Every dentist has patients who gag or believe they will gag during the taking of impressions and other procedures. This is unpleasant both for patients and dental professionals, and can prevent some patients from seeking oral healthcare. A recent Italian study suggests there may be a relatively simple solution: acupuncture (Acupuncture in Medicine, November 5, 2013).
A clinician administered acupuncture to 20 patients before taking dental impressions and found the patients' gagging scores were reduced more than sixfold on average.
"I now use acupuncture to reduce the gag reflex in many patients who have a history of this reflex," lead investigator Giuseppa Bilello, DDS, told DrBicuspid.com.
Giuseppa Bilello, DDS.Dr. Bilello, an orthodontics professor at the University of Palermo in Sicily, had previously received acupuncture training from a traditional Chinese medicine practitioner. She started the study by taking upper and lower alginate impressions on 14 women and six men ages 19 to 80 with a history of dentistry-related nausea. A month later, Dr. Bilello repeated the impressions, this time preceding them with acupuncture. After each procedure the patients scored their gag reflex sensation on a visual analogue scale (VAS) from 0 to 10.
Dr. Bilello inserted the acupuncture needles into three places: pericardium 6 (PC6 or Nei Guan -- three-finger widths above the wrist crease, between the palmaris longus and flexor carpi radialis tendons), extra acupuncture point 1 -- head and neck (EX-HN 1 or Shishencong -- in the skin projection of the forehead/nasal suture), and conception vessel 24 (CV24 or Cheng Jiang -- at the center of the mentolabial groove directly below the lip).
Dr. Bilello inserted the 0.25-mm-diameter needles to a depth of between 0.3 mm and 0.5 mm, and rotated them clockwise and counterclockwise for 25 to 35 seconds. She then took the impressions, leaving the acupuncture needles in place until the patients were ready to leave the dental clinic.
Dr. Bilello and a colleague analyzed the results. They found that the patients' mean VAS score for gagging reflex during the upper impression without acupuncture was 6.8, including five patients with VAS scores of 8 or 9. The mean score dropped to 1.1 with acupuncture; the highest score was 4 in one patient. The respective VAS scores for lower impressions were 5.45 and 0.4; the highest score without acupuncture was 4 experienced by four patients, and the highest score with acupuncture was 2 in two patients.
The researchers acknowledged that the study was not randomized and did not include sham procedures. In addition, the results could be attributed at least in part to patients becoming familiar and hence perhaps more comfortable with the impression-taking procedure during the first round, without acupuncture, they conceded. However, they also noted that their results are comparable to earlier studies showing acupuncture effectively controls severe gagging reflexes during impression taking (example, British Dental Journal, December 2006, Vol. 201:11, pp. 721-725).
