Altering the Gag Reflex Via a Palm Pressure Point

Scarborough, Donna; Kuren, Michael Bailey-Van; Hughes, Michael S.

doi:10.14219/jada.archive.2008.0048

Cited by 22 publications

(15 citation statements)

References 17 publications

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“…Scarborough et al. (2) reported that, in response to a stimulus, subjects with exaggerated gag reflexes begin to gag in regions that are more anterior to the trigger zone regions. We did not determine the specific point(s) in the oral cavity where the patient started to gag.…”

Section: Discussionmentioning

confidence: 99%

“…The purpose of the gag reflex is to remove unwanted material from the oropharynx and upper gastrointestinal tract (1). Generally, tactile stimulation of the anterior and posterior faucial pillars, base of the tongue, soft palate, uvula or posterior pharyngeal wall can elicit the gag reflex (2, 3). Visual, auditory and olfactory stimuli, as well as simply thinking about a stimulus, may trigger the reflex in rare cases.…”

Section: Introductionmentioning

confidence: 99%

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Utility of the gagging problem assessment questionnaire in assessing patient sensitivity to dental treatments

Akarslan¹,

Biçer²

2012

J of Oral Rehabilitation

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Although the Gagging Problem Assessment Questionnaire (GPA) can be used to identify patients with gag reflex, it does not provide information about patient sensitivity to dental procedures. The aim of this study was to assess the utility of GPA in determining patient sensitivity (i.e. gag reflex) in response to intra-oral radiography and impression-taking procedures. The study included 95 patients (65 women; mean age, 44·2 ± 13·4 years) undergoing dental treatment at a Turkish dental school. Patients completed the patient section of the GPA before their dental examination. An observing dentist monitored and scored the gag reflex of patients during each step of intra-oral radiographic examination and impression taking. The overall sensitivity of the patient to the entire process was also recorded. Descriptive statistics, one-way analysis of variance and the Tukey's test were used for statistical analysis. Patients with GPA scores of 1·00-1·74 did not show any gagging or displayed only mild discomfort during the procedures. Patients with GPA scores of 1·75-3·24 showed moderate gagging, which was managed with prophylactic and suppressive precautions. Patients with GPA scores of 3·25-4·00 were unable to complete the procedures because of gagging. Differences (all P < 0·001) were found between the three groups for the observed responses of patients during radiography (F, 203·343), impression (F, 175·035) and radiography + impression procedures (F, 228·319), with no significant difference between women and men. In conclusion, GPA may be helpful for the prediction of patient sensitivity to dental treatments.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Utility of the gagging problem assessment questionnaire in assessing patient sensitivity to dental treatments

Akarslan¹,

Biçer²

2012

J of Oral Rehabilitation

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“…Gagging was assessed using the gag trigger point index (GTPI) as modified from the original method [4]. The GTPI is an ordinal index in which the oropharyngeal regions are divided by anatomical landmarks and assigned a score (posterior pharynx with no motor response = 0, posterior pharynx with motor response = 1, between posterior faucial pillars and posterior pharyngeal wall = 2, posterior faucial pillars = 3, between anterior and posterior faucial pillars = 4, anterior faucial pillars = 5, between second molars and anterior faucial pillars = 6, second molars = 7, internal cheek = 8).…”

Section: Methodsmentioning

confidence: 99%

The comparison of feasibility and safety on fiberoptic guided intubation under conscious sedation with remifentanil and propofol

Lee

Sakong

Jee

2013

Korean J Anesthesiol

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BackgroundOropharyngeal manipulation is problematic when patients have a gag reflex. Sedation can suppress gag reflex, but can cause serious airway problems. We compared remifentanil (Group R) and propofol (Group P) in terms of cooperation and loss of gag reflex, while drugs were administered incrementally using target controlled infusion (TCI).MethodsFifty seven patients who required awake fiberoptic intubation were randomized to Group R or Group P. After measurement of baseline gag trigger point index (GTPI), TCI was set to effect-site concentration (Ce) of 1 ng/ml (Group R) or 1 µg/ml (Group P), then titrated by 0.5 increment until GTPI score reached 0. The incidence of drop-out and decreased cooperation, Ramsay sedation scale (RSS) and Ce at loss of GR, and complications were assessed.ResultsSeven patients were dropped out in Group P due to deep sedation and disobedient behavior, but none in Group R (P = 0.015). Gag reflex suppressed as RSS increased in both groups (P < 0.001), however, the incidence of elimination of gag reflex clustered at RSS 2 in Group R (P < 0.001), whereas it was evenly distributed in Group P (P = 0.20). The incidence of patients who were spontaneously roused (gag reflex elimination at RSS 1 and 2) were higher in Group R than in Group P (P = 0.002).ConclusionsDeep sedation and impaired cooperation were observed only in Group P and spontaneously roused patients were higher in Group R, suggesting that remifentanil is more suitable for cooperative elimination of GR.

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“…Several different strategies have been used to overcome the GR, including auricular acupuncture, palm pressing devices, or nerve block anesthesia [3][4][5]. However, current clinical applications of these methods are often not practical.…”

Section: Introductionmentioning

confidence: 99%

“…Although the glossopharyngeal nerve is considered to be the main afferent pathway for GR, which contributes to oropharyngeal mucosa sensation, tactile stimulation from areas innervated by the trigeminal nerve, such as the anterior faucial pillars, the base of the tongue and the soft palate may also elicit the GR [4][5][6][7][8][9]. It is worth noting that the trigeminal nerve allows for paradoxical preservation of the GR after a glossopharyngeus lesion [10].…”

Section: Introductionmentioning

confidence: 99%

An Earplug Technique to Reduce the Gag Reflex during Dental Procedures

et al. 2014

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Background: The gag reflex is a frequent problem occurring during dental treatment procedures, especially while making impressions of the maxillary teeth. The present study aims to evaluate the efficacy of a simple earplug as an external auditory canal stimulator to supress the profound gag reflex and as a second step, to map areas of the oropharynx suppressed by this technique. Methods: In the first step of the study, 90 patients who had a gag reflex during the impression procedure were allocated to a study group, a sham group, and a control group for evaluating the efficacy of the earplug technique. Second, 20 new patients with a gag reflex were included in order to map the oropharnygeal areas suppressed by this technique. Results: The severity of the gag reflex was reduced in the earplug group (but not in the sham or the control group). The affected area included the hard palate, uvula, and the tongue but not the posterior wall of oropharynx. Conclusion: An earplug technique can be a useful, practical, and effective tool to overcome the gag reflex during oral procedures, such as impression procedures of maxillary teeth.

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Altering the Gag Reflex Via a Palm Pressure Point

Cited by 22 publications

References 17 publications

Utility of the gagging problem assessment questionnaire in assessing patient sensitivity to dental treatments

Utility of the gagging problem assessment questionnaire in assessing patient sensitivity to dental treatments

The comparison of feasibility and safety on fiberoptic guided intubation under conscious sedation with remifentanil and propofol

An Earplug Technique to Reduce the Gag Reflex during Dental Procedures

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