Main amelioration of gagging indoctrination by communication - a MAGIC technique.

Gagging during dental work is a common concern for both dentists and patients and can prevent patients from seeking or completing essential and routine dental work, often leading to further problems in the future. This paper aims to describe and review the literature on an accessible alternative to other management options to treat a patient with an exaggerated gag reflex. The author compares the effectiveness of current available treatments from published, peer-reviewed sources. The effectiveness of the MAGIC (main amelioration of gagging indoctrination by communication) technique has not yet been clinically reviewed but the experiential success by the author is near 100%. Patients were explained the technique and talked through it during treatment, leading to almost all patients who have not been able to undergo any dental treatment coping with and completing treatment. As this technique has not been assessed under clinical research conditions, we only have experiential evidence of many patients continuing and completing dental treatment following use of the MAGIC technique. This has been used with patients who both have and have not self-reported that they have a hypersensitive gag reflex. This paper reviews a novel technique for the amelioration of a hypersensitive gag reflex that can easily be incorporated in the general dental practice to the benefit of both patient and dental professional.

Effect of aromatherapy with peppermint essential oil on the gag reflex: a randomized, placebo-controlled, single-blind, crossover study.

BACKGROUND: Sensitive gag reflexes prevent dental patients from receiving appropriate treatment. Aromatherapy helps patients relax during dental procedures. However, the effect of aromatherapy on the gag reflex caused by the stimulation of the oral cavity is unknown. This study aimed to evaluate whether aromatherapy reduces gag reflexes during oral stimulation. METHODS: In this randomized, placebo-controlled, single-blind, crossover study, the gag reflexes of 24 healthy individuals (12 females and 12 males; mean age: 34.3 ± 9.5 years) were quantified. A standard saliva ejector was slowly guided down the participant's throat to determine the maximum tolerance of the gag reflex, and the insertion distance was measured to quantify the gag reflex. All individuals participated in an aromatherapy session with peppermint essential oil and a placebo session with distilled water. The gag reflex was quantified before (baseline) and after each session. Another measurement was performed using nitrous oxide/oxygen inhalation as a positive control. RESULTS: Gag reflex values significantly increased after aromatherapy with both peppermint essential oil and placebo compared to baseline values (paired t-test, P < 0.001 and P = 0.014, respectively). The gag reflex value also increased significantly during nitrous oxide/oxygen inhalation (paired t-test, P < 0.001). There was no significant difference in the increase rate of gag reflex values between the positive control and aromatherapy interventions, but it was significantly lower after the placebo intervention (repeated measures analysis of variance, P = 0.003; post-hoc test, P = 0.83 and P = 0.02). CONCLUSION: Aromatherapy with peppermint essential oil has the potential for reducing gag reflex during dental procedures. TRIAL REGISTRATION: The study was registered in the University hospital Medical Information Network Clinical Trials Registry under the code UMIN000050616 (approved 17/03/2023).

Comparative evaluation of effect of microcurrent electrical stimulation on acupoints to control gag reflex in patients receiving prosthodontic treatment: An in vivo study.

Aims: The aim of this study is to see if microcurrent electrical stimulation on two acupoints, auricular and Hegus, can help patients prevent their gag reflex. Settings and Design: This was an in vivo cross-sectional study. Materials and Methods: Thirty patients were randomly assigned to three groups: A, B, or C, of ten patients present in each group. Group A and Group B undergone electroacupuncture (microcurrent electrical stimulation) using electroacupuncture device on auricular point and Hegus point (Li 4), respectively, for 1 min and Group C formed the placebo group, point Shou San Li (Li 10). The gag severity index and the gag prevention index were used to measure the gag reflex, which was done in two steps. Statistical Analysis Used: SPSS (SPSS Inc., Chicago IL, USA) version 24 software was used for statistical analysis. Paired t-test, one-way analysis of variance test, post hoc Bonferroni test was used to analyse and compare the data. Results: It was found that Point A and Point B were significantly effective in reducing the severity of gag reflex. Point C demonstrated insignificant results. In addition, Point B (Hegus [Li4]) is more effective than Point A (auricular) in controlling the gag reflex in patients within the set age group of 20-70 years of age. Conclusions: Microcurrent electrical stimulation is a useful adjuvant in the treatment of unfavorable gag reflexes during routine dental procedures. Point Hegus and point auricular acupuncture are both useful in decreasing the severity of gag reflex, with point Hegus being more effective than point auricular.

