In a recent study published in the International Dental Journal , researchers looked at the potential link between self-reported emetophobia, excessive nausea, and anxiety in the dental office.
Dental anxiety is a well-studied behavioral barrier to dental care, while the overactive gag reflex triggered by unpleasant stimuli is less studied but concerning. The gag reflex can affect dental treatment and is associated with sexual penetration problems and a history of abuse in women.
Self-assessment techniques, such as the Nausea Problem Assessment Tool (GPAR) and the Nausea Assessment Scale (GAS), assess nausea. Emetophobia, a specialized phobia of vomiting, has been less explored, but may be related. Emetophobic people experience intense dread, panic symptoms, avoidance, safety measures, and a higher likelihood of depression, anxiety disorders, and eating disorders.
In the present cross-sectional study, researchers investigated the relationship between self-reported anxiety, excessive nausea, and emetophobia in the dental chair.
Summary
Excessive gag reflex, dental anxiety and vomit phobia in dental care
Behavioral dysfunctions related to the oropharynx can represent a significant obstacle to routine dental care. Dental anxiety is the best known and most commonly studied of these dysfunctions. The excessive gag reflex, which has been less studied, is another such obstacle.
A physiological gag reflex is usually elicited by immediate noxious stimuli applied to the oropharynx. However, nausea is also associated with cognitive aspects that can cause the patient to recognize “neutral” stimuli as harmful, threatening or unpleasant, thus evoking the associated response. The estimated prevalence of nausea during dental treatment is around 8%. .
Emetophobia ( fear of vomiting) is a specific phobia that has been the subject of relatively little analysis. It is defined as an intense, irrational fear of vomiting that includes the fear of feeling nauseous, of seeing or hearing another person vomit, or of seeing vomit itself. People with emetophobia report high levels of fear, the presence of panic symptoms, and extensive avoidance and safety behaviors.
Background
The most well-known and commonly studied behavioral barrier to dental care is dental anxiety . A less studied but no less problematic obstacle is the excessive gag reflex , which can seriously impede dental treatment. Another understudied and possibly related syndrome is emetophobia (a specific phobia of vomiting).
Aim
The objective of this study was to examine the possible comorbidity between emetophobia, dental anxiety, and excessive nausea in the dental office.
Methods
A cross-sectional online survey was conducted using the following self-report questionnaires: Dental Anxiety Scale, Nausea Problem Assessment, Nausea Assessment Scale (GAS), and Specific Vomiting Phobia Inventory (SPOVI).
Results
In total, 164 participants completely completed the questionnaires (87.8% female; mean age, 34 ± 11.07 years). Positive correlations were found between all variables (p < 0.001).
Elevated nausea (GAS > 6) was associated with a 7.29-fold increased risk ( p < 0.000) of positive emetophobia (SPOVI ≥ 10).
Linear regression analyzes revealed that reflex intensity and nausea experience upon encountering odors in the dental office, as well as dental anxiety and vomiting phobia, significantly predicted participants’ nausea scores as assessed by GAS. (R2 = 0.59; F = 21.16; P < 0.001).
Conclusions
The study shows that excessive gag reflex in the dental office is closely related to both dental anxiety and emetophobia.
Discussion
The prevalence of behavioral dysfunctions related to the oropharyngeal region is substantial. For the most part, these behavioral dysfunctions do not pose immediate health dangers. However, they can have a significant impact on a person’s quality of life. One such dysfunction that can pose a serious challenge in dental care is excessive gag reflex . The estimated prevalence of nausea during dental treatment is around 8% to 9%, as is the prevalence of fear of vomiting. In the last decade, the scientific community has shown growing interest in these 2 phenomena.
The general report of the participants in the present study coincides with that reported in the literature on emetophobia. For example, Price et al reported that intrusive mental images can contribute to the maintenance of emetophobia and that aversive memories form a significant proportion of the images, with taste or smell being present in 30% of the images. In the present study, more than half of the participants reported negative memories associated with nausea or vomiting and many (10%-17%) stated that odors can evoke the syndrome.
The role odors play in nausea in the dental office is not surprising. Dental clinics are often associated with strong, distinctive odors, such as the smells of eugenol, disinfecting agents, and sodium hypochlorite. In the present study, olfactory stimuli from the dental office were part of the models predicting symptoms. Smells in the dental office apparently play a bigger role in nausea (and possibly dental anxiety, too) than previously thought. These results suggest that odor questions should be incorporated into any future measures to assess gold-related behavioral dysfunctions.
Research suggests that previous or existing physical health problems, such as breathing problems, a family history of retching, and the prevalence of other psychological difficulties, may have an impact among adults who experience difficulties with retching. Consistent with this finding, among the current population sample, almost a quarter reported mouth breathing and a relatively high proportion reported having undergone tonsillectomy (6.5%). Additionally, family history may be a factor, as 12.5% of participants reported that other members of their family also experience excessive nausea.
The present study confirms previous reports that excessive nausea in the dental office is closely associated with dental anxiety. This finding is consistent with the notion that nausea may be triggered by the dental procedure itself or by anxiety and negative expectations associated with a visit to the dental clinic. Some research has suggested that fear related to dental care and fear of pain are associated with more frequent nausea. A feedback loop is likely at play, where fear leads to more frequent nausea and this, in turn, amplifies and sustains the fear.
Regardless of the true cause-effect relationship between fear and nausea, Randall et al suggested that the association between fear and nausea is likely a result of conditioning (classical or operant).
Final message Excessive gag reflex in the dental office is closely related to both dental anxiety and emetophobia. When treating a patient with an excessive gag reflex, the dentist must be aware that this condition can cause deep-seated emotional reactions. |
Reference : Nir Uziel, Efrat Gilon, Idan Bar, Naftaly Edri, and Ilana Eli. Excessive Gag Reflex, Dental Anxiety, and Phobia of Vomiting in Dental Care, International Dental Journal 000 (2023):1–7, DOI: 10.1016/j.identj.2023.12.002, https://www.sciencedirect.com/science /article/pii/S0020653923009826
