Relationship between gagging severity and its management in dentistry

Abstract

The purpose of this study was to investigate how grading according to our new gagging reflex index correlated with patient background and subsequent management. After obtaining institutional approval and informed consent, 110 patients with a gagging problem were enrolled. The patients completed the State-Trait Anxiety Inventory (STAI), the Dental Anxiety Scale (DAS), and a health questionnaire at initial consultation. On the second visit, an intra-oral examination was carried out and the severity of gag reflex determined according to our new, 5-level Classification of Gagging Problem (CGP) index: normal gagging but not desensitised (G1 = score 1); mild gagging (G2 = score 2); moderate gagging (G3 = score 3); severe gagging (G4 = score 4); and very severe gagging (G5 = score 5). No difference was found in grade based on age or STAI or DAS scores. The CGP score in male patients was significantly higher than that in female. The management classification method and degree of desensitisation were investigated retrospectively in each patient at 3 months and 1 year after initial consultation. The higher the CGP grade, the more often intravenous sedation or general anaesthesia was required due to difficultly in desensitisation. The present results suggest that determining whether it is possible to examine the molar area without inducing the gag reflex offers the key to deciding the treatment strategy.

Gagging and its associations with dental care–related fear, fear of pain and beliefs about treatment

“…Other research that has focused exclusively on patients with problem gagging found a high degree of dental fear in such patients as a whole, but not differentiated across gagging severity levels. 7 …”

“…Reviews and recent empirical studies have been published on the myriad techniques available to manage gagging problems in dentistry. 1,7,29 Future work should address which of these techniques are most effective for reducing problems with gagging and whether certain methods are most appropriate for different severities of gagging.…”

“…5 Indeed, though it may be elicited reflexively, the type of gagging that often is encountered by dental professionals probably is most accurately viewed as a behavioral response (i.e., an action that is the product, at least in part, of psychological variables). 6,7 Gagging, especially when occurring frequently, can be particularly problematic in the context of dental care for some individuals; however, there is limited literature that specifically addresses the extent to which it interferes with treatment.…”

Assessment of Patients' Awareness and Factors Influencing Patients' Demands for Sedation in Endodontics

“…Some of the benefits include adjunctive pain control (13)(14)(15), behavior management (16), reduction of the gag reflex (17), and the reduction of fear and anxiety (2,7,9,11). The use of minimal and moderate sedation in endodontic practice allows for patient cooperation during treatment such as holding a radiographic sensor or film holder, opening or closing their mouth, and changing their head position (10,18).…”

A Reliable and Valid Survey to Predict a Patient’s Gagging Intensity

“…Although the GAS is positively correlated with patient anxiety levels [10], it does not assess the severity of a gag reflex during dental procedures. The 5-level Classification of Gagging Problem (CGP) assesses the severity of a patient's gagging reflex and classifies patients into those who can successfully be treated for desensitization of the gag reflex within one year and those who cannot [11]. Patients who scored a 1 or 2 (normal but not desensitized gagging or mild gagging) were desensitized within a year of treatment.…”