Is laser acupuncture effective in controlling gag reflex while taking dental impressions? A randomized double-blinded sham-controlled clinical trial.

OBJECTIVE: The purpose of this study was to investigate the effect of laser acupuncture on controlling gag reflexes by stimulating pericardium 6 (PC6) and conception vessel 24 (CV24) acupuncture points in patients in need of taking dental impressions. METHODS: In this randomized controlled double-blinded clinical trial study, in 30 patients aged 20-60 years, alginate impressions were taken in the prosthetic and orthodontic clinic at the Dental School of Mashhad University of Medical Sciences, Mashhad, Iran. The participants were randomly divided into 2 groups. The intervention and the control group each included 15 subjects. Both groups were in the exact status of age, gender, and indexes, including the Gagging Severity Index (GSI), Subjective Severity of Gag Reflex (SSGR), Vomiting Number (VN), as well as the Improvement Index, measured. Both groups underwent alginate impressions pre-and postintervention. PC6 and CV24 acupuncture points were irradiated for 4 seconds in contact mode with a laser prob pressure on the skin that was slightly bleached without causing pain for the patient. The laser energy was 0.8 J with an energy density of 2.854 J/cm2 at the surface of the probe (spot size, 0.28 cm2). The total radiation dose was 45.7 J/cm2, and the power density was 714.2 w/cm2. RESULTS: The findings showed that SSGR and VN significantly improved (P ≤ .05) in the intervention group compared to the control group, but GSI was higher in the intervention group. In the intragroups analysis for the comparison between before and after the intervention, it was found that although the average GSI was elevated after the intervention rather than before, the difference was insignificant (P = .083). Also, after the intervention, the average SSGR was significantly reduced (P< .001), and VN was insignificantly lessened (P = .334). Moreover, it was observed after the intervention rather than before that GSI was significantly increased (P< .001), whereas SSGR significantly declined (P< .001), and VN meaningfully decreased (P = .001). The observations demonstrated that the Improvement Index status was significantly better in the intervention group compared to the control group (P = .002). CONCLUSION: This study found that the application of laser acupuncture on PC6 and CV24 acupuncture points might be effective in reducing the gag reflex and can be used as a noninvasive technique while taking dental impressions.

Novel mouthpiece for reducing the gag reflex during esophagogastroduodenoscopy.

BACKGROUND AND AIM: Discomfort associated with the gag reflex during transoral endoscopy can be troublesome. To overcome this problem during esophagogastroduodenoscopy (EGD), we recently developed a novel mouthpiece. The aim of the present study was to compare acceptance and tolerability of transoral EGD with conventional and new mouthpieces in unsedated patients and analyze the effects of the new mouthpiece. METHODS: This study consisted of two phases of cephalometric and EGD examinations to analyze the effects of the new mouthpiece. Cephalometry was carried out in six subjects to evaluate differences in the size of the pharynx (anteroposterior diameter of the oropharynx and longitudinal diameter of the oral cavity) when subjects held the conventional mouthpiece (MAJ674) or the new mouthpiece in their mouths. EGD was done in 10 subjects using the conventional or new mouthpiece to evaluate the number of times the gag reflex occurred, examinee discomfort, and endoscope operability during EGD using a visual analogue scale (VAS). RESULTS: Anteroposterior diameter of the oropharynx and longitudinal diameter of the oral cavity were significantly larger with the new mouthpiece than with the conventional mouthpiece (oropharynx: P = 0.03; oral cavity: P = 0.03). With the new mouthpiece during EGD, subjects had significantly fewer instances of the gag reflex (P = 0.01); VAS score for discomfort was significantly lower (P < 0.01) and score for endoscope operability was significantly higher (P = 0.04). CONCLUSION: The new mouthpiece we developed reduced the gag reflex during EGD by extending the pharynx, thus decreasing examinee discomfort and increasing endoscopic operability.

