Gagging reflex

[Guest guest]

Hi all,

My mum has to have an impression for the making of false teeth. She has

a terrible problem with gagging as soon as the dentist puts anything in her

mouth. What points do you think i might use to help prevent this? Many thanks.

Val.

 

 

 

[Guest guest]

Hi Val & All,

 

Val wrote:

> My mum has to have an impression for the making of false teeth.

> She has a terrible problem with gagging as soon as the dentist puts

> anything in her mouth. What points do you think i might use to help

> prevent this? Many thanks. Val.

 

Google has several hits on this [ http://tinyurl.com/9hk2l ]. Medline also

has hits on it: http://tinyurl.com/abvpo

 

Points used included Earpoint " Gagging Reflex " , LI04, CV24, ST36 and

PC06 (more for nausea).

 

Br Dent J. 2001 Jun 9;190(11):611-3. Comment in: Br Dent J. 2001

Nov 24;191(10):537. The role of acupuncture in controlling the gagging

reflex using a review of ten cases. Fiske J, Dickinson C. Department of

Sedation and Special Care Dentistry, London. janice.fiske

The gagging reflex is a physiological reaction which safeguards the

airway from foreign bodies. In some people this response is

exaggerated to the extent that the acceptance/provision of dental

treatment is not possible. The aim of this paper is to review the role of

acupuncture in controlling gagging as a safe, cheap, quick and relatively

non-invasive technique. METHOD: Ten people agreed to try ear

acupuncture to control gagging during dental treatment. Prior to

treatment the severity of gagging was assessed. Acupuncture needles

were inserted into a specific anti-gagging point on each ear,

manipulated briefly and left in situ. Dental treatment was then carried

out and the effectiveness of the acupuncture in preventing gagging was

assessed. After treatment, the needles were removed and the patient

discharged. All acupuncture was carried out by a dentist trained in its

use. RESULTS: Four people had a severe gag reflex which made

treatment impossible and six had a very severe reflex which made

treatment impossible and affected their dental attendance. Ear

acupuncture completely controlled the gag reflex in eight cases (23

treatment episodes) and partially controlled the reflex in two cases (two

treatment episodes). Dental treatment could be carried out in all cases

and at all visits. The cost of materials was 0.2 pounds per person per

visit. Additional clinical time was in the order of 2-3 minutes. There were

no adverse reactions to the technique and, on all occasions, patients

were fit to leave the surgery and travel home unaccompanied.

CONCLUSIONS: Ear acupuncture was successful in controlling the gag

reflex. It is a safe, quick, inexpensive and relatively noninvasive

technique. A controlled clinical trial is required to investigate any placebo

effect. PMID: 11441900 [PubMed - indexed for MEDLINE]

 

http://www.acupuncturetoday.com/archives2001/sep/09dental.html

adds: Before being treated by the dentist, each patient received

acupuncture at a point on the upper part of the ear between the concha

and triangular fossa. The researchers used a fine needle (7mm) into the

anti-gagging point of each ear to a depth of three millimeters. The

needles were manipulated for 30 seconds prior to dental treatment and

remained in place until the patient was discharged. Using ear

acupuncture, the patients underwent a total of 25 dental treatment

episodes. Episodes ranged from routine forms of care, such as fillings,

impressions and teeth cleaning, to more complicated procedures,

including extractions, root canals and biopsies. All of the patients

tolerated the acupuncture extremely well; according to the researchers,

" there were no reactions to the technique. " Only two episodes of mild

gagging were noted, and all of the subjects were able to travel home

without assistance.

 

See also: Focus Altern Complement Ther 2001; 6: 36 Acupuncture

Acupuncture for control of gagging reflex German researchers

randomised 240 patients undergoing a laryngoscopy into seven groups:

(1) superficial anaesthesia with lidocaine, (2) acupuncture at

Chengjiang-CV24, (3) sham-acupuncture, (4) injection of NaCl at CV24,

(5) injection of 0.5% lidocaine at CV24, (6) injection of 2% lidocaine at

CV24 and (7) laryngoscopy without pretreatment. The results show the

most effective suppression of gagging in group 2. Ogal HP, Eistert B,

Hammermann H et al. Klinische Unter-suchung zur Beeinflussung des

Würgereflexes bei der Laryngoskopie mittels unterschiedlicher

Stimulation eines Trigger-punktes (Ren Mai 24) in der Mentolbialfalte.

Dtsch Z Akup 2000; 3: 227.

