Cochrane · intervention · CD011116
Management of gag reflex for patients undergoing dental treatment
Eachempati, P, Kumbargere Nagraj, S, Kiran Kumar Krishanappa, S, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
38
current version
GRADE rated
19
No studies
17
Included studies
4
as reported
No studies 17 · 44.7%Ungraded 2 · 5.3%Very low 19 · 50%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | People above the age of four years who were classified as having gagging of any degree of severity (and assessed by any means) that interfered with dental treatment. Exclusions: people who had undergone an intervention that can change the anatomy permanently (e.g. surgery); people using any systemic medications that might interfere with the interventional drug or reduce the gag reflex; people with any type of central or peripheral nervous system disorders; people with oral lesions that might reduce/enhance the gag sensation (e.g. oral submucous fibrosis, tumour). | 328 participants (263 adults and 65 children older than four years) who reported previous unpleasant nausea during dental procedures that hindered or prevented dental treatment. |
| Intervention | Any pharmacological or non-pharmacological intervention compared to placebo, or to no intervention, or to another intervention, given alone or in combination. | Acupuncture at P6 point (n=17); Acupressure at P6 point with thumb (n=15); Acupressure at P6 point with device (n=17); Acupressure at P6 point with sea band (n=10); Laser at P6 point (n=40) |
| Comparison | Placebo; No intervention; Another intervention | Sham acupuncture (n=42); Sham acupressure (n=83); Control (n=40) |
| Outcomes | Successful and comfortable completion of the dental treatment without any gagging problem; reduction in gagging measured by any scale/method and assessed by operator, patient or both; presence or absence of gagging measured by any scale/method and assessed by operator, patient or both; adverse effects related to the intervention. | Successful completion of dental treatment (n=328); Reduction in gagging (n=328); Presence or absence of gagging (n=40); Adverse effects (n=33) |
| Study designs | Randomised controlled trials (RCTs) with either a pharmacological or non-pharmacological intervention; quasi-RCTs excluded (cross-over trials eligible). | Not reported |
| Timing | Not specified | Not reported |
Search date: 2019-03. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; CINAHL EBSCO; AMED Ovid
Questions and results
Current version onlyAcupuncture at P6 point vs Sham acupuncture
Population: People (older than four years) classified as having gagging that interfered with dental treatment; included trials enrolled adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Successful completion of dental procedure | RR 1.78 [1.05, 3.01] 357 per 1000 vs 636 per 1000 | 2 studies · 59 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Reduction in gagging (patient-reported – ordinal converted to dichotomous) | RR 2.57 [1.12, 5.89] 333 per 1000 vs 857 per 1000 | 1 study · 26 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Reduction in gagging (assessor-reported – treatment effectiveness) Stage 1 (empty impression tray try-in) | MD 0.40 [-0.12, 0.93] | 1 study · 33 participants | Ungraded |
Adverse effects | Adverse effects: 33 participants (1 RCT, Zotelli 2014); very low certainty. The trial authors were unsure whether the reported adverse events (one control participant reported increased sweating) were due to… | 1 study · 33 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Presence or absence of gagging | Presence or absence of gagging: none of the trials reported this outcome. | 0 studies | No studies |
Reduction in gagging (patient-reported – VAS) | MD 0.86 [-1.13, 2.85] | 1 study · 33 participants | Ungraded |
Acupuncture at P6 point with sedation vs Sham (dummy) acupuncture with sedation
Population: People (older than four years) classified as having gagging that interfered with dental treatment; included trials enrolled adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Completion of dental procedure | RR 1.08 [0.91, 1.28] 933 per 1000 vs 1000 per 1000 | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Reduction in gagging (patient-reported – dichotomous) | RR 1.09 [0.87, 1.37] 867 per 1000 vs 945 per 1000 | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Presence or absence of gagging | Presence or absence of gagging: none of the trials reported this outcome. | 0 studies | No studies |
Adverse effects | Adverse effects: none of the trials reported this outcome (Lu 2000 did not report adverse events). | 0 studies | No studies |
Acupressure at P6 point with thumb vs Sham (dummy) acupressure
Population: People (older than four years) classified as having gagging that interfered with dental treatment; included trials enrolled adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Completion of dental procedure | RR 0.85 [0.50, 1.46] 692 per 1000 vs 588 per 1000 | 1 study · 30 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Presence or absence of gagging | None of the trials comparing acupressure with thumb, device or sea band to sham acupressure with or without sedation reported presence or absence of gagging. | 0 studies | No studies |
Adverse effects | None of the trials comparing acupressure with thumb, device or sea band to sham acupressure with or without sedation reported adverse effects. | 0 studies | No studies |
Reduction in gagging (patient-reported) | RR 0.92 [0.60, 1.41] 769 per 1000 vs 708 per 1000 | 1 study · 30 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Acupressure at P6 point with device vs Sham (dummy) acupressure
Population: People (older than four years) classified as having gagging that interfered with dental treatment; included trials enrolled adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in gagging (patient-reported) | RR 3.94 [1.63, 9.53] 222 per 1000 vs 876 per 1000 | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Adverse effects | None of the trials comparing acupressure with thumb, device or sea band to sham acupressure with or without sedation reported adverse effects. | 0 studies | No studies |
Completion of dental procedure | RR 2.63 [1.33, 5.18] 333 per 1000 vs 877 per 1000 | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Presence or absence of gagging | None of the trials comparing acupressure with thumb, device or sea band to sham acupressure with or without sedation reported presence or absence of gagging. | 0 studies | No studies |
Acupressure at P6 point with sea band vs Sham (dummy) acupressure