Management of gag reflex for patients undergoing dental treatment.

BACKGROUND: The gag reflex is an involuntary defence mechanism to protect the pharynx and throat from foreign objects. Gagging is a common problem encountered during dental treatment, making therapeutic procedures distressing and often difficult or even impossible to perform. Various interventions can be used to control the gag reflex: anti-nausea medicines, sedatives, local and general anaesthetics, herbal remedies, behavioural therapies, acupressure, acupuncture, laser, and prosthetic devices. This is an update of the Cochrane Review first published in 2015. OBJECTIVES: To assess the effects of pharmacological and non-pharmacological interventions for the management of gagging in people undergoing dental treatment. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the Cochrane Oral Health's Trials Register (to 18 March 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 2) in the Cochrane Library (searched 18 March 2019), MEDLINE Ovid (1946 to 18 March 2019), Embase Ovid (1980 to 18 March 2019), CINAHL EBSCO (1937 to 18 March 2019), AMED Ovid (1985 to 18 March 2019), and the proceedings of the International Association for Dental Research (IADR) online (2001 to 18 March 2019). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. We also conducted forwards citation searching on the included studies via Google Scholar. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included randomised controlled trials (RCTs), involving people who were given a pharmacological or non-pharmacological intervention to manage gagging that interfered with dental treatment. We excluded quasi-RCTs. We excluded trials with participants who had central or peripheral nervous system disorders, who had oral lesions or were on systemic medications that might affect the gag sensation, or had undergone surgery which might alter anatomy permanently. DATA COLLECTION AND ANALYSIS: We independently selected trials, extracted data, and assessed risk of bias. We followed Cochrane's statistical guidelines. We assessed the overall certainty of the evidence using GRADE. MAIN RESULTS: We included four trials at unclear risk of bias with 328 participants (263 adults and 65 children who were four years or older), in which one trial compared acupuncture and acupressure (with thumb, device and sea band) at P6 (point located three-finger breadths below the wrist on the inner forearm in between the two tendons) to sham acupuncture and acupressure with and without sedation. One trial compared acupuncture at P6 point to sham acupuncture. These trials reported both completion of dental procedure and reduction in gagging (assessor and patient reported) as their outcomes. One cross-over and one split-mouth trial studied the effect of laser at P6 point compared to control. One trial reported reduction in gagging and another reported presence or absence of gagging during dental procedure. Acupuncture at P6 showed uncertain evidence regarding the successful completion of dental procedure (RR 1.78, 95% CI 1.05 to 3.01; two trials, 59 participants; very low-certainty evidence) and uncertain evidence regarding the reduction in gagging (RR 2.57, 95% CI 1.12 to 5.89; one trial, 26 participants; very low-certainty evidence) in comparison to sham acupuncture. Acupuncture at P6 with sedation did not show any difference when compared to sham acupuncture with sedation (RR 1.08, 95% CI 0.91 to 1.28; one trial, 34 participants; very low-certainty evidence). Acupressure using thumb pressure with or without sedation showed no clear difference in completing dental procedure (RR 0.96, 95% CI 0.84 to 1.10; one trial, 39 participants; very low-certainty evidence; and RR 0.85, 95% CI 0.50 to 1.46; one trial, 30 participants; very low-certainty evidence; respectively), or reduction in gagging (RR 1.06, 95% CI 0.92 to 1.23; one trial, 39 participants; very low-certainty evidence; and RR 0.92, 95% CI 0.60 to 1.41; one trial, 30 participants; very low-certainty evidence; respectively) when compared to sham acupressure with or without sedation. Acupressure at P6 with device showed uncertain evidence regarding the successful completion of dental procedure (RR 2.63, 95% CI 1.33 to 5.18; one trial, 34 participants; very low-certainty evidence) and uncertain evidence regarding the reduction in gagging (RR 3.94, 95% CI 1.63 to 9.53; one trial, 34 participants; very low-certainty evidence) when compared to sham acupressure. However, device combined with sedation showed no difference for either outcome (RR 1.16, 95% CI 0.90 to 1.48; one trial, 27 participants; very low-certainty evidence; and RR 1.26, 95% CI 0.93 to 1.69; one trial, 27 participants; very low-certainty evidence; respectively). Acupressure using a sea band with or without sedation showed no clear difference in completing dental procedure (RR 0.88, 95% CI 0.67 to 1.17; one trial, 21 participants; very low-certainty evidence; and RR 1.80, 95% CI 0.63 to 5.16; one trial, 19 participants; very low-certainty evidence; respectively), or reduction in gagging (RR 0.88, 95% CI 0.67 to 1.17; one trial, 21 participants; very low-certainty evidence; and RR 2.70, 95% CI 0.72 to 10.14; one trial, 19 participants; very low-certainty evidence; respectively) when compared to sham acupressure with or without sedation. Laser at P6 showed a difference in absence of gagging (odds ratio (OR) 86.33, 95% CI 29.41 to 253.45; one trial, 40 participants; very low-certainty evidence) and reduction in gagging (MD 1.80, 95% CI 1.53 to 2.07; one trial, 25 participants; very low-certainty evidence) during dental procedure when compared to dummy laser application. No noteworthy adverse effects were reported. For acupuncture at P6, the trial authors were unsure whether the reported adverse effects were due to participant anxiety or due to the intervention. None of the trials on acupressure or laser reported on this outcome. We did not find trials evaluating any other interventions used to manage gagging in people undergoing dental treatment. AUTHORS' CONCLUSIONS: We found very low-certainty evidence from four trials that was insufficient to conclude if there is any benefit of acupuncture, acupressure or laser at P6 point in reducing gagging and allowing successful completion of dental procedures. We did not find any evidence on any other interventions for managing the gag reflex during dental treatment. More well-designed and well-reported trials evaluating different interventions are needed.

