The possible association between the types of soft palate and gag reflex: a preliminary study / A possível associação entre os tipos de palato mole e o reflexo de vômito: um estudo preliminar

Objective: whether gag reflex, a common problem encountered during dental procedures, is associated with the different types of the soft palate has not been addressed so far. This preliminary study sought to assess the potential association between the different types of soft palate and gag reflex. Material and Methods: one hundred dental patients were recruited. The type of soft palate was determined. Subjective (self-reported) gag reflex was recorded based on many questions and past experience and on a 0-6 VAS. Objective assessment of gag reflex was done using different maneuvers where the posterior part of the tongue and the soft palate were touched by dental mirror, and by taking impression for the upper arch. The association between the types of soft palate and the subjective and objective recorded gag reflex were statistically tested. Results: there were 53 (53%), 33 (33%) and 14 (14%) of the participants with class I, class II and class III soft palate, respectively. A significant association was found between the type of the soft palate and gag reflex in response to one of the subjective items (P= 0.039), more prominent among females (P= 0.009). Concerning the objective assessment, no significant associations were found among males. Meanwhile more females with class II and class III suffered gag reflex and/or actual gagging upon taking the impression (P = 0.001). Conclusion: this study illustrated an association between the type of soft palate and gag reflex, and its severity in females (more specifically soft palate types II and III) more than in males (AU)

Objetivo: o reflexo de vômito, um problema comum encontrado durante procedimentos odontológicos, está ou não associado aos diferentes tipos de palato mole, não foi ainda abordado até o momento. Este estudo preliminar procurou avaliar a possível associação entre os diferentes tipos de palato mole e o reflexo de vômito. Material e Métodos:cem pacientes odontológicos foram recrutados. O tipo de palato mole foi determinado. O reflexo de vômito subjetivo (auto-relatado) foi registrado com base em muitas perguntas e experiências anteriores e em um VAS de 0-6. A avaliação objetiva do reflexo de vômito foi feita por meio de diferentes manobras onde a parte posterior da língua e o palato mole foram tocados por espelho dental e por meio de moldagem da arcada superior. A associação entre os tipos de palato mole e o reflexo de vômito subjetivo e objetivo registrado foi testada estatisticamente. Resultados: houve 53 (53%), 33 (33%) e 14 (14%) participantes com palato mole classe I, classe II e classe III, respectivamente. Foi encontrada associação significativa entre o tipo de palato mole e o reflexo de vômito em resposta a um dos itens subjetivos (P= 0,039), mais proeminente no sexo feminino (P= 0,009). Em relação à avaliação objetiva, não foram encontradas associações significativas entre os homens. Enquanto isso, mais mulheres com classe II e classe III sofreram reflexo de vômito e/ou engasgo real ao receber a impressão (P = 0,001). Conclusão: este estudo ilustrou uma associação entre o tipo de palato mole e reflexo de vômito e sua gravidade em mulheres (mais especificamente palato mole tipos II e III) mais do que em homens. (AU)

Restorative Management of A Patient With Pronounced Gag Reflex: A Case Report

@#Patients with hyperactive gag reflexes pose challenges when undergoing routine dental procedures, and this can create difficulties in their treatment. The subsequent issues that dentists face in executing the proposed treatment plan could hinder optimal patient care and reduce the overall success of the treatment. The clinician should be skilled in diagnosing as well as competent when managing the care of patients presenting with a hyperactive gag reflex. This paper discusses a technique utilizing telescopic copings and a long-span fixed partial denture as an alternative to fixed implant restoration on a patient with a pronounced gag reflex.

Investigation of Efficacy of Lidocaine Spray for Sedated Esophagogastroduodenoscopy in Children / 대한소아소화기영양학회지

PURPOSE: Our aim in this study is to investigate efficacy of topical lidocaine spray for sedated esophagogastroduodenoscopy (EGD) in children. METHODS: The endoscopy of children aged between 3-18 years who underwent EGD in our endoscopy unit. Intravenous (IV) midazolam and ketamine were used for sedation. Prior to sedation, endoscopy nurse applied topical lidocaine 10% with pump spray at 1 mg/kg dose in group 1, and distilled water via identically scaled pump spray in group 2, in a double blinded fashion. RESULTS: Sedation was not applied in 24.1% of the cases in topical lidocaine spray group (LS group) and in 5.7% of the cases in distilled water spray group (DS group). Gag reflex was observed in 6.5% of cases in LS group and 33.3% of cases in DS group (p=0.024), increased oral secretion was observed in 9.3% of cases in LS group and 51.7% of cases in DS group (p=0.038), sore throat was observed in 3.7% of cases in LS group and 35.6% of cases in DS group (p=0.019) and the difference was statistically significant. CONCLUSION: The study showed that topical pharyngeal lidocaine reduces both requirement and amount of IV sedation before EGD in children and sore throat, gag reflex and decreased oral secretion increase.

