagging reflex using a review of ten cases. British Dental Journal. 2001; 190: 611–613.

14. Vachiramon A, Wang WC. Acupressure technique to control gag reflex during maxillary impression procedures. The Journal of Prosthetic Dentistry. 2002; 88: 236.

15. Eitner S, Wichmann M, Holst S. “Hypnopuncture”—a dentalemergency treatment concept for patients with a distinctive gag reflex. The International Journal of Clinical and Experimental Hypnosis. 2005; 53: 60–73.

16. Debs NN, Aboujaoude S. Effectiveness of intellectual distraction on gagging and anxiety management in children: a prospective clinical study. Journal of International Society of Preventive & Community Dentistry. 2017; 7: 315–320.

17. Dixit UB, Moorthy L. The use of interactive distraction technique to manage gagging during impression taking in children: a single-blind, randomized controlled trial. European Archives of Paediatric Dentistry. 2021; 22: 219–225.

18. Stavley S, Brasel H. Using stress balls to focus the attention of sixth-grade learners. The Journal of At-Risk Issues. 2006; 12: 7–16.

19. Sadana G, Grover R, Mehra M, Gupta S, Kaur J, Sadana S. A novel Chotta Bheem-Chutki scale for dental anxiety determination in children. Journal of International Society of Preventive and Community Dentistry. 2016; 6: 200–205.

20. Katsouda M, Tollili C, Coolidge T, Simos G, Kotsanos N, Arapostathis KN. Gagging prevalence and its association with dental fear in 4-12-year-old children in a dental setting. International Journal of Paediatric Dentistry. 2019; 29: 169–176.

21. Prabhakar AR, Marwah N, Raju OS. A comparison between audio and audiovisual distraction techniques in managing anxious pediatric dental patients. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2007; 25: 177–182.

22. Navit S, Johri N, Khan SA, Singh RK, Chadha D, Navit P, et al. Effectiveness and comparison of various audio distraction aids in management of anxious dental paediatric patients. Journal of Clinical and Diagnostic Research. 2015; 9: ZC05–ZC09.

23. Abhishek N. Effect of videos in reducing anxiety in patients undergoing dental treatment. Journal of Pharmaceutical Sciences and Research. 2016; 8: 1301–1303.

24. Kulkarni P, Chhattani B, Agrawal N, Mali S, Kale S, Thakur NS. Management of gagging and anxiety in children by play way method. International Journal of Drug Research and Dental Science. 2021; 3: 35–40.

25. Donaldson ZR, Piel DA, Santos TL, Richardson-Jones J, Leonardo ED, Beck SG, et al. Developmental effects of serotonin 1a autoreceptors on anxiety and social behavior. Neuropsychopharmacology. 2014; 39: 291–302.

26. Singh S, Ali FM, Nazirkar G, Dole VK, Gaikwad B. Gag- etiology and its skillfull management- a review. Journal of Evolution of Medical and Dental Sciences. 2013; 2: 1509–1516.