Intranasal Midazolam May Prevent Gagging Reflex: a Case Report

Abstract

BackgroundGagging can become a conditioned response that makes dental treatment difficult or impossible for both the individual and the dentist. The aim of this study is to report a 50 year old female and two children (15 and 11 years old) with exaggerated gag reflex referred to Faculty of Dentistry of Selçuk University.MethodsDuring obtaining records, taking impression procedure was elicited the patients’ hypersensitive gagging reflex. Therefore, it was decided to administer intranasal midazolam to facilitate the taking of accurate dental impressions. After given verbal information about the procedure, 2.5 mg intranasal midazolam (Demizolam, Dem Medikal, Istanbul) were applied incrementally in both nostrils.ResultsFive minutes later; patients had no gagging reflex and allowed the clinician to take satisfying impressions. No serious adverse effects were observed and the patients remained cooperative during the entire procedure which was completed to the full satisfaction of all involved. The short absorption time and the fast relief process of anaesthetics transferred to the systemic circulatory system are important advantages of nasal application.ConclusionsIntranasal midazolam may be very useful for the treatment of gag reflex probably effecting on the depression of upper airway reflex sensitivity.

The Greek version of the Gagging Assessment Scale in children and adolescents: psychometric properties, prevalence of gagging, and the association between gagging and dental fear

“…In children with an intense gagging reflex, procedures such as radiological examinations may not be completed, making it harder to arrive at the correct diagnosis. Further, difficulties in taking maxillary impressions may prevent other children from undergoing orthodontic treatment or wearing (prosthetic) removable appliances 16,17 .…”

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

“…Relaxation techniques [22,23] and even diverting attention [24] can also ameliorate gagging. 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].…”

Gagging Assessment Scale: A Reliable Tool For Assessing Association Between Gagging And Dental Fear In Children Prior Dental Treatment- A Cross-Sectional Pilot Study

“…8.2% of dutch adults stated that they generally gagged during dental treatment (van Houtem et al, 2015) and who were primarily seeking emergency dental care stated that 49% of them gagged sometimes or frequently at the site of a dentist, whereas an additional 7.5% of adults stated that they almost always gagged (Randall et al, 2014). Knowledge of an individual's likelihood to gag is highly essential and of particular importance to the pediatric dentists as prior information of gagging problem in children can help clinicians to deliver treatment effectively with appropriate use of behavioural management techniques (Malkoc et al, 2013;Sari and Sari, 2010).…”