Open wide! Managing gagging in dental patients

0302 Gagging.jpgThe gag reflex is a normal process to protect the throat and airway from foreign objects and prevent choking. Many people have an exaggerated gag reflex that causes distress during dental treatment. This can make 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, lasers and prosthetic devices.

We wanted to know how effective and safe these interventions are in helping people to complete their dental treatment with less gagging. We compared them to no intervention or a placebo or to other interventions.

What was the research?

A systematic review to find out the best way to manage gagging in people having dental treatment.

Who conducted the research?

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

What evidence was included in the review?

This review was up-to-date as of 18 March 2019. We included four randomised controlled trials with 328 people (263 adults and 65 children who were four years old or older). These people had had nausea before when having dental treatment that caused the treatment to be stopped or not carried out properly.

What did the evidence say?

Acupuncture at P6 point (a point located in the inside of the wrist) showed successful completion of dental treatment and reduction in gagging when compared to “sham” (fake) acupuncture. The same intervention with sedation did not show a difference.

Acupressure with thumb or a sea band (bands that fit around the wrist like a sweat band with a pressure stud sewn inside) at P6 point with or without sedation did not show any difference when compared to sham acupressure. Acupressure at P6 point with device showed a difference in completing dental treatment and reduction in gagging. It did not show a difference when combined with sedation.

Laser at P6 point showed a difference in the absence of gagging and reduction in gagging during dental treatment when compared to sham laser application.

The included studies did not report any harmful effects of the treatment.

How good was the evidence?

The level of certainty we have in these findings is very low. This was due to unclear risk of bias and the small number of people involved in the trials.

What are the implications for dentists and the general public?

We do not have enough evidence to say which intervention works better to manage gagging in people having dental treatment. We suggest that more well-conducted studies should be done in this area.


Eachempati  P, Kumbargere Nagraj  S, Kiran Kumar Krishanappa  S, George  RP, Soe  HHK, Karanth  L. Management of gag reflex for patients undergoing dental treatment. Cochrane Database of Systematic Reviews 2019, Issue 11. Art. No.: CD011116. DOI: 10.1002/14651858.CD011116.pub3.

This post is an extended version of the review’s plain language summary, compiled by Anne Littlewood at the Cochrane Oral Health Editorial Base.