Effect of Virtual Reality and Musical Earplug Temporal Tap Technique in Reduction of Gag Reflex in Pediatric Patients

Gagging is a stimulated, protective reflex to prevent any material from entering the mouth or oropharynx. However, a hyperactive gag reflex is a common occurrence and anxiety-provoking stimulus while performing routine clinical procedures. Impression making is a clinical procedure that causes pronounced gagging and severe discomfort to the patient. As making an impression is a crucial step in routine dental treatment, it is imperative to make the process of impression making as comfortable as possible to provide quality dental care. Very few studies have reported on the effect of virtual reality (VR) and musical earplug temporal tap technique (METTT) in impression making.

To evaluate the effect of VR and METTTs on the reduction of the gag reflex in pediatric patients.

Sixty healthy patients aged 6-12 years were diagnosed with the presence of a hyperactive gag reflex using the Gag Severity Index (GSI). GSI scores of 2 and above were included in the study, and mandibular alginate impressions were made with standard distraction methodology, which served as the baseline level of gag in each patient. These children were then randomly divided into two groups. In the first group, 30 patients' maxillary alginate impressions were made with VR facilitated techniques, while the remaining 30 patients' impressions were made with the METTT. The amount of gag reduction was evaluated with the Gag Prevention Index (GPI) score during the impressions at intervals of 0, 30, and 60 seconds. Anxiety was assessed using heart rate, oxygen saturation, and the modified version of the faces dental anxiety scale following impression making.

Intragroup METT-facilitated impression-making showed a statistically significant reduction in heart rate. However, intergroup comparison showed no statistically significant difference in the amount of reduction of the gag reflex, oxygen saturation, or patient experience.

The gag reflex was not reduced by VR or METTT. Nevertheless, a decrease in heart rate during METTT-facilitated mandibular impression making indicated a reduction in anxiety. Hence, METTT can be applied as an adjuvant in patients with severe gag reflexes when making an impression.

Gandhi M, Lakade L, Kunte S, et al. Effect of Virtual Reality and Musical Earplug Temporal Tap Technique in Reduction of Gag Reflex in Pediatric Patients. Int J Clin Pediatr Dent 2024;17(9):981-986.