The gag reflex is a protection mechanism that prevents food and unwanted agents from entering the lower airways. It is usually part of the physical examination of swallowing to detect oropharyngeal dysphagia, but it is a potentially ambiguous sign.
To evaluate the diagnostic value of the gag reflex in patients with neurogenic oropharyngeal dysphagia and adults without it.
We conducted an analytical observational study in patients with neurogenic oropharyngeal dysphagia (cases) and patients without dysphagia (controls). We evaluated the absence or presence of the reflex bilaterally, by direct visualization, and adjusted it according to sex, age, and other interaction variables.
We included 86 patients with neurogenic oropharyngeal dysphagia and 80 control subjects. The gag reflex on swallowing physical examination showed a positive relationship with the patients (right side: OR = 3.97; 95 % CI: 2.01-7.84; left side: OR = 4.84; 95 % CI: 2.41-9.72), but a negative association with the control group. In both groups, neither sex, nor age, nor other interaction variables modified the gag reflex.
The gag reflex absence or presence does not confirm or exclude the existence of oropharyngeal dysphagia due to neurological and neuromuscular causes. Therefore, health professionals must not rely on this reflex. Clinicians must go beyond a simple reflex revision, even in neurological patients where it is supposed to be absent.
Introducción. El reflejo nauseoso es un mecanismo de protección que impide que alimentos y agentes no deseados penetren en la vía aérea inferior. Usualmente, hace parte del examen físico de la deglución para detectar la disfagia orofaríngea, pero es un signo potencialmente ambiguo. Objetivo. Evaluar el valor diagnóstico del reflejo nauseoso en pacientes con disfagia orofaríngea neurogénica y en pacientes sin ella. Materiales y métodos. Se trata de un estudio observacional, analítico, en pacientes con disfagia orofaríngea neurogénica (casos) y en personas sin disfagia (controles), en el cual se evaluó por visualización directa la ausencia o la presencia del reflejo nauseoso de forma bilateral. Este resultado se ajustó por sexo, edad y otras variables de interacción. Resultados. Se evaluaron 86 pacientes con disfagia orofaríngea neurogénica y 80 personas sin ella. En el examen físico de la deglución, la presencia del reflejo mostró una relación positiva con los pacientes (lado derecho: OR = 3,97; IC95%: 2,01-7,84; lado izquierdo: OR = 4,84; IC95%: 2,41-9,72), pero una asociación negativa con los controles. En ambos grupos, ni el sexo ni la edad, ni otras variables de interacción modificaron el reflejo nauseoso. Conclusiones. La ausencia o la presencia del reflejo nauseoso no confirma ni excluye la existencia de una disfagia orofaríngea por causas neurológicas o neuromusculares; por lo tanto, no es recomendable que los profesionales de la salud se fíen del resultado de este reflejo. Los médicos tratantes deben ir más allá de una simple revisión del reflejo nauseoso, incluso en pacientes neurológicos en quienes se supone que debería estar ausente.

Gagging during dental work is a common concern for both dentists and patients and can prevent patients from seeking or completing essential and routine dental work, often leading to further problems in the future. This paper aims to describe and review the literature on an accessible alternative to other management options to treat a patient with an exaggerated gag reflex. The author compares the effectiveness of current available treatments from published, peer-reviewed sources. The effectiveness of the MAGIC (main amelioration of gagging indoctrination by communication) technique has not yet been clinically reviewed but the experiential success by the author is near 100%. Patients were explained the technique and talked through it during treatment, leading to almost all patients who have not been able to undergo any dental treatment coping with and completing treatment. As this technique has not been assessed under clinical research conditions, we only have experiential evidence of many patients continuing and completing dental treatment following use of the MAGIC technique. This has been used with patients who both have and have not self-reported that they have a hypersensitive gag reflex. This paper reviews a novel technique for the amelioration of a hypersensitive gag reflex that can easily be incorporated in the general dental practice to the benefit of both patient and dental professional.

Feeding is a complex skill requiring coordination of multiple body systems. Multiple factors are considered in feeding dysfunction in pediatric patients with eosinophilic gastrointestinal disorders, including overall development, nutritional status, mealtime behaviors, and medical comorbidities. Symptoms of feeding dysfunction vary by age, with maladaptive learned feeding behaviors spanning all age ranges. Knowledge of the normal acquisition of feeding skills is critical to interpret the impact of the disease and plan appropriate intervention. Assessment and treatment from a feeding and swallowing disorders specialist can dramatically impact successful outcomes in nutrition, growth, mealtime dynamics and ultimatly quality of life for children and their caregivers in home and social settings.

