Management of Gag Reflex During Dental Impression Recording

Objectives: Dental anxiety is a common problem that can negatively impact the patient, clinician and the delivery of oral health care. Gagging is one of the experiences found to be most likely associated with high dental fear. Moreover, problems related to gagging accounted for about 20% of the incidents of dental avoidance. Dentists have been exploring a variety of techniques to manage gag reflex, however, no comparison of these methods are published. The aims of this study are (1) To investigate the efficacy of two approaches in controlling gag reflex during dental impression recording. (2) To compare their efficiency in the management of dental anxiety during dental procedures.
Methods: After subjects completed a Dental Anxiety and Predictive Gagging Survey for baseline measurement, three impressions of the maxillary arch were taken. A control impression was taken using a traditional method of mixing alginate and water. For the first intervention, a pair of ear plugs are placed in the external auditory canal for 10 minutes before completing the traditional impression. For the second intervention, 1.8 mL of local anesthetic (2% lidocaine with 1:100,000 epinephrine) was mixed with the alginate and water for impression recording. Patients completed post-surveys for each technique where they rated the severity of gag reflex and evaluate the level of related anxiety. Paired t-test was conducted to determine whether there are significant differences between the two interventions and traditional method for impression recording. We compared the pair at a 5% significant level.
Results: Comparison to the traditional method, both interventions were able to reduce the severity of gag reflex. In addition, mixing the local anesthetic with the impression materials significantly decreased patients’ stress level (P<0.05).
Conclusions: A technique of incorporating local anesthetic with dental impression materials may be useful in reducing patients’ gag reflex as well as anxiety during dental procedure.