Population: People (older than four years) classified as having gagging that interfered with dental treatment; included trials enrolled adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects | None of the trials comparing acupressure with thumb, device or sea band to sham acupressure with or without sedation reported adverse effects. | 0 studies | No studies |
Presence or absence of gagging | None of the trials comparing acupressure with thumb, device or sea band to sham acupressure with or without sedation reported presence or absence of gagging. | 0 studies | No studies |
Completion of dental procedure | RR 1.80 [0.63, 5.16] 333 per 1000 vs 600 per 1000 | 1 study · 19 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Reduction in gagging (patient-reported) | RR 2.70 [0.72, 10.14] 222 per 1000 vs 600 per 1000 | 1 study · 19 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Acupressure at P6 point with thumb plus sedation vs Sham (dummy) acupressure with sedation
Population: People (older than four years) classified as having gagging that interfered with dental treatment; included trials enrolled adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in gagging (patient-reported) | RR 1.06 [0.92, 1.23] 944 per 1000 vs 1000 per 1000 | 1 study · 39 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Presence or absence of gagging | None of the trials comparing acupressure with thumb, device or sea band to sham acupressure with or without sedation reported presence or absence of gagging. | 0 studies | No studies |
Adverse effects | None of the trials comparing acupressure with thumb, device or sea band to sham acupressure with or without sedation reported adverse effects. | 0 studies | No studies |
Completion of dental procedure | RR 0.96 [0.84, 1.10] 1000 per 1000 vs 960 per 1000 | 1 study · 39 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Acupressure at P6 point with device plus sedation vs Sham (dummy) acupressure with sedation
Population: People (older than four years) classified as having gagging that interfered with dental treatment; included trials enrolled adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in gagging (patient-reported) | RR 1.26 [0.93, 1.69] 786 per 1000 vs 990 per 1000 | 1 study · 27 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Adverse effects | None of the trials comparing acupressure with thumb, device or sea band to sham acupressure with or without sedation reported adverse effects. | 0 studies | No studies |
Presence or absence of gagging | None of the trials comparing acupressure with thumb, device or sea band to sham acupressure with or without sedation reported presence or absence of gagging. | 0 studies | No studies |
Completion of dental procedure | RR 1.16 [0.90, 1.48] 857 per 1000 vs 994 per 1000 | 1 study · 27 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Acupressure at P6 point with sea band plus sedation vs Sham (dummy) acupressure with sedation
Population: People (older than four years) classified as having gagging that interfered with dental treatment; included trials enrolled adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects | None of the trials comparing acupressure with thumb, device or sea band to sham acupressure with or without sedation reported adverse effects. | 0 studies | No studies |
Presence or absence of gagging | None of the trials comparing acupressure with thumb, device or sea band to sham acupressure with or without sedation reported presence or absence of gagging. | 0 studies | No studies |
Completion of dental procedure | RR 0.88 [0.67, 1.17] 1000 per 1000 vs 880 per 1000 | 1 study · 21 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Reduction in gagging (patient-reported) | RR 0.88 [0.67, 1.17] 1000 per 1000 vs 880 per 1000 | 1 study · 21 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Laser (low-level laser) at P6 point vs Control (sham/dummy laser)
Population: People (older than four years) classified as having gagging that interfered with dental treatment; included trials enrolled children
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects | Adverse effects: none of the trials reported adverse effects. | 0 studies | No studies |
Completion of dental treatment | Completion of dental treatment: none of the trials reported this outcome. | 0 studies | No studies |
Reduction in gagging (assessor-reported) | MD 1.80 [1.53, 2.07] 1.80 [1.53, 2.07] points higher (gagging severity score) | 1 study · 25 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Presence or absence of gagging | OR 86.33 [29.41, 253.45] 125 per 1000 vs 925 per 1000 | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Acupuncture at P6 point vs Sham acupuncture
Population: People (older than four years) classified as having gagging that interfered with dental treatment; included trials enrolled adults
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in gagging (patient-reported – VAS) | MD 0.86 [-1.13, 2.85] 0.86 [-1.13, 2.85] points higher (VAS 0-10, higher = worse) | 1 study · 33 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Successful completion of dental procedure | RR 1.65 [0.59, 4.57] 250 per 1000 vs 412 per 1000 | 1 study · 33 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Reduction in gagging (assessor-reported – treatment effectiveness) Stage 1 (empty impression tray try-in) | MD 0.40 [-0.12, 0.93] 0.40 [-0.12, 0.93] points higher (GSI/GPI 0-5 scale, higher = worse) | 1 study · 33 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Adverse effects | Adverse events: see comment; not estimable; 0 (1 trial). One participant in the control group reported increased sweating; the trial authors were unsure whether the reported adverse events were due to participant… | 1 study | Ungraded |
Any behavioural, pharmacological, or non-pharmacological intervention (any route or mode of application; including head-to-head and different-dose comparisons) vs Placebo, no intervention, or another intervention
Population: People above the age of four undergoing dental treatment, classified as a gagger by any assessment method, whose dental treatment is interfered with by the gagging sensation
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Successful and comfortable completion of the dental treatment without any gagging problem | Protocol version; planned outcome, no trials included yet | 0 studies | No studies |
Improvement in gagging severity (reduction by at least one grade, by VAS, by depth of swab insertion, or in number of gagging episodes) | Protocol version; planned outcome, no trials included yet | 0 studies | No studies |
Adverse effects related to the intervention | Protocol version; planned outcome, no trials included yet | 0 studies | No studies |