Influence of gag reflex on dental attendance, dental anxiety, self‐reported temporomandibular disorders and prosthetic restorations

Abstract

To assess the influence of gag reflex severity, assessed according to the short form of the patient part of Gagging Problem Assessment Questionnaire (GPA-pa SF), on the dental attendance, dental anxiety, self-reported temporomandibular disorder (TMD) symptoms and presence of prosthetic restorations among patients requiring prosthodontic treatment in Turkey. A total of 505 patients (305 women; mean age: 46·35 years, SD: 28·2 years) undergoing dental examination were administered a questionnaire containing questions regarding their age, gender, education level, dental attendance, TMD symptoms (limitation in jaw opening, muscle pain, pain/sounds in the temporomandibular jaw), the Turkish version of the Modified Dental Anxiety Scale (MDAS) and the GPA-pa SF. Subsequently, any prosthetic restoration was recorded by a dentist. Descriptive statistics, one-way analysis of variance (anova) and the chi-square test were used for statistical analysis. Differences were found between GPA-pa SF scores 0, 1 and 2 for education level (P = 0·001), MDAS scores (P = 0·003), self-reported TMD (P = 0·000) and prosthesis wear (P = 0·000), but not for attendance patterns (P = 0·826). Patients with gag reflex had lower education levels, higher levels of dental anxiety, more self-reported TMD symptoms and fewer fixed or removable prosthetic restorations than patients without gag reflex. Gag reflex has impacts on dental anxiety, self-reported TMD and prosthetic restorations, but not on dental attendance patterns, according to the results of the GPA-pa SF.

A Reliable and Valid Survey to Predict a Patient’s Gagging Intensity

“…This survey identifies patients with a significant gagging problem, but again relies on invasive prob. There is also a nine question version of the GPA that can be completed by the patient that is not complimented by invasive probing, and this has been shown to be reliable and valid [13][14][15]. The shortened GPA contains questions that have patients estimate the level of gagging induced by 'feeling a mirror between posterior teeth', 'taking an impression of the upper jaw', and 'taking an impression of the lower jaw'.…”

“…A case report found that intranasal midazolam, a benzodiazepine, reduced the patient's experience of the gag reflex [25]. Additionally, some case reports show that using chemical stimulation of the oral palate with a sodium chloride solution can temporarily reduce the gag reflex [26][27][28], although a controlled study failed to find a significant effect of table salt in reducing the gag reflex [13]. It may also be interesting to examine whether a stronger gag reflex is correlated with increased orofacial pain that is itself related to third molar extraction [29].…”

Managing Gag Reflex during Removable Partial Denture Treatment: A Review and a Clinical Report

“…Exaggerated gag reflex may lead to problems during clinical stages of fabrication and during wearing of removable complete and partial prostheses . An unusually active gag reflex upsets the patient and consequently may lead to avoidance of routine dental treatment, poor oral hygiene, and tooth loss …”

The Effect of Various Concentrations of Nitrous Oxide and Oxygen on the Hypersensitive Gag Reflex

“…4 HGR may cause selfconsciousness, embarrassment, avoidance of dental treatment, fear, anxiety, and a negative impact on overall quality of life. [5][6][7][8][9] Various behavioral and pharmacological methods have been suggested to reduce HGR in dental patients. [10][11][12][13][14][15][16] It has been claimed that nitrous oxide and oxygen sedation (N 2 O) is able to completely obtund the HGR 17 ; however, we searched the literature and could find no study in which this was proven.…”