Acupuncture May Cure Gag Reflex in Dental Patients

For many people, a visit to the dentist’s office can be a frightening experience.In fact, some health experts estimate that up to half of all American adultswill not seek dental care for fear of going to the dentist. Some patients areparticularly sensitive to dental equipment, which can cause them to gag uncontrollablywhen an instrument such as a drill or mirror is placed in the mouth. Others areso terrified, either due to a bad prior experience or to stories they’ve heardabout bad dental experiences, that the mere thought of dental treatment may causethem to gag even before any work has begun.

Whether the fear is real or imagined, patients who are overly sensitive to dentalwork are usually forced to choose one of two options. Many people choose sedationor general anesthesia, but these options drive up the cost of care, carry a widerange of possibly dangerous side-effects, and can render patients incapacitatedfor several hours following treatment. Other people simply choose not to seethe dentist, which brings with it a wide variety of personal health and hygieneproblems.

Researchers in Great Britain appear to have found a solution to the problem ofdental gagging. According to a new study published in the British Dental Journal,stimulation of an acupuncture point on the ear prior to undergoing treatmenteffectively controls the gag reflex, allowing dentists to perform a variety ofprocedures without compromising the patient’s safety and comfort.

The investigators chose 10 people between the ages of 40 and 65, each of whomhad been referred to a sedation unit because of an exaggerated gag reflex. Allof the subjects were rated either a four or five (out of five points) on theGagging Severity Index, making conventional treatment impossible and having anadverse affect on their ability to seek a dentist for care. Prior to referral,six people were able to receive treatment only with intravenous sedation; twowere unable to receive treatment because of their gag reflexes; and two had avoideddental care altogether out of fear.

Before being treated by the dentist, each patient received acupuncture at a pointon the upper part of the ear between the concha and triangular fossa. The researchersused a fine needle (7mm) into the anti-gagging point of each ear to a depth ofthree millimeters. The needles were manipulated for 30 seconds prior to dentaltreatment and remained in place until the patient was discharged.

Using ear acupuncture, the patients underwent a total of 25 dental treatmentepisodes. Episodes ranged from routine forms of care, such as fillings, impressionsand teeth cleaning, to more complicated procedures, including extractions, rootcanals and biopsies. All of the patients tolerated the acupuncture extremelywell; according to the researchers, “there were no reactions to the technique.” Onlytwo episodes of mild gagging were noted, and all of the subjects were able totravel home without assistance.

Many of the participants expressed their joy at being able to undergo treatmentwithout gagging. Some patients said they had “tried everything” tocontrol their gag reflexes before taking part in the study. Others reported thatbecause of their fear, they had avoided seeing a dentist and worried how theywould cope if faced with a dental emergency. One patient even reported she hadsearched “for the last 20 years” trying to find a cure for her dentalgagging before turning to acupuncture.

“You would not expect 100% success with just a placebo effect, especially as thepatients had had the problem for a long, long time, and their attitude was itprobably won’t work,” said Dr. Janice Fisk, a clinical assistant at thedepartment of sedation and special care dentistry at Guy’s Hospital in Londonand the study’s lead author.

In addition to the perceived patient benefits, ear acupuncture was considereda quick and cost-effective adjunctive to dental care. The researchers estimatedan added cost of only 0.2 pounds (approximately 29 cents) per person per treatmentepisode, and an additional treatment time of only 2-3 minutes per episode.

“The technique of ear acupuncture is relatively non-invasive,” they wrote. “Itcauses little discomfort, is cheap and requires little additional time. The patientis unaffected by the technique, does not require an escort, and can return tonormal daily activities after treatment.”

While the scientists were unable to determine how acupuncture suppressed thegag reflex, they did offer a possible explanation. In the traditional theoriesof auricular acupuncture, different ear points are associated with differentbody parts and are roughly equivalent to those of a fetus mapped out on the externalsurface of the ear. In this instance, the anti-gagging point did not correspondto the traditional location of the head on the lobe of the ear. In describingthe technique’s mechanism of action, however, they observed that one of the mainnerves involved in swallowing, the vagus nerve, also supplies the part of theear that contains the anti-gagging acupuncture point. The point is also adjacentto a branch of the trigeminal nerve. Together, the trigeminal and vagus nervesare responsible for much of the sensory and motor functions of the larynx, pharynxand palate. “One can only speculate that in some way, as yet not understood,stimulation of the anti-gagging points activates mechanisms that inhibit themuscle activity of the gag reflex,” they wrote.

Because the study was based on the results of a group of clinical cases and nota planned, controlled clinical trial, Fiske and her team stopped short of labelingear acupuncture as a cure for the dental gag reflex. They also recommended thatbecause the people seeking a cure for their condition had been doing so for along time, a larger, controlled study should be conducted to rule out the possibilityof a placebo effect.

Despite these limitations, the researchers believe acupuncture may be used tocontrol the dental gag reflex so that dentists can provide the necessary treatment- and so that patients can cope with it.

“Ear acupuncture helped all ten people to accept dental treatment comfortably,” theyconcluded, adding that the procedure “· was successful in controllingthe gag reflex in the ten cases reviewed, and it was not necessary to compromisedental treatment. The technique is safe, quick, inexpensive and relatively non-invasive.”

References

1. Fiske J, Dickinson C. The role of acupuncture in controlling the gagging reflex using a review of ten cases. British Dental Journal June 9, 2001;190(11):611-613.
2. Acupuncture cures dental gagging. BBC News, June 12, 2001. Available online at http://news.bbc.co.uk/hi/english/health/newsid_1383000/1383004.stm.
3. Norton A. Acupuncture may ease gag reflex during dental work. Reuters Health, June 13, 2001.