Management of gagging in dental patients

Prashanti Eachempati, Sumanth Kumbargere Nagraj, Salian Kiran Kumar Krishanappa, Renjith P George, Htoo Htoo Kyaw Soe, Laxminarayan Karanth

Review question

With this Cochrane Review we tried to find out the best way to manage gagging in people having dental treatment.

Background

The gag reflex is a normal process to protect the throat and airway from foreign objects and prevent choking. Many people have an exaggerated gag reflex that causes distress during dental treatment. This can make it difficult or even impossible to perform the treatment. The interventions used to manage gagging include anti‐nausea medicines, sedatives, local and general anaesthetics, herbal remedies, behaviour therapy and cognitive behaviour therapy, acupressure, acupuncture, laser, and prosthetic devices.

We wanted to know how effective and safe these interventions are in helping people complete their dental treatment with less gagging. We compared them to no intervention or a placebo or to other interventions.

Study characteristics

This review is up‐to‐date as of 18 March 2019. We included four trials with 328 people (263 adults and 65 children who were 4 years or older). These people had nausea before when having dental treatment that caused the treatment to be stopped or not carried out properly.

Key results

Acupuncture at P6 point (a point located in the inside of the wrist) showed successful completion of dental treatment and reduction in gagging when compared to sham (fake) acupuncture. The same intervention with sedation did not show a difference.

Acupressure (with thumb or sea band (bands that fit around the wrist just like a sweat band with a pressure stud sewn inside)) at P6 point with or without sedation did not show any difference when compared to sham acupressure. Acupressure at P6 point with device showed a difference in completing dental treatment and reduction in gagging. It did not show a difference when combined with sedation.

Laser at P6 point showed a difference in absence of gagging and reduction in gagging during dental treatment when compared to sham laser application.

The included studies did not report any important harmful effects of the treatment.

Certainty of the evidence

The level of belief we have in these findings is very low. This was due to unclear risk of bias and the small number of people studied in the four included trials.

Conclusion

We do not have enough evidence to say which intervention works better to manage gagging in people having dental treatment. We suggest that more well‐conducted studies should be done in this area.

Read the full review.

Eachempati  P, Kumbargere Nagraj  S, Kiran Kumar Krishanappa  S, George  RP, Soe  HHK, Karanth  L. Management of gag reflex for patients undergoing dental treatment. Cochrane Database of Systematic Reviews 2019, Issue 11. Art. No.: CD011116. DOI: 10.1002/14651858.CD011116.pub3.