The gagging patient in ORL examinations: predictors, evaluation and treatment.

PURPOSE: Gagging may be a challenge in daily otorhinolaryngology (ORL) routine. This cross-sectional study aimed to examine conditions of gagging as limitation to ORL examination and the efficacy of acupressure as tool to reduce exaggerated gagging. METHODS: The study was conducted on a total of 360 study subjects. There was a survey part and a routine ORL examination with observation of gagging behaviour. Through binomial univariate logistic regression, predictors of clinically relevant exaggerated gagging were identified. Wilcoxon signed rank test was used to evaluate efficacy of acupressure point CV-24 to reduce gagging while examination. RESULTS: First gagging's relevance was indicated by over 40% of study subjects showing clinically relevant exaggerated gagging. Furthermore, we found that more psychogenic than somatogenic features proved to be predictors of exaggerated gagging. Third acupressure point CV-24 showed statistical significant reduction of gagging intensity and improved examination feasibility. CONCLUSION: Awareness of exaggerated gagging's predictors are the first step to deal with gagging in daily practice. Acupressure might be an effective tool to overcome gagging in the affected patients. LEVEL OF EVIDENCE: We suggest at least Level IV according to Oxford (UK) CEBM Levels of Evidence.

Reliability, validity, and sex differences in a quantitative gag reflex measurement method.

