Management of Exaggerated Gag Reflex Using Intravenous Sedation in Prosthodontic Treatment

Management of Exaggerated Gag Reflex Using Intravenous Sedation in Prosthodontic Treatment

HARUSHI YOSHIDA,¹ TERUMI AYUSE,¹ SATORU ISHIZAKA,² SHINGO ISHITOBI,¹ TOMOYUKI NOGAMI¹ and KUMIKO OI^1,2

¹Department of Special Care Dentistry, Nagasaki University Hospital of Medicine and Dentistry, Japan
²Division of Clinical Physiology, Nagasaki University Graduate School of Biomedical Sciences, Japan

The gag reflex is a somatic natural response in which the body attempts to eliminate instruments or agents from the oral cavity by muscle contraction. Some patients suffered from such severe retching that behavioral techniques did not sufficiently reduce gagging in dentistry. In these patients, pharmacological management was thought to be the last alternative to eliminate the reflex. However, the potential of intravenous (IV) sedation as a way to overcome problems in gagging management during prosthodontic (prosthetic) therapy has not been sufficiently explored. We examined the benefit of IV sedation to facilitate prosthodontic treatment for problematic gagging patients intolerable to dental therapy. The subjects were 10 severely retching patients (7 males and 3 females) who received prosthodontic or restorative therapy under propofol IV sedation. The number, location and prognosis of dentures/restorations were reviewed retrospectively. Eight dentures (3 removable and 5 fixed partial dentures) and 22 restorations (18 crowns and 4 inlays) were seated successfully in the oral cavity without serious complications related to IV sedation. The restored teeth were located predominantly in the posterior regions. Throughout the observation period of at least 6 months, no symptoms of postoperative pain or swelling were found. Five of the 10 patients showed improved tolerance to oral inspection, indicating a behavioral adjustment to dental care. In prosthodontic treatment extended to the posterior regions, propofol IV sedation proved useful in managing reflex control.

keywords —— gag reflex; behavioral management; intravenous sedation; prosthodontic therapy

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Tohoku J. Exp. Med., 2007, 212, 373-378

Correspondence: Harushi Yoshida, D.D.S., Ph.D., Department of Special Care Dentistry, Nagasaki University Hospital of Medicine and Dentistry, 7-1 Sakamoto 1-chome, Nagasaki 852-8588, Japan.

e-mail: harushi@nagasaki-u.ac.jp