CASEBOOK

Managing Endodontic Patients with Severe Gag Reflex by Glossopharyngeal Nerve Block Technique

By Dr. Barry H. Korzen

If you haven’t had a patient with an exaggerated gag reflex you just haven’t been in practice long enough. Over the years we have all devised techniques to help our patients who present with this problem, as it can interfere with all aspects of our treatment, from performing diagnostic tests, taking radiographs to carrying out the needed procedures.

In a well documented case study published on-line in March 2014 on the Journal of Endodontics website, Garg et al report on a case of severe gag reflex in which a glossopharyngeal nerve block was utilized to control the reflex and allow endodontic treatment to be carried out.

In their published abstract the authors state that “the glossopharyngeal nerve block technique is a relatively safe, simple, and easy to master technique “.  However, the authors caution that “more clinical studies are required before routine dental use of this technique can be advocated.”

The published abstract appears below:

Abstract

Introduction

Gagging is a protective reflex, but when the gag reflex becomes abnormally active, it poses a difficulty for the dentist because it hinders all aspects of dental procedures including diagnosis, radiography, and any form of active procedure.

Methods

In this case report, to overcome this difficulty the authors used a glossopharyngeal nerve block technique that is used by anesthetists and otolaryngologists, but its endodontic use has gone previously unreported.

Results

Response to gag reflex decreases after successful glossopharyngeal nerve block.

Conclusions

The glossopharyngeal nerve block technique is a relatively safe, simple, and easy to master technique as compared with general anesthesia for treating a patient with an exaggerated gag reflex. The glossopharyngeal nerve block technique may be used in dental procedures in patients with an exaggerated gag reflex or when performing procedures in the posterior aspect of the mouth. Due caution should be exercised to prevent inadvertent intravascular administration of local anesthetic when using this procedure.

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