 

http://www.nature.com/bdj/journal/v191/n10/full/4801228a.html says:

Acupuncture for controlling gag reflex? Sir,- I read this article with

interest (BDJ 2001; 190: 611-613), but was surprised to note that the

authors were 'unable to find any reference in the dental literature to the

previous use of this technique for controlling the gag reflex.' They

correctly report the effective use of acupuncture in reducing nausea

induced by stimulation of the chemoreceptor trigger zone through blood

borne emetics such as opiods and cytotoxic agents,1 but may have

missed that acupressure is also effective,2 albeit less so in children.3 In

1985, Pershek published anecdotal evidence of the effectiveness of

both acupuncture and acupressure in reducing gagging,4 while Deng et

al in 1986 reported significant improvements with acupressure, although

the study's methodology was fundamentally flawed (ie there was neither

blinding nor any controls).5 These earlier reports prompted further study

into the possible benefits of acupressure for controlling gagging during

maxillary orthodontic impressions of children, culminating in two

publications which reported on the findings of a prospective,

randomized, controlled double blind clinical trial with cross over.6, 7

These were that acupressure on either PC 6 (Neiguan), the sixth point

on the pericardial meridien, or a sham dummy point, were both equally

effective at reducing nausea induced in this way. A number of factors

were proposed to account for this, with the one that had the most appeal

being that since (a) acupressure has a beneficial effect on

pharmacologically induced emesis, (b) an equivocal effect on motion

sickness8, 9, and © no proven effect on nausea induced through tactile

stimulation of the soft palate, that perhaps the site of influence is not the

vomiting centre, but rather the adjacent chemoreceptor trigger zone,

which sends efferent signals to it. As Fiske and Dickinson point out,

without a controlled trial the potential effectiveness of acupuncture in

reducing gagging cannot be definitely established, not without

discounting the possibility of the placebo effect, which could otherwise

explain or contribute to their impressive results. Nevertheless, as

previously noted, there exists in all controlled trials a number of potential

sources of bias, one of which for those involving acupucnture is that, in

contrast to acupressure, they can only be single blind, in that the

researcher must administer the technique and is therefore aware when

the 'correct' point is being stimulated.10 Also, it has been calculated that

the estimated cross over sample size required to detect a 10mm

difference in the nausea scores on a 100mm visual analogue scale

between a sham and 'effective' acupressure joint, with a standard

deviation of 40, and an 80% power of achieving a statistically significant

result at the 5% level would be 126.7 It is therefore commendable that

the present authors plan to extend their study to involve a controlled

clinical trial, even if the numbers to be recruited may be otherwise

daunting, that is without resorting to multi-centre participation. However,

once done, the results will undoubtedly contribute to our understanding

of both the specific efficacy of acupuncture for controlling gagging, as

well as the potential site it influences for nausea in general. R. A. C.

Chate Colchester 1 Vickers A J. Can acupuncture have specific

effects on health? J Roy Soc Med 1996; 89: 303-311. 2 Fry E N S.

Acupressure and postoperative vomiting. Anaesth 1986; 41: 661-662.

3 Lewis I H, Pryn S J, Reynolds P I, Pandit U A, Wilton N C T.

Effect of P6 acupressure on postoperative vomiting in children

undergoing outpatient stabismus correction. Br J Anaesth 1991; 67: 73-

78. 4 Pershek R J. Preventing the gagging reflex. Basal Facts 1985;

7: 283-286. 5 Deng D H, Tan Q L, Han J S. Observations on

combating nausea by finger pressure on the Hegu point. J Trad Chin

Med 1986; 6: 111-112. 6 Chate R A C. PC.6 acupressure for

dental nausea: A preliminary report of a prospective randomised double

blind clinical trial, Part I. Acupunct Med 1997; 15: 6-9. 7 Chate R A C.

PC.6 acupressure for dental nausea: A prospective randomised double

blind clinical trial with crossover, Part 2. Acupunct Med 1998; 16: 69-72.

8 Warwick-Evans L A, Masters I J, Redstone S B. A double-blind

placebo controlled evaluation of acupressure in the treatment of motion

sickness. Aviat Space Environ Med 1991; 62: 776-778. 9 Hu S. Stritzel

R, Chandler A, Stern R M. P6 acupressure reduces symptoms of

vection-induced motion sickness. Aviat Space Environ Med 1995; 66:

631-634. 10 Vincent C, Lewith G. Placebo controls for acupuncture

studies. J Roy Soc Med 1995; 88: 199-202.

 

The author Dr Janice Fiske responds: We thank Dr Chate for his

interest in our article and for drawing attention to the use of acupressure

in reducing nausea and controlling the gag reflex. Indeed the

acupressure point (P6) mentioned in the references cited by Dr Chate is

commercially advocated for the control of motion sickness. We have

utilised acupressure to control gagging during dental treatment in a few

cases. However, the article was restricted to the use of acupuncture (dry

needling) and we chose not to confuse the issue by extending it to the

use of acupressure.

 

 

Best regards,

 

 

Tel: (H): +353-(0) or (M): +353-(0)

 

 

 

 

Ireland.

Tel: (W): +353-(0) or (M): +353-(0)

 

 

 

" Man who says it can't be done should not interrupt man doing it " -

Chinese Proverb

 

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[Guest guest]

Hi Phil,

Thanks for the info. Used the point on the ear that you suggested

today with great success. Thank you. There was no gagging,Mum was so pleased

and

the Dentist was duly impressed.

Once again, many thanks. Regards, Val.