Influence of gag reflex on removable prosthetic restoration tolerance according to the patient section of the short form of the Gagging Problem Assessment Questionnaire

PURPOSE: To assess removable prosthetic restoration tolerance according to the patient section of the short form of the Gagging Problem Assessment Questionnaire (GPA-pa SF) and the influence of gender, education level and prosthesis type and denture-related mucosal irritation on the GPA-pa SF scores before treatment and over a period of two months after prosthesis insertion. MATERIALS AND METHODS: 130 participants who required removable prosthesis were surveyed with a standard form that included questions regarding age, gender, education level, dental attendance, and prosthetic restoration type. Participants answered the GPA-pa SF before restoration (T0) and 1 day (T1), 2 days (T2), 15 days (T3), 1 month (T4), and 2 months (T5) after prosthesis insertion. RESULTS: Of the 130 participants, 110 participants completed the prosthetic restoration procedure, but only 93 of these were able to use the prosthesis over the two-month period. The mean GPA-pa SF score obtained at T0 was higher than the scores obtained at the other periods in the total of the sample. Significant difference was present between mean scores obtained at T0-T1 and T2-T3 than scores obtained at other periods (P.05). CONCLUSION: GPA-pa SF scores were higher before the restoration procedure began, and decreased over time with the use of prosthesis. Gender and denture-related mucosal irritation affected the GPA-pa SF scores.

Management of Gagging In Complete Denture Wearer- A Case Report.

Gagging is a common phenomenon observed in Upper Complete denture patients. An Approach in management of Severe GAG reflex in an Edentulous patient who were to undergo complete Denture prosthesis.

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

BACKGROUND: Oropharyngeal 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). METHODS: Fifty 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 microg/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. RESULTS: Seven 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). CONCLUSIONS: Deep 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.

Gag Reflex: No More A Gag To A Dentist The Behavioral Techniques, Pharmacological Techniques, Acupressure and Acupuncture in Controlling the Gag Reflex - A Review.

Gagging in dental patients can be disruptive to dental treatment and may be a barrier to a patient care, preventing the provision of treatment and the wearing of prostheses. Many management techniques have been described to control the gagging. This article reviews the literature on various management strategies described to prevent and control the gagging.

Oropharyngeal examination as a predictor of obstructive sleep apnea: pilot study of gag reflex and palatal reflex / Avaliação orofaríngea como preditor da apneia obstrutiva do sono: estudo piloto dos reflexos nauseoso e palatal

Obstructive sleep apnea (OSA) has high prevalence and may cause serious comorbities. The aim of this trial was to show if simple noninvasive methods such as gag reflex and palatal reflex are prospective multivariate assessments of predictor variables for OSA. METHOD: We evaluate gag reflex and palatal reflex, of fifty-five adult patients, and their subsequent overnight polysomnography. RESULTS: Forty-one participants presented obstructive sleep apnea. The most relevant findings in our study were: [1] absence of gag reflex on patients with severe obstructive apnea (p=0.001); [2] absence of palatal reflex on moderate obstructive apnea patients (p=0.02). CONCLUSION: Gag reflex and palatal reflex, a simple noninvasive test regularly performed in a systematic neurological examination can disclose the impact of the local neurogenic injury associated to snoring and/or obstructive sleep apnea syndrome.

A síndrome da apneia obstrutiva do sono (SAOS) possui alta prevalência e pode causar sérias comorbidades. O objetivo deste estudo foi mostrar se métodos não invasivos como os reflexos nauseoso e palatal podem ser avaliações prospectivas multivariadas preditoras para SAOS. MÉTODO: Avaliamos os reflexos palatal e nauseoso em 55 pacientes adultos, com exame polissonográfico subsequente. RESULTADOS: 41 pacientes apresentaram SAOS. Os achados mais relevantes em nosso estudo foram: [1] ausência do reflexo nauseoso em pacientes com SAOS grave (p=0,001); [2] ausência do reflexo palatal em pacientes com SAOS moderada (p=0,02). CONCLUSÃO: Os reflexos nauseoso e palatal, um simples exame não invasivo, aplicado em uma avaliação neurológica rotineira, pode revelar o impacto de lesões neurogênicas locais associadas ao ronco e/ou a SAOS.

Unilateral Retraction the Umlateral Eyelid on Vomiting

I examined a patient who showed retraction of the right eyelid on vomiting. The right eyelid of the patient elevated concomitantly with the induction of gag reflex. She did not have ptosis. The levator function of the both eyes was normal. This case would be the first case report of glossopharyngeal-vagal-oculomoter synkinesis in the literature.