Reducing gagging during dental treatment – insufficient evidence for any intervention


Gagging is a natural response that attempts to eliminate foreign objects or agents from the mouth. However, an exaggerated gagging response can cause problems with dental treatment. The aim of this Cochrane review was to assess the effects of pharmacological and non-pharmacological interventions for the management of gagging in people undergoing dental treatment.


Searches were conducted in the Cochrane Oral Health Group’s Trials Register, CENTRAL, Medline, Embase, CINAHL, AMED, IADR Conference Proceedings, clinical trial registries and Google search engine with no restrictions on language or date of publication. Randomised controlled trials (RCTs) involving people who were given a pharmacological or non-pharmacological intervention to manage gagging that interfered with dental treatment were considered. Quasi-RCTs and crossover trials were excluded. Standard Cochrane protocols were followed for data abstraction and synthesis.


  • Only 1 RCT of acupuncture at P6 (Pericardium 6 – situated on the anterior surface of wrist) met the inclusion criteria. It involved 33 patients and was at unclear risk of bias. The trial reported on reduction in gagging; however, details on successful completion of the dental procedure were obtained from the trial author.
  • There were no differences in
    • Successful completion of dental procedure for acupuncture at P6 group compared to sham acupuncture (RR 1.65, 95% CI 0.59 to 4.57).
    • Reduction in gagging any stage (stage 1: MD 0.40, 95% CI -0.12 to 0.93; stage 2: MD 0.49, 95 % CI -0.26 to 1.24; stage 3: MD 0.67, 95% CI -0.18 to 1.53).
    • Reduction in gagging as reported by the participant (MD 0.86, 95% CI -1.13 to 2.85).
  • The quality of the evidence for all outcomes was very low.
  • No noteworthy adverse effects were reported.
 We did not find trials evaluating any other interventions used to manage gagging in people undergoing dental treatment.


The authors concluded:

We found very low quality evidence from a single trial that was insufficient to conclude if there is any benefit of acupuncture 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.


Despite a wide-ranging search for studies, as is typical with Cochrane reviews, only a single small study of acupuncture was identified, which was not sufficient to demonstrate clear results. The review does highlight the wide range of interventions that have been suggested for patients for gagging problems but no high quality evidence is available at present to assess which is the best approach.


PrashantiE,SumanthKN,RenjithGeorgeP,KaranthL,SoeHHK.Management of gag reflex for patients undergoing dental treatment. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD011116. DOI:10.1002/14651858.CD011116.pub2.

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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