A reliable assessment method is required to manage the gag reflex. We tested the inter- and intra-examiner reliability and validity of a quantitative measurement method and evaluated the differences between sexes. This study included 21 healthy adults (10 women, 11 men; mean age, 27.1 ± 9.9 years). An examiner inserted a standard saliva ejector slowly down the participant's throat to determine the maximum tolerance of the gag reflex; the insertion depth was used as an index of gag reflex. The reflex was measured by one examiner during two sessions (S1 and S3) and by a second examiner during one session (S2) under the same conditions. The galvanic skin response (GSR) and heart rate (HR) were recorded during each session to test the method validity. Data were analysed using the intraclass correlation coefficient (ICC), paired t test, and two-way repeated-measures analysis of variance. The ICC of the gag reflex measurements was 0.91 between S1 and S2, and 0.93 between S1 and S3. The GSR and HR increased significantly after the maximum tolerance of the reflex in S1, S2, and S3 (GSR: P < 0.001, P = 0.004, P = 0.001, respectively; HR: all, P < 0.001). Differences in the measurements according to sex and session were not significant. Our method exhibited excellent inter- and intra-examiner reliability and was unaffected by the participants' sex. Measurement revealed significant autonomic reactivity, which is common for this reflex. Consequently, this method may be used in clinical and laboratory-based applications.

The Effect of Adding Midazolam to Propofol Intravenous Sedation to Suppress Gag Reflex During Dental Treatment.

We retrospectively investigated the efficacy and safety of propofol administration alone and in combination with midazolam for gag reflex suppression during dental treatment under intravenous sedation. We included 56 patients with an overactive gag reflex who were to undergo dental treatment under intravenous sedation. They were divided into propofol (P group, n = 22) and midazolam with propofol (MP group, n = 34) groups. The P group received propofol alone, while the MP group received midazolam (0.04 mg/kg) prior to target-controlled infusion (TCI) of propofol (titrated for adequate sedation). The patients' anesthetic records were evaluated for vital sign changes, adverse cardiovascular or respiratory event frequency, the number of forced treatment interruptions, and the TCI-predicted cerebral propofol concentration at gag reflex suppression (posterior tongue stimulation with a dental mirror). No significant differences were observed between the 2 groups preoperatively. There were no cases of forced interruptions or significant respiratory compromise in either group. Cardiovascular adverse event frequency was lower in the MP group than in the P group (all p < .05). Our results suggest that propofol, when combined with midazolam, minimized cardiovascular effects compared with propofol alone when used to suppress the gag reflex in patients during dental treatment under intravenous sedation.

Engasgo

O engasgo é uma manifestação do organismo para expelir alimento ou objeto que toma um “caminho errado”, durante a deglutição (ato de engolir). O engasgo é considerado uma emergência, e em casos graves, pode levar a pessoa à morte por asfixia ou deixá-la inconsciente por um tempo. Sendo assim, agir rapidamente evita complicações.

Effect of Low-level LASER Therapy on P6 Acupoint to Control Gag Reflex in Children: A Clinical Trial.

OBJECTIVE: To investigate the effect of low level laser therapy (LLLT) on PC6 acupuncture point in suppressing gag reflex, regulating pulse rates and oxygen saturation, thereby reducing the anxiety levels. MATERIALS AND METHOD: A total of 40 patients who demonstrated hyperactive gag reflex in the age group of 4-14 years were included in the study. In Group A (20 patients), maxillary impression was recorded. In the second step, PC6 acupuncture point was stimulated with LLLT followed by recording of second maxillary impression. In group B (20 patients), steps were reversed. Gag reflex, anxiety levels, pulse rate and oxygen saturation levels were assessed. RESULTS: Values of pulse rate and oxygen saturation were regulated to normal, signifying lowered anxiety levels. Gag reflex was also significantly decreased after stimulating PC6 acupuncture point with LLLT. CONCLUSION: LLLT on PC6 point was found to be effective in lowering anxiety levels as observed by faces modified anxiety rating scale. Further, it was authenticated as the pulse rates were significantly reduced and oxygen saturation levels were significantly increased. Also, gag reflex was significantly controlled when LASER stimulation was done at PC6.

Effect of propofol combined with opioids on cough reflex suppression in gastroscopy: study protocol for a double-blind randomized controlled trial.