The ultrasound-guided selective glossopharyngeal nerve block (UGSGNB) has been developed as an approach to overcome the drawbacks of the conventional glossopharyngeal nerve block. The UGSGNB may be performed when a gag reflex occurs during dental treatment. Case 1 involved a 67-year-old man with a medical history of cervical spondylosis and dilated cardiomyopathy. Dental treatment with conscious sedation and the UGSGNB was performed three times. Case 2 involved a 25-year-old woman who was scheduled for dental treatment under general anesthesia because of dental phobia and gagging. Because the patient experienced severe tooth pain and desired urgent treatment, anesthesia was induced with intravenous sedation and the UGSGNB. In both cases, treatments were completed without intraoperative gagging or any complications. Our observations indicate that the UGSGNB can suppress the gag reflex during dental treatment; it may allow surgeons to avoid inducing general anesthesia and deep sedation in patients with a severe gag reflex.

BACKGROUND: Sensitive gag reflexes prevent dental patients from receiving appropriate treatment. Aromatherapy helps patients relax during dental procedures. However, the effect of aromatherapy on the gag reflex caused by the stimulation of the oral cavity is unknown. This study aimed to evaluate whether aromatherapy reduces gag reflexes during oral stimulation.
METHODS: In this randomized, placebo-controlled, single-blind, crossover study, the gag reflexes of 24 healthy individuals (12 females and 12 males; mean age: 34.3 ± 9.5 years) were quantified. A standard saliva ejector was slowly guided down the participant\'s throat to determine the maximum tolerance of the gag reflex, and the insertion distance was measured to quantify the gag reflex. All individuals participated in an aromatherapy session with peppermint essential oil and a placebo session with distilled water. The gag reflex was quantified before (baseline) and after each session. Another measurement was performed using nitrous oxide/oxygen inhalation as a positive control.
RESULTS: Gag reflex values significantly increased after aromatherapy with both peppermint essential oil and placebo compared to baseline values (paired t-test, P < 0.001 and P = 0.014, respectively). The gag reflex value also increased significantly during nitrous oxide/oxygen inhalation (paired t-test, P < 0.001). There was no significant difference in the increase rate of gag reflex values between the positive control and aromatherapy interventions, but it was significantly lower after the placebo intervention (repeated measures analysis of variance, P = 0.003; post-hoc test, P = 0.83 and P = 0.02).
CONCLUSIONS: Aromatherapy with peppermint essential oil has the potential for reducing gag reflex during dental procedures.
BACKGROUND: The study was registered in the University hospital Medical Information Network Clinical Trials Registry under the code UMIN000050616 (approved 17/03/2023).

BACKGROUND: The most known and commonly studied behavioral obstacle to dental care is dental anxiety. An obstacle that is less studied though no less problematic is excessive gag reflex, which can severely impede dental treatment. Another understudied and possibly related syndrome is emetophobia (a specific phobia of vomiting).
OBJECTIVE: The aim of this study was to examine possible comorbidity amongst self-reported emetophobia, dental anxiety, and excessive gagging in the dental office.
METHODS: A cross-sectional online survey was conducted using the following self-report questionnaires: Dental Anxiety Scale, Gagging Problem Assessment, Gagging Assessment Scale (GAS), and Specific Phobia of Vomiting Inventory (SPOVI).
RESULTS: In all, 164 participants fully completed the questionnaires (87.8% female; mean age, 34 ± 11.07 years). Positive correlations were found amongst all variables (P < .001). High gagging (GAS > 6) was associated with a 7.29 times (P < .000) greater risk of positive emetophobia (SPOVI ≥ 10). Linear regression analyses revealed that the intensity of the reflex and the experience of gagging upon encountering odours in the dental office as well as dental anxiety and vomiting phobia significantly predicted participants\' gagging scores as evaluated by GAS (R2 = 0.59; F = 21.16; P < .001).
CONCLUSIONS: The study shows that excessive gagging reflex in the dental office is closely related both to dental anxiety and to emetophobia.

