Open wide! Only one randomized controlled trial found on management of gag reflex in dentistry

pulp treatmentThe gag reflex is a normal mechanism to protect the throat and airway from foreign objects. Many people have an exaggerated gag reflex that causes distress during dental treatment, making it difficult or even impossible to perform the treatment. The interventions used to manage gagging include anti-nausea medicines, sedatives, local and general anaesthetics, herbal remedies, behaviour therapy and cognitive behaviour therapy, acupressure, acupuncture, and prosthetic devices. We wanted to know how effective and safe these interventions are compared to no intervention or a placebo or to other interventions in helping people undergo dental procedures successfully and in reducing the severity of gagging.

What was the research?

A systematic review of the evidence to find out what evidence is available regarding the different ways of managing gagging in a patient undergoing dental treatment.

Who conducted the research?

The research was conducted by a team led by Eachempati Prashanti from the Faculty of Dentistry at Melaka-Manipal Medical College, Malaysia, on behalf of the Cochrane Oral Health Group. Kumbargere N Sumanth, P Renjith George, Laxminarayan Karanth and Htoo Htoo Kyaw Soe were also on the team.

What evidence was included in the review?

Only one randomised controlled trial was found that met the inclusion criteria for this review. It involved 33 adults who had experienced nausea during previous dental procedures that hindered or prevented dental treatment from being carried out properly. Patients were assigned at random to either an acupuncture group or a sham acupunture group.

What did the evidence say?

The results did not show a difference between acupuncture at P6 (Pericardium 6 – situated on the front surface of wrist) and sham acupuncture in reducing gagging or allowing successful completion of dental procedure. No noteworthy adverse events were reported.

How good was the evidence?

The quality of the evidence for successful completion of dental treatment and reduction in gagging was very low, due to unclear risk of bias and the small number of people studied in the single included trial.

What are the implications for dentists and the general public?

The evidence currently available is insufficient to draw reliable conclusions regarding the effects of interventions used to manage gagging in people undergoing dental treatment. Better designed and well-reported trials evaluating different interventions are needed to provide evidence to inform clinical decisions.


Prashanti E, Sumanth KN, Renjith George P, Karanth L, Soe HHK. 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.