INTRODUCTION: The best methods for inducing analgesia and sedation for gastroscopy are still debated but finding an adequate regimen of sedation/analgesia is important. Stimulation of the larynx under sedation can cause reflex responses. Propofol with opioids has been recommended for gastroscopy sedation but the effects on cough reflex suppression remain unclear. This trial will evaluate the effects of propofol combined with small doses of dezocine, oxycodone, sufentanil or fentanyl for gastroscopy. We hypothesise that better performance may be obtained with a combination of propofol and oxycodone. We will observe the incidence and degree of reflex coughing and gagging under sedation when using propofol combined with one of the above drugs or propofol alone. METHODS AND ANALYSIS: This will be a prospective, randomised, double-blind, controlled trial. ASA I-II level patients aged 18-65 years and scheduled for gastroscopy will be included. It is planned that 500 subjects will be randomised to intravenously receive 2-2.2 mg/kg propofol plus 0.5-0.8 µg/kg fentanyl (fentanyl group), 2-2.2 mg/kg propofol plus 0.05-0.08 µg/kg sufentanil (sufentanil group), 2-2.2 mg/kg propofol plus 0.04-0.05 mg/kg dezocine (dezocine group), 2-2.2 mg/kg propofol plus 0.04-0.05 mg/kg oxycodone (oxycodone group), or 2.4-3 mg/kg propofol plus 2-2.5 mL saline (control group) for sedation. The primary endpoint is the incidence and degree of reflex coughing and gagging. The secondary endpoints include the occurrence of discomfort or side effects, the use of jaw thrust, assisted ventilation or additional propofol, recovery time, duration of procedure and Steward score. ETHICS AND DISSEMINATION: This study has been approved by the Institutional Ethics Committee for Clinical Research of Zhongda Hospital, Affiliated to Southeast University (No. 2015ZDSYLL033.0). The results of the trial will be published in an international peer-reviewed journal. TRIAL REGISTRATION: This study has been registered with the Chinese Clinical Trial Register (No. ChiCTR-ICR-15006952). TRIAL STATUS: At the time of manuscript submission, the study was in the recruitment phase.

Optimal dose of succinylcholine for laryngeal mask airway insertion: systematic review, meta-analysis and metaregression of randomised control trials.

OBJECTIVES: To evaluate the optimal dose of succinylcholine for laryngeal mask airway (LMA) insertion and all related morbidities. DESIGN: Systematic review, meta-analysis and metaregression of randomised controlled trials (RCTs). DATA SOURCE AND STUDY ELIGIBILITY CRITERIA: A comprehensive search of RCTs in the PubMed, Embase, the Cochrane Library and the ClinicalTrials.gov registry up to July 2016 and articles that evaluated the use of succinylcholine chloride for LMA insertion were included in the analyses. The relative risk (RR) and the corresponding 95% CIs were determined. INTERVENTION: Succinylcholine as the coinduction agent and the doses were divided into mini (≤0.3 mg/kg) and low (0.3-1.0 mg/kg) doses for dose-dependent effect analyses. PRIMARY AND SECONDARY OUTCOMES: The primary outcome was the first-attempt LMA insertion failure rate. Secondary outcomes included all related adverse events. RESULTS: Data from 10 RCTs comprising 625 participants showed that succinylcholine reduced the first-attempt LMA insertion failure rate (RR, 0.22; 95% CI 0.12 to 0.43), coughing and gagging (RR, 0.26; 95% CI 0.15 to 0.45) and laryngospasm (RR, 0.14; 95% CI 0.05 to 0.39). The use of succinylcholine did not result in a significant increase of postoperative myalgia (RR, 2.58; 95% CI 0.79 to 8.44) and did not reduce the risk of postoperative sore throat (RR, 0.76; 95% CI 0.55 to 1.03). Subgroup analysis further showed that low-dose succinylcholine reduced the LMA insertion failure rate and its related coughing and gagging when compared with mini dose. CONCLUSION: The use of succinylcholine compared with none can facilitate LMA insertion and reduce insertion-related reflexes without significant postoperative myalgia. However, additional prospective studies with a larger sample size are required to fully evaluate the dose-dependent effect and complications of succinylcholine for LMA insertion.

