Reducing gagging during dental treatment – insufficient evidence for any intervention

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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.

Methods

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.

Results

  • 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.

Conclusions

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.

Comments

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.

Links

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 the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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