暂无摘要。

Objective: To evaluate the effect of compound chamomile and lidocaine hydrochloride gel on oropharyngeal complications after the use of laryngeal mask airway with positive pressure ventilation. Methods: A total of 64 patients undergoing elective surgery under general anesthesia using laryngeal mask airway (LMA) with positive pressure ventilation in Beijing Tongren Hospital Affiliated to Capital Medical University From January to March 2023 were prospectively selected and divided into two groups by the random number table method: normal saline group (n=32), with 18 males and 14 females, aged 28-64 (48.4±10.6) years, and the compound chamomile and lidocaine hydrochloride gel group (chamomile gel group, n=32), with 18 males and 14 females, aged 24-64 (46.3±10.8) years. Patients in both groups received total intravenous anesthesia. Before LMA placement, the front, shoulder and back of LMA were lubricated with normal saline and compound chamomile and lidocaine hydrochloride gel in the normal saline group and the chamomile gel group, respectively. The main outcome measure was the incidence of postoperative oropharyngeal mucosal inflammation at different time points after the removal of the laryngeal mask. Secondary outcome measures included oropharyngeal mucositis score, sore throat score, hoarse voice score, cough score and throat dryness score at different time points after LMA removal, the number of LMA insertion times, time of successful insertion and leakage pressure, as well as stress reactions such as cough and agitation before and after LMA removal, and adverse reactions such as tongue numbness and protective pharyngeal reflex limitation during recovery. Results: The incidence of oropharyngeal mucositis in the chamomile gel group was 25.0% (8/32), 31.3% (10/32), 28.1% (9/32) and 3.1% (1/32) at 0.5, 3, 6 and 24 h after LMA removal, respectively, which were lower than those of normal saline group [53.1% (17/32), 59.4% (19/32), 59.4% (19/32) and 21.9% (7/32)] (all P<0.05). The oropharyngeal mucositis scores of patients in the chamomile gel group were 0 (0, 0.8), 0 (0, 1.0), 0 (0, 1.0) and 0 (0, 0) respectively at 0.5, 3, 6 and 24 h after LMA removal, which were lower than those in the saline group [1.0 (1.0, 1.8), 1.0 (0, 2.0), 1.0 (0, 2.0) and 0 (0, 0)] (all P<0.05). The cough score of the patients in the chamomile gel group was 0 (0, 0) and 0 (0, 0) at 3, 6 h after LMA removal, which were lower than those of the normal saline group [(0, 0) and 0 (0, 0)] (both P<0.05). The throat dryness score of the patients in the chamomile gel group was 0 (0, 1.0) at 3 h after LMA removal, which was lower than that of the normal saline group [1.0 (0.3, 1.0)] (P=0.019). The time of successful LMA insertion in the chamomile gel group was 25.0 (20.3, 29.8) s, which was shorter than that in the saline group [29.0 (25.0, 32.0) s] (P=0.016). There were no significant differences in the number of LMA insertion, leakage pressure, postoperative sore throat and hoarse voice scores between the two groups (all P>0.05). Likewise, there were no stress reactions such as cough and agitation before and after LMA removal, and no adverse reactions such as tongue numbness and limited protective pharyngeal reflex during recovery. Conclusion: Compound chamomile and hydrochloride lidocaine gel can reduce the incidence of postoperative oropharyngeal mucositis, relieve the symptoms of postoperative oropharyngeal mucositis, pharyngeal dryness and cough, and improve the postoperative comfort of patients using the laryngeal mask airway with positive pressure ventilation.
目的： 评估复方甘菊利多卡因凝胶对喉罩正压通气患者术后口咽部并发症的影响。 方法： 前瞻性选取首都医科大学附属北京同仁医院2023年1至3月在全身麻醉喉罩正压通气下行择期手术的患者64例，采用随机数字表法分为2组：生理盐水组（n=32），男18例，女14例，年龄28~64（48.4±10.6）岁；复方甘菊利多卡因凝胶组（简称甘菊凝胶组，n=32），男18例，女14例，年龄24~64（46.3±10.8）岁。两组患者都采用全凭静脉麻醉，生理盐水组喉罩置入前，对喉罩的前、肩、背部进行生理盐水润滑处理，甘菊凝胶组使用复方甘菊利多卡因凝胶润滑处理。主要观察指标为喉罩拔除后0.5、3.0、6.0、24.0 h不同时间点的术后口咽黏膜炎发生率；次要观察指标包括喉罩拔除后不同时间点的口咽黏膜炎评分、咽喉痛评分、声音嘶哑评分、咳嗽评分和咽干评分，喉罩置入次数、成功置入用时和漏气压，拔除喉罩前后的呛咳、躁动等应激反应和苏醒期舌麻、保护性咽反射受限等不良反应发生率。 结果： 甘菊凝胶组患者的口咽黏膜炎发生率在喉罩拔除后0.5、3.0、6.0、24.0 h分别为25.0%（8/32）、31.3%（10/32）、28.1%（9/32）和3.1%（1/32），均低于生理盐水组的53.1%（17/32）、59.4%（19/32）、59.4%（19/32）和21.9%（7/32）（均P<0.05）。甘菊凝胶组患者的口咽黏膜炎评分［M（Q1，Q3）］在喉罩拔除后0.5、3.0、6.0、24.0 h分别为0（0，0.8）、0（0，1.0）、0（0，1.0）和0（0，0）分，均低于生理盐水组的1.0（1.0，1.8）、1.0（0，2.0）、1.0（0，2.0）和0（0，0）分（均P<0.05），甘菊凝胶组患者的咳嗽评分在喉罩拔除后3.0、6.0 h分别为0（0，0）、0（0，0）分，均低于生理盐水组的0（0，0）、0（0，0）分（均P<0.05），甘菊凝胶组患者的咽干评分在喉罩拔除后3.0 h为0（0，1.0）分，低于生理盐水组的1.0（0.3，1.0）分（P=0.019）；甘菊凝胶组患者喉罩成功置入用时25.0（20.3，29.8）s，低于生理盐水组的29.0（25.0，32.0）s（P=0.016）；两组患者的喉罩置入次数、漏气压、术后咽喉痛和声音嘶哑的评分差异均无统计学意义（均P>0.05）；两组患者均未见拔除喉罩前后的呛咳、躁动等应激反应和苏醒期舌麻、保护性咽反射受限等不良反应。 结论： 复方甘菊利多卡因凝胶用于全身麻醉喉罩正压通气手术患者，可降低术后口咽黏膜炎的发生率，减轻术后口咽黏膜炎、咽干和咳嗽的症状，提高患者术后的舒适度。.