An Innovative Approach to Overcome Gagging Through Acupressure for an Edentulous Patient: A Case Report.

The gag reflex is a physiological reaction, which safeguards the airway from foreign bodies. In some people, this response is exaggerated to the extent that the acceptance/provision of dental treatment becomes impossible. Management of patients with gagging involves many different approaches. The aim of this report is to illustrate the role of acupressure in controlling gagging, because it is a safe, affordable, quick, and relatively noninvasive technique.

Awareness and prevention of patient gag reflex among pedodontists in India: A web-based survey.

AIM: The aim of this study is to devise a reliable and valid web-based survey to predict the awareness level and prevention of patient's gag reflex among Indian pedodontists. MATERIALS AND METHODS: An 11-question predictive gagging survey was created, refined, and tested on 377 pedodontists. The questions focused on age group, common procedure associated with gag reflex and the most common technique adapted by dentists in their clinics to prevent gag. RESULTS: There was no statistically significant difference in gagging reflex among age groups with 53.5% of patients reported anxiety and fear as a main cause of gag; behavioral modification technique was considered as the most reliable method for gagging prevention in 68.5% of patients and there was no statistically significant difference in gagging severity index among patients irrespective of age, causes, and methods used to prevent it. CONCLUSION: The web-based gagging survey established that level of awareness regarding management of patient's gag is significantly low among pedodontists in India and hence is a major hindrance in the clinical practice.

Training Plates: A Solution for Patients Unable to Tolerate a Removable Prosthesis.

Dealing with patients who are unable to tolerate dentures can present a challenge to the general dental practitioner (GDP). Careful assessment of patients and their dentures will identify any causes of the intolerance to dentures. Training plates are a useful technique that can be used to allow patients to become accustomed to removable prosthesis but will inevitably lengthen the treatment process. CPD/Clinical Relevance: Training plates offer a possible solution to general dental practitioners who treat patients who are struggling to tolerate dentures.

The use of low-level laser therapy for controlling the gag reflex in children during intraoral radiography.

The current literature suggests that low-level laser stimulation of the PC 6 acupuncture points may prevent gagging. This study aimed to determine if low-level laser therapy (LLLT) can reduce the gag reflex in children undergoing intraoral maxillary radiography. This randomized, controlled, double-blind clinical trial was conducted with 25 children with moderate-to-very severe gag reflexes who required bilateral periapical radiographic examination of the maxillary molar region. Children's anxiety levels were initially evaluated using Corah's Dental Anxiety Scale (DAS) to identify any possible relationship between gagging and anxiety. A control radiograph was taken of one randomly selected side in each patient after simulated laser application so that the patient was blinded to the experimental conditions (control group). Laser stimulation was then performed for the experimental side. A laser probe was placed on the Pericardium 6 (PC 6) acupuncture point on each wrist, and laser energy was delivered for 14 s (300 mW, energy density 4 J/cm(2)) at a distance of 1 cm from the target tissue. Following laser stimulation, the experimental radiograph was taken (experimental group). Gagging responses were measured using the Gagging Severity Criteria for each group. Data were analyzed using Spearman's rho correlations and Mann-Whitney U tests. Both mean and median gagging scores were higher in the control group than in the experimental group. Patients who were unable to tolerate the intraoral control radiography were able to tolerate the procedure after LLLT. Differences between gagging scores of the control and experimental groups were statistically significant (P = .000). There was no significant correlation between gagging severity and anxiety score (P > .05). A negative correlation was found between age and gagging score in the control group (P ˂ .05). Within the limitations of this study, LLLT of the PC 6 acupuncture points appears to be a useful technique for controlling the gag reflex in children during maxillary radiography.

Laser therapy on points of acupuncture: Are there benefits in dentistry?

Studies have shown the use of laser therapy at points of acupuncture as an alternative to metal needles. The scientific literature in the area of laser acupuncture is rather large; however, the actual mechanisms and effects have not yet been proven in detail. Therefore, the current manuscript reviews the existing literature regarding the effects of laser acupuncture in Dentistry, seeking treatment modalities in which this technique is used and which are able to generate positive clinical results. Thus, the literature survey was conducted in electronic databases--Medline/Pubmed, VHL and Science Direct--using the uniterms "alternative medicine", "low-power laser and acupuncture", "laser acupuncture and dentistry" and "laser therapy and acupuncture". Retrospective and prospective clinical studies were considered. According to the findings of the literature, laser therapy at points of acupuncture was effective for the treatment of various orofacial problems encountered in dentistry, but there are still many differences among the parameters used for irradiation and there is a lack of important information reported by the studies, such as the wavelength, dose, power density, irradiation time and frequency, points of acupuncture selected for irradiation and therapy outcomes. Although these results indicate the potential benefit of the use of laser therapy at points of acupuncture on Dentistry, further double-blinded, controlled clinical trials should be carried out in order to standardize protocols for clinical application.

Prosthetic rehabilitation of the gagging patient using acrylic training plates.

Patients with a hyper-responsive gag reflex pose dentists with a challenging problem. The gag reflex of some patients may be so severe that patients (and operating clinician) may favour extraction of any painful, infected teeth as opposed to more lengthy and complicated procedures such as root canal therapy. However, consistently adopting this approach may render the gagging patient completely edentulous. Such patients may then present to the dental surgeon requesting tooth replacement with some form of denture. This in itself can be a challenging task given the difficulties one may experience whilst taking impressions in this cohort of patients. This article will discuss the prosthetic management of the maxillary arch in edentulous patients with a severe gag reflex. There will be particular emphasis on the aetiology and physiology of the gag reflex, impression-taking techniques to allow the construction of an acrylic training plate (as an interim measure), principles of training plate design and construction of the definitive removable denture. Clinical Relevance: Removable training plates can be used as an interim measure to desensitize edentulous gagging patients before providing them with a definitive removable denture.

Sedation-analgesia with propofol and remifentanil: concentrations required to avoid gag reflex in upper gastrointestinal endoscopy.

BACKGROUND: The purpose of this study was to identify optimal target propofol and remifentanil concentrations to avoid a gag reflex in response to insertion of an upper gastrointestinal endoscope. METHODS: Patients presenting for endoscopy received target-controlled infusions (TCI) of both propofol and remifentanil for sedation-analgesia. Patients were randomized to 4 groups of fixed target effect-site concentrations: remifentanil 1 ng•mL (REMI 1) or 2 ng•mL (REMI 2) and propofol 2 µg•mL (PROP 2) or 3 µg•mL (PROP 3). For each group, the other drug (propofol for the REMI groups and vice versa) was increased or decreased using the "up-down" method based on the presence or absence of a gag response in the previous patient. A modified isotonic regression method was used to estimate the median effective Ce,50 from the up-down method in each group. A concentration-effect (sigmoid Emax) model was built to estimate the corresponding Ce,90 for each group. These data were used to estimate propofol bolus doses and remifentanil infusion rates that would achieve effect-site concentrations between Ce,50 and Ce,90 when a TCI system is not available for use. RESULTS: One hundred twenty-four patients were analyzed. To achieve between a 50% and 90% probability of no gag response, propofol TCIs were between 2.40 and 4.23 µg•mL (that could be achieved with a bolus of 1 mg•kg) when remifentanil TCI was fixed at 1 ng•mL, and target propofol TCIs were between 2.15 and 2.88 µg•mL (that could be achieved with a bolus of 0.75 mg•kg) when remifentanil TCI was fixed at 2 ng•mL. Remifentanil ranges were 1.00 to 4.79 ng•mL and 0.72 to 3.19 ng•mL when propofol was fixed at 2 and 3 µg•mL, respectively. CONCLUSIONS: We identified a set of propofol and remifentanil TCIs that blocked the gag response to endoscope insertion in patients undergoing endoscopy. Propofol bolus doses and remifentanil infusion rates designed to achieve similar effect-site concentrations can be used to prevent gag response when TCI is not available.