Compare the occurrence of choking and gagging in infants subjected to three complementary feeding (CF) methods.
Randomized clinical trial with mother-infant pairs, allocated according to the following methods of CF: a) Parent-Led Weaning (PLW) - group control, b) Baby-Led Introduction to SolidS (BLISS), and c) mixed (initially BLISS and if the infant presents a lack of interest or dissatisfaction, PLW), with the last two methods guided by the infant. Mothers received nutritional intervention on CF and prevention of choking and gagging according to the method at 5.5 months of age and remained in follow-up until 12 months. Frequencies of choking and gagging were collected by questionnaire at nine and 12 months. The comparison between groups was performed using the analysis of variance test (p < 0.05).
130 infants were followed, and 34 (26.2%) children presented choking between six and 12 months of age, 13 (30.2%) in PLW, 10 (22.2%) BLISS, and 11 (26.2%) mixed method, no significative difference between methods (p > 0.05). The choking was caused mainly by the semi-solid/solid consistency. Moreover, 100 (80%) infants aged from six to 12 months presented gagging and their characteristics were not statistically different among groups (p > 0.05).
Infants following a baby-led feeding method that includes advice on minimizing choking risk do not seem more likely to choke than infants following traditional feeding practice that includes advice on minimizing choking risk.

For this exploratory study, ALS patients and their partners/caregivers were interviewed to find out what problems they encounter when performing oral care. In addition, the tooth brushing procedure was recorded on video. Most mentioned by the six patients was that the performance of oral care is hampered by the loss of motor skills and by the gag reflex. They also mentioned various adjustments that would ease dental visits. Three of the four partners indicated that an instructional video would have additional value, and two partners said they sometimes felt insecure whether they were performing oral care properly. The five videos showed that there are major differences regarding tooth brushing duration, which surfaces are being brushed, and the brushing technique. This study shows that there are several ways in which oral care is performed in ALS patients. Furthermore, not all caregivers are aware of how oral care should be performed.
Samenvatting. Voor een verkennende onderzoek werden ALS-patiënten en hun partners/verzorgers geïnterviewd om te achterhalen tegen welke problemen zij aanlopen bij het uitvoeren van de mondverzorging. Daarnaast werd een videoregistratie gemaakt van het tandenpoetsen. Meest genoemd door de 6 patiënten was dat de uitvoering van de mondverzorging belemmerd wordt door het verlies van motoriek en door de kokhalsreflex. Ook werden diverse aanpassingen genoemd die het tandartsbezoek zouden vergemakkelijken. Van de 4 partners gaven 3 aan dat een instructievideo een toegevoegde waarde zou hebben en 2 partners waren soms onzeker of zij de mondverzorging wel goed uitvoeren. Uit de 5 videoregistraties bleek dat er grote verschillen bestaan betreffende de duur van het poetsen, welke vlakken worden gepoetst en de poetstechniek. Uit dit onderzoek blijkt dat er meerdere manieren zijn waarop de mondverzorging wordt uitgevoerd bij ALS-patiënten. Verder zijn niet alle verzorgers op de hoogte hoe mondverzorging dient te worden uitgevoerd.